Managed care litigation, also known as In Re Managed Care, can begin with a single claim in one state or multiple claims across the country. Health care providers and policyholders who are affected by the practices and business structures spread across plans in multiple regions under the management of an HMO have the right to pursue claims against the HMO or MCO (managed care organization), alleging violations including:
- Antitrust violations
- RICO Act violations
- Payment practices claims
- Unfair business practices claims
At Reich & Binstock LLP, we have extensive experience pursuing multidistrict litigation (MDL) claims on behalf of health care providers in Texas and throughout the United States, dating back to the late 1990s when these HMO/MCO business practices began.
Attorney Dennis Reich is appointed Chairman of the Damages Committee in the Blue Cross Blue Shield antitrust litigation.
MDL Managed Care Litigation Against HMOs/MCOs
Antitrust lawsuits seek financial injury compensation and corrective measures for damages caused by HMO licensing pacts that create geographic boundaries and allocate health insurance markets among the plans. Such practices stifle competition and consumer choice. An environment is created in which premiums can be increased significantly and health care providers can experience substantial financial injury. In the case of Blue Cross Blue Shield litigation, antitrust violations are spread across its 38 regional member health insurance plans across the nation.
Payment practices lawsuits involve HMO claim payment failures and refusals, according to provider contracts. Additional claims we handle on behalf of health care providers involve HMOs downcoding and bundling charges, which reduces the amount due in claims substantially.
RICO Act violations in managed care litigation also involve wrongfully and fraudulently paying health care providers less than they are owed for services and procedures.
Unfair business practices lawsuits involve HMO tactics and strategies to limit the number of physicians approved to treat policyholders in the insurance plan. The HMO may then limit patient volumes and business relationships between medical practices. In such cases, our law firm can hold the HMO liable for causing health care providers to lose income as a result of negotiated lower fee schedules.
Speak With One of Our Lawyers About Full Management of Your Claim
We offer comprehensive representation and advocacy to handle all communications with the HMO/MCO and all legal aspects in your best interests. Please call our firm in Houston at 713-352-7883 or contact us confidentially through our online form to schedule a meeting with a plaintiffs' lawyer.