Arbitration Between Managed Care Organization and Hospital System

Analysis Group was retained on behalf of a large, integrated managed care organization, the defendant in a matter involving allegations that it denied payment of valid emergency-room and related inpatient care claims for services provided to its members by a large California-based hospital system. The plaintiff sought damages in excess of $100 million. The managed care organization, in turn, submitted counterclaims against the hospital system for fraud and the provision of medically unnecessary services. The parties agreed to arbitrate their dispute.

An Analysis Group team led by Managing Principal Mark A. Gustafson and Vice President Hristina Bojadzieva Bartlett supported Managing Principal Bruce F. Deal, who testified at trial regarding business practices and damages.

The arbitration panel returned a defense verdict highly favorable to the defendant, awarding damages of over $70 million, including interest. The panel noted in its decision that it “accepts Mr. Deal’s methodology as reasonable and adequately supported” and found his regression analysis “persuasive.”