Health & Managed Care Litigation
Protecting the interests of our clients with the know-how to navigate complex litigation in the health care industry.
WHY LOCKE LORD
Our Health & Managed Care Litigation team includes trial and regulatory lawyers who routinely represent the interests of multinational health insurers, managed care organizations (MCOs), pharmaceutical companies, medical device companies, distributors, PBMS, TPAs, hospitals, multihospital health systems, physicians and physician groups, academic medical centers, skilled nursing centers, and home health, hospice, and long-term care facilities in a range of disputes, litigation, arbitration, investigations, civil investigative demand (CID) proceedings, administrative proceedings and threatened litigation, including high-profile matters involving billion-dollar claims and cutting-edge issues.
We have tried cases and presented at evidentiary hearings in matters across the United States in the following areas:
- Qui tam matters, sealed and unsealed
- State and federal false claims (FCA) allegations
- Defense of health plans and other MCOs in connection with reimbursement claims involving contractual arrangements, risk sharing, stop loss and medical procedure coding issues
- Insurance and managed care disputes (payor-provider, member, and broker)
- Class actions
- Licensure proceedings
- Certification and survey, and de-certification, suspension and termination proceedings
- Cost reporting
- Claims reimbursement
- Post pay
- Fraud and abuse and Stark Law allegations
- Civil monetary penalties, exclusion and sanctions
- Corporate Integrity Agreements
- Change of ownership or control evidentiary hearings
- Employment and labor, medical staff, corporate, contract and non-competition issues
- Peer review and staff privilege disputes
- ERISA
- Restrictive covenants, deed restrictions, statutory charity care obligations and charitable trust restrictions
- Antitrust
- Medical malpractice and products liability matters
- Pharmaceutical industry matters, such as product recalls and product liability claims
- Enforcement Investigations & Proceedings
- Reinsurance premium disputes
Our enforcement and investigation experience includes:
- Attorneys General consumer fraud probes
- Medicare and Medicaid fraud and abuse matters
- Civil monetary penalty matters
- HHS, CMS, State health agencies and State department of insurance compliance investigations, examinations and audits
- False Claim Act matters
- Whistleblower and qui tam litigation
- Internal investigations and voluntary disclosures
- OIG, DOJ, DEA, FDA, FTC and other federal enforcement investigations
- State Attorney General investigations
- Grand jury and parallel civil investigations
- Defense of fraud and abuse investigations and enforcement proceedings
- Anti-kickback and Stark Law matters
- Pricing and consumer fraud issues
- Medical device and drug marketing and pricing issues
- Price fixing, market allocation, conspiracy and other antitrust claims
- Market Conduct Exams
The Locke Lord team, including former HHS, DOJ, USAO, state AG, and other state agency lawyers, has experience and expertise in some of the most complex areas facing the health and managed care industries today, including risk adjustment, federal and state medical loss ratio (MLR) and risk corridor calculations, pharmacy benefits, Opioid litigation, COVID-19 testing and treatment reimbursement, UCR issues, Medicare marketing and broker requirements.