Insurance and Healthcare

Few sectors of the U.S. economy are currently exposed to so many competing forces as insurance and healthcare. OnPoint economists are experts on health insurance practices, including premium pricing, coverage conventions and plan types, as well as reimbursement procedures for subscribers and providers. Our experts have testified in dozens of cases that examine these practices. Major engagements have included many cases challenging the payment of undisclosed brokerage commissions that restricted competition and gave rise to higher premiums for subscribers and plan sponsors. Our experts have also been involved in most of the major litigation challenging coding, bundling and other claims processing practices used by insurers to calculate provider reimbursement. OnPoint is also currently engaged in evaluating the anti-competitive effects of insurer control over benchmarking products used to determine how much will be reimbursed for out of network (as opposed to in network) health care services. Over the course of these engagements, OnPoint has worked with some of the largest, most complex transnational databases present in any U.S. industry, successfully transforming multiple proprietary systems into a single relational database.

In addition to insurance, OnPoint’s health care practice focuses heavily on pharmaceuticals and medical devices. Our experts have testified in major litigation involving numerous products covering at least thirty therapeutic classes. These cases examine market potential, pricing and promotional practices, rebating, chargebacks and other discounting practices, order of entry effects, formulary status and evolving formulary strategies, government reimbursement practices, effects of Medicare Part D, and issues relevant to patent validity such as commercial success and long-felt need. In addition to health care insurance, pharmaceuticals and medical devices, OnPoint experts provide testimony on health care employment issues, including labor shortages, wages, and benefits.

OnPoint’s expertise in the insurance field extends far beyond health care. Our testifying experts have been at the forefront of antitrust litigation challenging commercial insurance marketing and pricing practices. OnPoint also regularly handles large scale coverage litigation presenting especially complex questions of loss causation and damage estimation.