Health Care Litigation

Health care litigation calls for a broad understanding of both insurance and innovation regulation. Our experience spans multiple industry needs, including:

Payor Disputes

• Provider and provider network disputes, including claims relating to network participation, network discounts, out-of-network reimbursement, claim review and adjudication, pricing pursuant to provider agreements, and silent PPO claims
• Medicare Part D and Workers’ Compensation complex cases

Life Sciences, Generic Pharmaceutical, and Medical Device

• Appellate and Advocacy Guidance
• Arbitrations and International Arbitration
• Business Counseling and Advice
• Due Diligence
• International Trade Commission Proceedings
• IP Monetization
• Patent Office Trials
• Transactions and Licensing

Our health care litigation team serves multiple entities within the health care sector, including:

• ERISA Plan Sponsors
• Generic Pharmaceutical
• Health Benefit Plan Payors and Administrators
• Health Network Organizations
• Health Services Providers
• Health and Life Sciences
  
• Medical Device

• Represented defendants UnitedHealth Group, Inc. and PacifiCare, Inc. in an antitrust lawsuit involving alleged price-fixing and fraud related to prescription drug reimbursement under the federal Medicare Part D program.  Plaintiff Omnicare sought damages exceeding $1 billion and permanent injunctive relief.  After summary judgment motion was argued in August 2008, the U.S. District Court granted summary judgment to defendants on all claims in January 2009.  Published decision:  Omnicare, Inc. v. UnitedHealth Group, Inc., 594 F. Supp. 2d 945 (N.D. Ill. 2009).  Summary judgment was subsequently affirmed. Omnicare, Inc. v. UnitedHealth Group, Inc., 629 F.3d 697 (7th Cir. 2011).

  Omnicare, Inc. v. UnitedHealth Group, Inc.

• Settlement reached for health insurers in litigation against drug manufacturer for overpayments made for the prescription drug Paxil and Paxil CR. 
  

  Blue Cross Blue Shield of Minnesota, American Medical Security Life Insurance Company, Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Nebraska, Carefirst, Inc., Blue Cross Blue Shield of Delaware, Inc., Excellus Health Plan, Inc., Hawaii Medical Service Association, Health Care Services Corporation, Horizon Health Care Services, Inc., Humana Inc., Louisiana Health Service & Indemnity Company, Medical Mutual of Ohio, Mutual of Omaha Insurance Company, Oxford Health Plans, LLC, Wellmark, Inc., The Regence Group, Time Insurance Company, Union Security Insurance Company, John Alden Life Insurance Company v. Glaxosmithkline plc, et al.

• Defended eight ERISA plan sponsors and medical insurers (including Blue Cross plans) in an antitrust action by an out-of-program mental health care provider claiming that a wide ranging conspiracy existed among scores of insurers, plan administrators and plan sponsors to establish agreed compensation standards which foreclosed competition from non-PPO providers.  Our clients and most of the complaint were dismissed, which was upheld on appeal to the Ninth Circuit.

  Stephen Simon v. Value Behavioral Health (United States District Court for the Central District of California, civil action SA-CV96-0711 GLT (EEx))

• Represented Blue Cross Blue Shield of Massachusetts as class representative and prevailing plaintiff in consumer fraud class action against manufacturers of various physician-administered medications.

  In re: Pharmaceutical Industry Average Wholesale Price Litigation.  

• Represented Blues plans and other health insurers in litigation against drug manufacturers for overpayments made for the prescription drug BuSpar on claims which included allegations of antitrust violations arising from manufacturers’ use of patents and the FDA regulations in conjunction with the Hatch-Waxman Act to keep generics out of the market, settlement obtained for plaintiffs.

