ERISA Health Care Claims

The Employee Retirement Income Security Act of 1974 (“ERISA”) regulates many aspects of employee health and welfare benefit plans established or maintained by private employers, including both fully-insured and self-insured benefit plans. Litigation under ERISA includes a wide range of claims. While many such actions involve an individual suit over a determination of plan benefits, class action litigation is also common.

Analysis Group has worked on class action litigation involving health and welfare benefit plans and insurance claims matters for some of the largest employers, health insurance companies, and hospital groups. Our team is strengthened by a unique combination of expertise in ERISA and insurance litigation, the health care industry, and claims data analysis.

Our academic, industry, and in-house experts have provided strategic assistance to counsel at key points in litigation, including pretrial discovery, settlement negotiations, and trial preparation. We have deep experience analyzing hundreds of thousands of detailed claims, applying data science to optimize the efficiency of a detailed analysis. We have also analyzed the billing practices of hospitals and calculated damages related to disputes about the rate at which claims were paid. 

Our Expertise

Our work on ERISA health care and claims-related matters includes:

  • Litigation regarding overpayment offsets to out-of-network health care providers
  • Disputes concerning inappropriate hospital admissions and improper billing
  • Government investigation of an insurer’s role as the third-party administrator of self-funded company insurance plans and the appropriateness of access fees charged by the insurer
  • Health care litigation related to deductibles and out-of-pocket expenses
  • A class action alleging breach of fiduciary duties under ERISA regarding artificially high premiums for health care services
  • A class action litigation initiated by a worker’s union’s self-insured health plan
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