Health Care

Health Insurance Services

Besides a large number of hospital mergers, NERA's Health Care Practice has analyzed the competitive effects, both vertical and horizontal, for numerous health insurance mergers. We have also worked on litigations involving exclusive contracting and exclusive dealing issues as well as analysis of subscriber and provider class actions against insurers. NERA health economists have:

• Advised several insurers on whether some providers are behaving or pricing anticompetitively in their contract negotiations;
• Advised a hospital system with a large HMO of its own on how to deal with non-integrated insurers seeking to contract for the system's facilities and non-integrated hospital providers seeking to contract with the system's health plan;
• Analyzed relevant market issues and the competitive effects of affiliations between major health insurers, for example, Aetna's acquisition of Prudential and Pacificare's acquisition of FHP;
• Analyzed the competitive effects of alleged physician boycotts against major health insurers;
• Analyzed the potential for exclusive provider contracts and most-favored-nations provider contracts with a health insurer to facilitate monopolization by the insurer;
• Analyzed and provided assistance to counsel in several class action suits against managed care plans over the insurer's proper disclosure of member benefits and physician reimbursement methodologies as well as over adequate notification of the insurer's dropping out of the Medicare-Choice program in a particular county; and
• Defended several insurers accused of anticompetitive exclusions of some providers from their networks.