Litigation for the Healthcare System

In the complex health care delivery system now existing in this country, litigation can arise in many, many, many contexts.  As an example health care providers often challenge payors' claim adjudications pursuant to healthcare policies as well as related practices and payment amounts.  Health insurance beneficiaries and health care providers often dispute coverage decisions by payors.  The drug pricing and/or marketing practices of pharmaceutical companies and pharmacy benefit managers also often lead to litigation claims by payors.  The complex regulatory environment that impacts our health care system also results in challenges that include issues related to the FDA, Hatch-Waxman Act, Medicare, Medicaid, ERISA, COBRA and claims of conspiracy, antitrust violations, false or deceptive trade practices, federal or state false claims act violations, workers compensation and other state law violations, and litigation or regulatory enforcement action by federal and state agencies.

Healthcare Litigation

There is no shortage of healthcare litigation.  Below are just a few examples common examples of healthcare related litigation:

• Claims adjudication policies and practices
  • Above all the policies and practices of a health care coverage insurance policy can determine beneficiary rights and benefits and is extremely important to comply with State and Federal requirements as necessary.
• Claims payment disputes.
  • Healthcare beneficiaries often need to act to file litigation concerning a refused payment of healthcare claim in order to preserve their own assets and credit rating.
• Pharmacy claims disputes and submission requirements, coverage determination, and claims payment disputes
• Medicare Advantage and Medicare Part D prescription drug benefit plans disputes, including compliance actions.
• Beneficiaries and providers coverage determination disputes.

• Beneficiaries and providers are often hotly debating coverage decisions concerning the provision of necessary medical care and treatment or lack of coverage of treatment.

• Pharmaceutical drug pricing disputes 
  • Drug prices can vary radically and patients often dispute the amount they have been charged for necessary prescription drugs

• Claims payment administration and “repricing” of claims disputes, in the contexts of commercial health plans and workers compensation.

• Regulatory authority disputes regarding compliance with statutory and administrative requirements
• Anti-kickback violations and other federal and state regulation deficiencies.  
  • This area of litigation concerns statutes are intended to prevent healthcare providers from illegally personally profiting from providing care or denying care to policy beneficiaries

• Misappropriation of Trade Secrets and Unfair Competition.
  • This kind of litigation can include cases from violation of pharmaceutical patents of popular drug to various kinds of unfair competition such as corporate takeovers intended to monopolize and control national regions of healthcare provision.

• Development and production of medical device disputes.
  • This is often patent litigation generated in connection with the manufacture and royalties arising from production and design of surgical instruments and equipment.

There are simply countless legal and personal repercussions generated by of healthcare litigation. The rights and interests of large amounts of people can be affected by healthcare litigation on a local, national and even global basis.  For example large pharmaceutical companies want to get the highest price for their patented drugs on the general, country wide market and in contrast federal and State government authorities covering the cost of those drug therapies seek to pay the very lowest price for those drugs on behalf of countless patients and hospitals.