Health Insurance Companies
Recovery for Health Insurance Companies Nationwide
Under the U.S. healthcare system, patients generally receive services and products from their doctors who then bill the insurance companies. In many cases, the patients never see the itemized bills, or if they do see the charges, they do not understand the meaning of the multiple billing codes. Moreover, insurance companies are unlikely to question doctors unless there are red flags that indicate an unusual pattern or above-normal charges. This autonomy puts medical providers in a unique position to file fraudulent claims against health care insurance providers. Common health insurance schemes include:
- Billing the insurer for unnecessary procedures or goods: Doctors are trusted to know what is best for their patients, so it is assumed that a doctor would not order a test, treatment or medical product that the patient did not need. However, the insurance company may legitimately question the necessity of certain procedures or items.
- Billing for services or medical products not provided: In some cases, the doctor never performs the procedure or delivers the medical product to the patient. This improper billing often occurs in situations in which patients are undergoing multiple or extensive medical tests or treatments.
- Unbundling of packaged services: Some services are so intertwined that the insurance company bundles them. A lab or hospital might try to unbundle the package of services to bill for each separate service individually for a higher fee.
- Upcoding: Upcoding is common in the pharmaceutical and medical device industries. The scheme involves billing for a higher priced item, but delivering an inferior item to the patient.
Antitrust Class Actions
When pharmaceutical companies conspire to fix drug prices, participate in “pay for delay” schemes, or otherwise engage in anticompetitive behavior, Schneider Wallace represents the interest of health insurers in multi-district litigation. While class actions can be an effective way for individuals with relatively small personal damages to recover their losses, insurance companies bear a large proportion of that burden in the first instance. As a result, insurance companies often suffer substantial damages as a result of anticompetitive conduct in the healthcare industry. Our team of experienced antitrust litigators have the knowledge and experience that it takes to successfully prosecute these complex matters.
Contact Us Regarding Our Healthcare Recovery Practice
Contact Schneider Wallace at our Houston, San Francisco, Scottsdale or San Juan office to discuss healthcare recovery opportunities. Our law firm represents national insurance companies in cases involving fraud, antitrust violations and other cost recovery matters.