Connell Foley has attained the status of a leading firm in the area of healthcare and ERISA litigation, successfully representing health insurance carriers in numerous high-profile national class actions, among other disputes. We have achieved significant results in defending carriers sued in individual actions by subscribers and providers, as well as putative class actions and associational standing cases where significant damages and broad sweeping plan changes are sought. Further, we have represented carriers in prosecuting breach of contract and fraud claims, including multiple recoveries in excess of $1,000,000. Team members are ranked in leading legal directories and are recognized in the business and trade press as leaders in the field.

Comprehensive Services

Our broad litigation experience, both at the state and federal levels, serves as the foundation from which our diverse team provides comprehensive, cost-effective representation. We provide a full range of services for critical disputes facing our health carrier clients, including:

  • ERISA benefit claims and preemption
  • ERISA breach of fiduciary duty claims
  • ERISA, RICO, and antitrust class actions
  • Provider reimbursement disputes
  • Fraud, abuse, and overpayment recoveries
  • Medical liability claims against managed care entities
  • Declaratory judgment actions
  • Medicare and Medicaid fraud

Track Record of Success

The Healthcare/ERISA Litigation practice group is handling or has successfully resolved numerous recent high-profile litigations on behalf of its clients, including:

  • Defending a healthcare insurance carrier in a national, multi-district putative class action brought by subscribers, providers, and medical associations alleging ERISA, RICO, and Sherman Act violations relating to the use of certain databases to determine usual and customary rates (UCR) for out-of-network services
  • Representing a healthcare insurance carrier in a national putative class action brought by individual healthcare providers and chiropractic associations asserting ERISA and RICO challenges to the carrier’s fraud investigation unit, and prosecuting counterclaims to recover overpayments made to the plaintiff providers
  • Defending an associational action seeking to enjoin the inclusion of provisions in network agreements setting maximum fees to be charged for services that do not result in a payment from the carrier
  • Prosecuting an overpayment recovery from an alcohol and drug dependency treatment facility that submitted healthcare insurance claim forms allegedly misrepresenting the patients’ diagnosis to procure a greater reimbursement than that to which they are entitled
  • Represented a healthcare insurance carrier in a subscriber putative class action challenging coverage policies for eating-disorder treatments brought under ERISA and state parity laws
  • Obtained summary judgment against defendant doctors who violated the IFPA through the illegal self-referral of patients between practices
  • Prosecuted an overpayment recovery from an anesthesiology group that billed and received double payments from the healthcare insurance carrier, despite receiving payments under a hospital capitation agreement
  • Defended a provider pain specialist’s request for payments under a network agreement and pursuing overpayment counterclaims based upon overbilling, overutilization, unbundling, and upcoding

These recent accomplishments, among others, have garnered significant recognition within the industry.