The ERISA and Benefit Plan Litigation practice combines in-depth knowledge of the health care insurance industry — as well as the complex laws governing benefit plans — with proven experience defending carriers in class actions and other high-profile claims. Our sophisticated and intimate understanding of ERISA laws allows us to develop legal strategies and arguments that save our clients significant time and costs.
With extensive litigation experience at both state and federal levels, we provide health insurance companies and self-funded plan sponsors with a comprehensive range of services that allow for the cost-effective resolution of critical disputes. We assist clients with:
- ERISA benefit claims and preemption
- ERISA breach of fiduciary duty claims
- ERISA, RICO, and antitrust class actions
- Provider reimbursement disputes
- Fraud, abuse and over-payment recoveries
- Medical liability claims against managed care entities
- Declaratory judgement actions
- Medicare and Medicaid fraud
Our practice also has an impressive track record defending insurance companies when they are sued by subscribers and providers in individual actions, as well as resolving putative class actions and associations standing cases where significant damages and broad sweeping plan changes are sought.
In addition to defending carriers, we aggressively prosecute breach of contract and fraud claims and have won multiple recoveries in excess of $1,000,000. We often advise clients as outside counsel, monitoring fraud through the client’s Special Investigations Unit. Moreover, we are at the forefront of challenging over-billing by providers for emergency room services, a growing area of health care fraud. Taking a comprehensive approach, we are not only effective at recovering funds after incidents of fraud have occurred, we also help clients implement the plans and mechanisms they need to detect and prevent fraud as soon as possible.
Representative Experience
- Defending a health care insurance carrier in a national, multi-district putative class action brought by subscribers, providers and medical associations alleging ERISA, RICO and Sherman Act violations relating to the use of certain databases to determine usual and customary rates (UCR) for out-of-network services
- Representing a health care insurance carrier in a national putative class action brought by individual health care providers and chiropractic associations asserting ERISA and RICO challenges to the carrier’s fraud investigation unit, and prosecuting counterclaims to recover over-payments made to the plaintiff providers
- Defending an association action seeking to enjoin the inclusion of provisions in network agreements setting maximum fees to be charged for services that do not result in a payment from the carrier
- Prosecuting an over-payment recovery from an alcohol and drug dependency treatment facility that submitted health care insurance claim forms allegedly misrepresenting the patients’ diagnosis to procure a greater reimbursement than that to which they are entitled
- Represented a health care insurance carrier in a subscriber putative class action challenging coverage policies for eating-disorder treatments brought under ERISA and state parity laws
- Obtained summary judgement against defendant doctors who violated the IFPA through the illegal self-referral of patients between practices
- Prosecuted an over-payment recovery from an anaesthesiology group that billed and received double payments from the health care insurance carrier, despite receiving payments under a hospital capitation agreement
- Defended a provider pain specialist’s request for payments under a network agreement and pursuing over-payment counterclaims based upon over-billing, overutilization, unbundling and up-coding