Insurance and Healthcare

Our economists are well-versed in the complex and sometimes byzantine world of insurance markets. We have worked on dozens of insurance cases, including In re Antitrust Brokerage, the well-known challenge to undisclosed brokerage commissions for both Commercial and Employee Benefits policies. Our antitrust engagements have included class certification, liability, and damages and involved analyses of market concentration, market power, brokerage practices, contingent commission agreements, government regulation of premiums and capital requirements. While we have studied all forms of insurance, some of our cases have focused on particular lines, such as health, title, crop, and excess casualty. Our expertise extends beyond direct insurance to global reinsurance markets and to the use of insurance products in enterprise risk management strategies. Our experts have testified in high-profile tax shelter litigation on regulatory capital and other ratings criteria for insurers and reinsurers. Over the course of these engagements, we have compiled and analyzed some of the largest, most complex transactional databases available for any U.S. industry, successfully transforming multiple proprietary systems into a single relational data base.

Health insurance is unlike any other form of insurance. We have expertise in its special features such as closed network structures, coverage conventions, and plan types. We have analyzed reimbursement for in-network and out-of-network services, procedure bundling and coding practices, and data pooling by insurers for the purpose of benchmarking usual-and-customary rates. Contributing to our understanding of healthcare markets, we have an extensive practice in pharmaceuticals, and our intellectual property experts have also testified on the value of medical device technology at various stages of development. We work on a daily basis with prescription drug coverage issues, including formulary placement and the different reimbursement schemes of Medicare Parts A, B, C, and D.