  Anthem Blue Cross Blue Shield, Blue Cross and Blue Shield of Florida, Inc., Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Minnesota, Blue Cross Blue Shield of Nebraska, Blue Cross Blue Shield of Oklahoma, Blue Cross Blue Shield of Tennessee, Blue Shield of California, CareFirst, Inc., Excellus Health Plan, Inc., The Guardian Life Insurance Company of America, Hawaii Medical Service Association, Health Care Service Corporation, Horizon Blue Cross Blue Shield of New Jersey, Humana, Inc., Mutual of Omaha, Regence Blue Shield of Idaho, Wellchoice, Inc., Wellmark, Inc. v. Bristol-Myers Squibb, et al

• Represented BCBS Minnesota in multiple class action lawsuits in which insured employer plans sought premium refunds out of BCBS Minnesota’s historic $469 million settlement with the tobacco companies.  We guided BCBS Minnesota through contested regulatory proceedings, and gained approval from state and federal regulators for BCBS Minnesota’s plan to rebate $30 million.  BCBS Minnesota then settled the class claims for $11 million, permitting it to use remaining funds to reduce the incidence of smoking, cancer, and heart disease in Minnesota.

  Tow Distributing Inc., et al. v. BCBS Minnesota.

• Represented Blues plans and other health insurers against drug manufacturers for overpayments made for the prescription drug Taxol on claims which included allegations of antitrust violations arising from manufacturers’ use of patents and the FDA regulations in conjunction with the Hatch-Waxman Act to keep generics out of the market.  We obtained settlement for our clients.
  
  
• Defended $2 million claim against nursing registry for misappropriation of trade secrets to a verdict of $494.03, and obtained grant of nonsuit for individual defendant.
  
  
• Represented Coventry Health Care subsidiaries in two companion tag-along cases to the Managed Care Litigation MDL, brought by physicians in Kansas and Missouri, containing allegations against managed care companies that were similar to the allegations in the lead Shane case in the MDL.  After denying the plaintiffs’ motions to remand the cases to state court, the district court granted the defendants’ motions to dismiss the cases without prejudice.  The plaintiffs then filed new complaints, this time alleging breach of contract, again on behalf of statewide classes of providers.  Once again the district court dismissed the cases without prejudice, requiring, as a condition for refiling the cases, that the plaintiffs exhaust their administrative remedies under ERISA.

  Blue Springs Internal Medicine, P.C., et al. v. Blue Cross and Blue Shield of Kansas City, et al.

• Represented Coventry Health Care, Inc., in arbitration with nationwide provider of pharmacy services relating to dispute over submission, adjudication, and payment of claims for prescription drugs under the Medicare Part D prescription drug program.  The arbitrator found in favor of Coventry as to some claims and in favor of the claimant as to some claims.  The award was confirmed on appeal to the Superior Court in California.

  Omnicare, Inc. v. Coventry Health Care, Inc.

• Represented Coventry Health Care of Georgia, Inc., in action by terminated employee alleging entitlement to health insurance continuation coverage benefits under COBRA.  Coventry’s motion for summary judgment on the ground that the small employer exception to COBRA applied was granted.

  Rogers v. I D Design, Inc., et al.

• Represented Coventry Health Care, Inc., in purported nationwide class action by health care provider alleging a systematic breach of contract in the repricing and adjudication of workers' compensation bills submitted by participants in Coventry’s provider network.  Upon Coventry’s immediately moving to dismiss the class claims and moving for summary judgment on the named plaintiff’s individual claims the plaintiff moved to dismiss, with prejudice.

  Hoda v. Coventry Health Care, Inc.

• Represent Coventry Health Care, Inc., in another purported nationwide class action alleging substantially the same claims as those asserted in Hoda v. Coventry Health Care, Inc., but filed in a different federal District Court. The Court granted Coventry's motion to dismiss the plaintiff's claim for injunctive relief on the ground that the plaintiff did not have standing to assert the claim.  After discovery, the Court denied the plaintiff's motion for class certification on its claim for damages.  The Court then granted the plaintiff's motion for leave to amend its complaint to add a plaintiff that had standing to assert a claim for injunctive relief.  After additional discovery the plaintiffs moved for class certification of the added plaintiff's claim for injunctive relief and for summary judgment. Motion for summary judgment was denied.

  Chehalem Physical Therapy, Inc. v. Coventry Health Care, Inc.

* Past results are reported to provide the reader with an indication of the type of litigation we practice. They do not and should not be construed to create an expectation of result in any other case, as all cases are dependent upon their own unique fact situation and applicable law.