Managed Care Litigation
Kaplan Johnson Abate & Bird LLP handles a wide range of matters for health care payers, including Medicare, Medicaid, and ERISA plans.
A Broad Range of Industry Knowledge and Experience
Our team brings significant knowledge of the relevant industry, as well as federal and state regulatory guidelines, which we combine with our litigation experience to ably and effectively represent our clients.
Among other things, the firm’s attorneys have:
- Served as national counsel for Medicare Advantage Organizations (MAO) in groundbreaking litigation to establish MAO recovery rights under the Medicare Secondary Payer Act.
- Represented MAOs in bid protest litigation concerning state Medicaid contract procurement processes.
- Served as plaintiff’s counsel in litigation initiated by payers against opioid and other pharmaceutical manufacturers.
- Represented payers in numerous litigations and arbitrations brought by providers and insurance agents.
- Defended a Medicaid MCO in novel litigation seeking to force MCOs to pay hospitals for treating non-emergent conditions in emergency rooms.
Our attorneys have also represented payers in connection with internal investigations and False Claims Act litigation.
We Teach Other Attorneys This Law
Our attorneys are frequently recognized for their expertise in representing payers particularly in the area of representing MAOs, and are often asked to speak on these issues at CLEs and conferences around the country.
In addition, our managed care litigation attorneys serve as appellate counsel to a major trade association of health plans, filing amicus briefs in multiple cases in the U.S. Supreme Court and various U.S. Courts of Appeals.
- Aetna v. Big Y Foods, No. 20-3853 (2d Cir. 2021): Represented Medicare Advantage Organization in appeal seeking to set aside judgment obtained under the Medicare Secondary Payer Act;
- Humana Med. Plan, Inc. v. Western Heritage Ins. Co., 832 F.3d 1229 (11th Cir. 2016): Successfully established MAOs’ rights to pursue affirmative recoveries from liability insurers under the MSP law;
- Moore v. Swerna, 19-CI-00093 (Fleming Cir. Ct. May 11, 2020): Obtained dismissal of state-law claims filed against MAO on preemption and exhaustion grounds;
- Humana v. Bi-Lo, LLC, 18-cv-2151 (D.S.C. Sept. 24, 2019): Successfully represented MAO in lawsuit seeking to recover conditional Medicare payments against a self-insured tortfeasor;
- Humana Ins. Co. v. Paris Blank LLP, 187 F. Supp. 3d 676 (E.D. Va. 2016): Successfully established MAOs’ rights to pursue affirmative recoveries from attorneys under the MSP law;
- Cariten Health Plan, Inc. v. Mid-Century Ins. Co., 2015 WL 5449221 (E.D. Tenn. Sept. 1, 2015); and Humana Ins. Co. v. Farmers Texas Cty. Mut. Ins. Co., 95 F. Supp. 3d 983 (W.D. Tex. 2014): Successfully established MAOs’ rights to pursue affirmative recoveries from no-fault carriers under the MSP law;
- Harrison Mem’l Hosp., Inc. v. Wellcare Health Ins. Co. of Kentucky, Inc., 509 S.W.3d 69 (Ky. Ct. App. 2016), review denied (Feb. 9, 2017): Obtained and defended dismissal of suit seeking to force Medicaid MCOs to pay for non-emergency services rendered in emergency room setting.
- Represented healthcare payors in affirmative claims against medical device and pharmaceutical manufacturers, reaching favorable settlements;
- Represented healthcare payors in numerous confidential arbitrations on a wide range of statutory and contract interpretation issues brought by hospitals and insurance agents;
- Conducted multiple confidential internal investigations for healthcare payors;
We counsel and represent clients in Metro Louisville and throughout the nation. To speak with one of our lawyers, call our office at 502-416-1630.