Butler Rubin regularly represents and advises insurance and reinsurance companies, as well as other healthcare companies and managed care organizations (“MCOs”), with respect to a wide variety of matters. From breach of contract and coverage issues to more complicated class actions and disputes implicating the Employee Retirement Income Security Act (ERISA), Butler Rubin attorneys bring seasoned litigation and dispute resolution expertise to obtain results and creative solutions to the issues facing the insurance and healthcare industries. Butler Rubin successfully guides its clients through complicated disputes, helping its clients avoid unnecessary litigation. And, where litigation is warranted Butler Rubin succeeds through formal dispute resolution.
The following describes some of the firm’s representative experience involving healthcare litigation:
- 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.))
- Lead counsel defending Liberty Mutual Insurance Company in provider class action relating to use of FairHealth database to assess reasonableness of provider usual and customary charges for covered treatments under PIP and MedPay coverages. (Schiff v. Liberty Mutual Fire Insurance Co. and Liberty Mutual Ins. Co., No. 17-2-11676-9 SEA (Sup. Ct. County of King).
- 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)).
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