Health Plan and Healthcare Litigation

Rx for Success

Blank Rome’s health plan and litigation attorneys provide a broad range of litigation, transactional, regulatory, and counseling services to healthcare providers and payors, including insurance plans and managed care organizations (MCOs), as well as large employer and union health plans throughout the United States.

Our litigation services on behalf of our health plan and healthcare clients include litigation in state and federal courts around the country involving groundbreaking claims in the areas of:

  • antitrust
  • breach of contract
  • fraud and abuse
  • deceptive trade practices
  • False Claims Act
  • government investigations
  • class actions

Blank Rome represents health providers before federal and state-level regulatory agencies and audit contractors, including, among others, the Centers for Medicare and Medicaid Services, the Public Health Service, the Federal Trade Commission, the Department of Defense, and the Department of Veteran Affairs.

Select Engagements:

  • Counseling and litigation concerning drug pricing issues related to Medicaid Best Price, Medicare Part D, nominal pricing, and off-label marketing.
  • Numerous matters involving the negotiation, auditing, internal investigations, compliance, and litigation related to pharmacy benefit management (PBM) contracts.
  • Counseling and litigation on behalf of a mid-sized PBM related to issues of best practices, transparency, rebate contracting, and alleged receipt of kickbacks.
  • Negotiation and litigation regarding pharmaceutical rebate contracts, educational grants, data sales contracts, and service agreements between drug manufacturers and MCOs.
  • Numerous fraud investigations into renal dialysis centers, psychiatric hospitals, clinical laboratories, therapy, home healthcare companies, and for-profit hospital chains—including forensic data analysis, interviewing hundreds of witnesses, and leading negotiation on behalf of consortia of healthcare payers.
  • Representation of a large Medicare fiscal intermediary in response to a U.S. Department of Justice (DOJ) False Claims Act action, including issues related to cooperation with the government, document preservation and retention, management and scope of the investigation, notification, and voluntary disclosure issues.
  • Representation of a large health management organization (HMO) in the first DOJ False Claims Act investigation into allegations of violations of Medicaid Best Price Statute, including charges of criminal collusion with drug manufacturers.
  • Antitrust counseling and litigation concerning marketing activities of drug manufacturers, settlements between brand and generic drug manufacturers, and sham litigation claims related to patent evergreening, including representation before the FTC.
  • Counseling and litigation for numerous clients related to the False Claims Act and the Anti-Kickback Act, including analysis of relevant safe harbors.
  • Numerous cases involving defense of class actions, multidistrict litigation, and coordination and management of complex multiparty litigation.
  • Counseling and litigation concerning numerous ERISA preemption, HIPAA privacy, Medicare Secondary Payer (MSP), and Social Security issues. Lead counsel for COBRA administrator on behalf of numerous employer plans covering over three million covered lives.