HEALTHCARE REGULATORY AND LITIGATION EXPERT SERVICES
In healthcare, in addition to Personal Injury and Certificate of Need work, we have participated in cases on behalf of hospitals, physicians, nursing homes, insurance carriers and government agencies to address a wide range of healthcare liability and damage issues.
Examples of RPC’s work in healthcare forensic services include the following:
- Analysis of geographic and product market shares to evaluate contractual, reimbursement and pricing issues
- Quantitative and comparative analyses of hospital efficiency using local, state and national data
- Analysis of hospital financial health and performance
- Analysis of reimbursement systems including comparisons of healthcare costs to payments that take into consideration many different variables such as bed size, location and case mix
- Review of all materials provided by the opposing side, including any reports and supporting analytical findings prepared by the opposition's experts
- Assistance to legal counsel in preparing document requests, interrogatories and deposition question
- Attendance at depositions and evaluation of witness responses
- Presentation of analytical findings and conclusions in expert reports, affidavits, exhibits and testimony
- Evaluation of settlement proposals
RPC has assisted health law attorneys, hospitals, nursing homes, home health agencies, physician practices, government agencies and other healthcare organizations in legal and administrative proceedings nationwide. Our areas of expertise include health planning, health finance and market research. RPC prepares studies for litigation support for general and specialty hospitals, nursing homes, managed care organizations and multi-specialty physician clinics. Examples of RPC’s healthcare consulting and forensic services include:
- Medical Staff Issues
- Construction Litigation
- Payment Disputes
- Contract Disputes
- Fraud and Abuse
- Patient Rights
- Medical Records Review
- Anti-trust Matters
- Property Casualty
- Hospital and Related Healthcare Institution Liability Issues
- Physician Liability Issues
- Life Care and Vocational Rehabilitation Planning
- Workers Compensation Payment Disputes
Many of these studies have formed the basis for expert witness testimony before courts, administrative agencies and legislative committees. Dr. Luke has testified in federal and state courts on health care matters including anti-trust, billing fraud and abuse, medical staff credentialing and physician contracts. In the course of providing this testimony, Dr. Luke has been accepted as an expert witness in demography, economics, statistics, market research, socioeconomic impact analysis, health planning, land use planning and financial analysis.
Following are some examples of the kind of cases on which RPC has consulted:
- Determined the rate of payment to which healthcare facilities are entitled for services to workers compensation patients under the Texas statute in the absence of a valid rule establishing a fee guideline.
- Determined the interest payments owed healthcare providers by an insurance carrier under rules of the Texas Workers’ Compensation Commission.
- Established product and geographic market definition and demonstrated the defendant had market power that it was using to compel managed care plans to exclude a hospital from provider networks in a state anti-trust action.
- Established product and geographic market definition and demonstrated the defendant had market power to force employers to exclude a healthcare provider from their provider networks in a federal anti-trust action.
- Determined the damages to a physician group due to a hospital's breach of contract and fiduciary duties regarding a managed care joint venture.
- Determined the damages to physicians from loss of hospital privileges or closure of hospital-based programs.
- Determined the damages suffered by a psychiatric practice group due to unlawful conversion of a long-term psychiatric hospital to short-term programs.
- Assessed the damages to a neurosurgeon's income caused by a hospital management company's failure to fulfill its recruitment agreement.
- Evaluated the damages to a household from the loss of health insurance due to inappropriate business practices of an insurance company in managing risk pools.
- Determined the relevant market areas, market size and market shares for cardiology and cardiovascular surgery services for a defendant hospital in anti-trust litigation regarding medical staff privileges.
- Analyzed discrimination in payment of charges, the market area and the availability of competing hospitals for defendant insurance companies and hospital in anti-trust litigation.
- Determined the damages to third-party payers from improper billing practices of a revenue enhancement firm for the Texas Attorney General's Office.
- Determined the damages to a hospital from the breach of a non-competition agreement by the purchaser of a long-term psychiatric hospital.
For sample RPC reports and professional references please contact Ron Luke at (512) 371-8000