Healthcare Litigation

BR-800x350-11

Representative Matters

Butler Rubin represents and advises major managed care organizations, insurance and reinsurance companies and other healthcare entities with respect to actual or potential disputes arising within the evolving healthcare industry. From the risk-stabilization policies of the Affordable Care Act to disputes implicating the Employee Retirement Income Security Act (ERISA) as well as class actions, breach of contract claims, licensing disputes, insurance coverage issues and claims for reimbursement by healthcare providers, Butler Rubin attorneys bring seasoned litigation and dispute resolution expertise and client-focused strategies to successfully navigate complicated conflicts and challenges, achieve results and mitigate risk.

The following describes some of the firm’s representative experience involving healthcare litigation:

  • Representing Premera Blue Cross in the prosecution of claims for over $117 million in risk corridors underpayments under the Affordable Care Act. (Premera Blue Cross et. al. v. USA, Civil Action 1:17-cv-01155-LKG (U.S. Dist. Ct., Fed. Cl. 2017))
  • Represented the Blue Cross Blue Shield Association as amicus curiae in a federal appeal implicating health insurers’ entitlement to over $8.3 billion in risk corridors payments under the Affordable Care Act. (Moda Health Plan v. USA, Civil Action 17-1994 (U.S. Ct. App., Fed. Cir.))
  • Representing major managed care organization in reimbursement dispute opposite laboratory as part of confidential arbitration.
  • Represented healthcare information technology company in licensing dispute opposite licensee as part of confidential arbitration.
  • Represented Cigna in litigation brought by Anheuser-Busch alleging that it should submit to an in-depth claim payment recovery analysis via its third-party consultant.  Anheuser-Busch claimed that Cigna violated ERISA and breached an Administrative Services Agreement by authorizing certain health benefit claims that purportedly should not have been paid.  The case involved an evaluation of alleged anomalies in claims payment, ERISA preemption, and utilization review. (Anheuser Busch Companies, et. al v. Connecticut General Life Insurance Company, Civil Action 12-CV-1333 (U.S. District Court, E.D. Mo.))
  • Representing insurer in connection with indemnity claim.  This matter relates to a putative class action brought by network providers alleging failure to steer patients in return for physician discounts.  (Liberty Mutual v. First Health Group, Inc., No. 1:14-cv-2363 (U.S. District Court, N.D. Ill.))
  • Advising insurer on issues related to use of a database for medical bill review, as well as the potential for obtaining contractual indemnity against class actions filed by beneficiaries and health care providers.
  • Representing insurer in confidential arbitration seeking coverage declaration.  This arbitration relates to an MCO’s settlement of underlying class action litigation brought by physician providers alleging breach of contract and certain state statutory violations in connection with MCO’s reimbursement practices.
  • Represented and defended third-party post-payment cost containment vendor in response to subpoena for deposition in federal court litigation concerning alleged overpayment of healthcare claims.
  • Represented MCO in a confidential arbitration with its reinsurer arising out of claims asserted pursuant to the MCO’s professional liability and errors and omissions liability policies.  The underlying claims against the managed care administrators involved alleged violations of fiduciary duties to the benefit plans and violations of ERISA by accepting kickbacks and discounts from pharmaceutical companies.
  • Handled confidential reinsurance arbitration for insurer seeking coverage for claims paid to managed care insured relating to alleged violations of ERISA stemming from failure to disclose benefits to enrollees and discouraging enrollees from pursuing coverage.
  • Sought reinsurance coverage for insurer in confidential arbitrations.  The arbitrations arose out of claims against MCOs related to purported violations of RICO stemming from shortchanging providers on amounts owed for services by using software to “downcode” claims.
  • Represented physician group in litigation with its former, third-party billing service.  This litigation included claims of fraud and breach of contract that involved improper claim handling and reimbursement coding. (Progressive Care, S.C. v. The Abrix Group, L.P., No. 99 L 13170 (Cir. Ct. Cook County, Illinois))