The jury found for our client, a major health insurance company, in this case related to the business practices of a group of surgery centers.
Our client, a major health insurance company, alleged that the defendants billed them at excessive rates and caused physicians to improperly refer medical care out of network. After a month-long trial, the jury found for the insurance company on all counts and awarded the precise amount of damages calculated by healthcare expert Professor Daniel Kessler of Stanford University and Cornerstone Research senior advisor.
The jury awarded the precise amount of damages calculated by healthcare expert Professor Daniel Kessler.
The insurance company alleged the defendants used kickbacks to induce in-network physicians to refer patients to out-of-network ambulatory surgery centers. Specifically, the surgery centers provided financial incentives to physicians in the form of discounted ownership stakes and payments in proportion to the volume of surgeries they referred to the centers. The defendants also allegedly waived patient coinsurance payments without disclosing this to the insurance company.
Professor Kessler’s trial testimony demonstrated that the ownership stakes influenced physician referral patterns. In addition, he calculated the amount that the insurance company overpaid relative to in-network benchmark prices at other area providers.