Managed Care Litigation: Latest Developments

Litigating Issues Involving Coverage, Health Reform, Payment Practices and More

Recording of a 90-minute CLE webinar with Q&A

Conducted on Wednesday, June 19, 2013

Recorded event now available

or call 1-800-926-7926
Program Materials

This CLE webinar will prepare healthcare counsel to litigate managed care lawsuits. The panel will discuss legal, substantive and practical considerations in common areas of dispute.


The trend of payors, providers and members of managed care plans litigating over such issues as coverage, payment and network participation continues unabated. The adoption and now ongoing implementation of the Affordable Care Act have added new disputes in areas such as medical loss ratio regulation, essential health benefits, and network inclusion.

Likewise, changes in healthcare reimbursement can be expected to drive a trend toward tiered and narrow networks, which will only increase the amount of litigation over out-of-network reimbursement, the right to participate in managed care networks, and whether the tiering arrangements in such networks are valid.

Listen as our authoritative panel of healthcare practitioners analyzes recent developments in managed care litigation and discusses substantive, strategic and practical considerations involved in litigating managed care suits.



  1. Hot topics in coverage litigation
    1. Autism spectrum disorder litigation
    2. Mental health parity litigation
  2. PPACA-related litigation
    1. Medical loss ratio requirements
    2. Provider inclusion and exclusion from networks
  3. Out-of-network reimbursement trends and litigation
    1. UCR class actions
    2. Alternatives that have emerged to replace Ingenix
  4. Key ERISA litigation trends
    1. Class actions based on recoupment practices
    2. Special attorney-client privilege issues in ERISA setting
    3. Developing law on equitable relief under ERISA
  5. Antitrust litigation targeting Blues plans’ geographic distribution of markets
  6. Payor actions challenging provider waivers of co-insurance, co-pays and deductibles


The panel will review these and other key questions:

  • What are the bases for the recent wave of managed care suits--and what defenses are available to providers and healthcare plans?
  • What litigation and settlement strategies have proven effective for counsel litigating managed care claims?
  • What are the best practices for counsel to providers and healthcare plans to minimize the expanding risk of managed care suits?

Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.


James W. Boswell, III
James W. Boswell, III

King & Spalding

He has extensive experience in handling a full range of commercial litigation matters. He has handled jury trials,...  |  Read More

Andrew J. Hefty
Andrew J. Hefty

Crowell & Moring

He is a member of the firm’s Healthcare Group. He focuses his practice on healthcare litigation and regulatory...  |  Read More

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