RDB’s expertise in professional liability insurance has led to our extensive involvement in liability claims asserted against health care organizations. Our attorneys serve as coverage counsel in connection with claims under health care D&O policies and managed care E&O policies. For example:

• We serve as coverage counsel in matters that may add to the rapidly-evolving law of federal preemption under the Employee Retirement Income Security Act (ERISA). The underlying claims include alleged instances of refusal to approve treatment, delayed referral to specialists, negligent referral to unqualified providers, and discriminatory refusal to treat.
• We are actively involved in a number of matters addressing the alleged conflict between providers’ financial self-interests and their medical judgments. These matters include attacks upon holdback arrangements and group and individual utilization incentives, as well as more broad-brush attacks upon capitation schemes.
• We serve as coverage counsel in a number of D&O liability claims involving the merger of managed care organizations (MCOs). In resolving these claims, the firm draws upon its experience in both the MCO and D&O areas.
• We have recently been called upon to handle claims involving allegations of MCO overcharges to patients and underpayments to physicians. The patient overcharges allegedly result from misrepresentation of negotiated costs while the physician underpayments allegedly result from misrepresentation of overall financial performance.
• We serve as D&O coverage counsel in a number of putative class actions alleging violations of the antitrust laws and/or asserting novel claims for relief against multiple hospitals and health care systems across the country. These cases are high impact, high visibility claims that challenge the fundamental structure of the health care industry.

We also have experience with recurring claims involving malpractice, employment practices liability, defamation, gatekeeper liability, peer review, and plan management, among others.