MANAGED CARE • RISK MODELING • DECISION SUPPORT
Litigation has become a fact of life in the health care marketplace. From CMS Fraud & Abuse investigations to consumer class-action lawsuits, virtually any participant in the health care marketplace may be involved in some form of litigation.
Ross Health Actuarial has the necessary experience, tools, and knowledge to provide litigation support services for matters in the health care financing arena. Our knowledge of claim distributions, the marketplace, and analytical tools allow us to provide expert assistance in a variety of matters, including:
Fraud & Abuse Investigations. Please see our page discussing compliance programs and our approach to statistical sampling studies.
Consumer Class-Action Cases. Consumers have brought class-action cases against HMO's and insurers alleging improper handling of claim payments, copayments, provider discounts, or premium administration. Very often, these allegations can only be resolved by reviewing claim records and using a statistical sampling approach. Please see our discussion of statistical sampling under Compliance Programs.
Managed Care Dispute Resolution. We have significant experience with managed care contracting arrangements, capitation rate development, claim reserve estimates, and related matters. This expertise is applicable to disputes involving managed care contracts between providers and HMO's or other payers.
Other Health Care Cost Studies. Our knowledge of health care costs and markets provide the basis for evaluating health care costs in a variety of settings. Examples include the projected future health care costs for an affected population, or estimating the market value of a health care procedure or technology in a patent infringement case.
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