In re Managed Care Litigation
Analysis Group was retained by Cooley Godward on behalf of PacifiCare Health Systems in this class action brought by a national class of 600,000 physicians against eight of the country's largest HMOs. The allegations included RICO claims that the health plans conspired to reduce and delay payments to physicians through the use of automated claims adjudication software.
The Analysis Group team, led by Managing Principal Bruce Strombom and Principals Howard Birnbaum, and Marnie Moore, with Vice Presidents Pete Simon, and Mark Gustafson, analyzed over 100 million health care claims and evaluated PacifiCare's claims payment practices for evidence of down-coding, bundling, and slow payment to physicians. Academic affiliate Professor Thomas McGuire submitted an expert report on behalf of the joint defense group addressing the defendants' use of capitated reimbursement to compensate physicians for services provided to health plan enrollees.