Case Studies: Claims Payers
Third Party Administrator Payer Investigation and Litigation
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BlickenWolf was retained by counsel of a third party administrator
(TPA) of medical insurance plans. The TPA, which represented employees
of nearly 100 companies and governmental organizations of varying size,
was charged with seven counts of felony theft. The State contended
that the TPA straddled claim payments across different fiscal years
to avoid reaching cumulative claim amounts, which would disqualify
it from receiving bonus payments from the reinsurer. We assisted counsel
in building its defense beyond the analysis of discovery documentation,
including the creation of financial impact scenarios and industry cost
models. The results of our analysis culminated in our provision of
expert testimony that proved to be the backbone of the TPA’s defense.
The jury subsequently exonerated the TPA of all charges.
