We represent and advise health insurers, managed care organizations (MCOs), and their internal pharmacy benefit managers with respect to actual or potential disputes arising within the dynamic and complex healthcare industry.

Some examples of our litigation and dispute resolution services include:

  • Payor-provider disputes
  • Affordable Care Act issues
  • Third-party subpoenas and investigations
  • Prosecution and defense of claims based on contract, equity, breach of fiduciary duty, racketeering, conspiracy, and fraud
  • False Claims Act liabilities or opportunities
  • Licensing disputes
  • Takings Clause violations
  • Directors and Officers liability
  • ERISA violations
  • Insurance coverage and reinsurance issues and claims

With experience in both state and federal courts as well as arbitration forums, Strategic Health Law is well-equipped to guide healthcare entities through an evolving legal landscape. Our seasoned litigators devise strategies to successfully navigate complicated conflicts and challenges, achieve results, and mitigate risk.

Representative Clients and Matters

  • Representing Humana Inc. and Humana Pharmacy Solutions in responding to subpoenas related to allegations of conspiracy and price fixing of EpiPen drug devices.
  • Representing Premera Blue Cross in the prosecution of claims for over $117 million in risk corridors underpayments under the Affordable Care Act.
  • Defended an Illinois Medicaid plan against a major hospital system for alleged underpayment of claims.
  • Representing the Blue Cross Blue Shield Association as amicus curiae in a federal appeal implicating health insurers’ entitlement to over $12.3 billion in risk corridors payments under the Affordable Care Act.
  • Representing Medical Supplement health insurance plan opposite hospital system as part of confidential AAA arbitration.
  • Represented national health insurer in reimbursement dispute opposite national laboratory as part of confidential AAA arbitration.
  • Represented a national health insurance company in connection with the successful recovery of victim restitution amounts as part of a $125 million criminal and civil settlement between the federal government and a global pharmaceutical company. The pharmaceutical manufacturer was alleged to have engaged in multiple fraudulent schemes involving the improper sales and promotion of various drugs, anti-kickback schemes and other fraud.