Insurance and Health Care Fraud Litigation

Katten’s Insurance and Health Care Fraud Litigation Practice is the preeminent leader in the nation in helping insurers reduce their exposure to systemic fraud through the development of effective claims handling practices and affirmative litigation against parties responsible for driving fraudulent claims activity. For more than 15 years, Katten has worked extensively with automobile, worker’s compensation and health insurers across the country to identify fraudulent claim trends in high-exposure markets, develop multifaceted strategies that substantially reduce clients’ exposure to these activities, and recover payments that were never owed in the first place. Our attorneys work to combat fraudulent insurance claims by targeting patterns and parties who are driving systemic fraudulent claims activity.

We have helped our clients to avoid payment of fraudulent claims through the design and implementation of claims handling practices tailored to the issues raised by suspect claims. We also provide coordinated defense of claim denials if they are challenged.

Katten routinely represents insurers in affirmative litigation directed at the parties who are primarily responsible for fraudulent claims activity and has successfully recovered significant sums on behalf of our clients. We have brought cases and argued many positions that have established controlling legal principles in the relevant areas of law and jurisdictions, which in turn have been used to reduce future exposures. We have creatively used the tools of litigation to expose previously unknown fraudulent practices and participants. Our attorneys also work with law enforcement authorities and regulatory bodies in related criminal and disciplinary proceedings.

The Insurance and Health Care Fraud Litigation Practice includes several former federal prosecutors and others with considerable knowledge and experience in the following areas:

• patterns and practices of those who engage in insurance and health care fraud;
• insurance claims operations, company and industry-wide claims databases;
• various forms of medicine including physiatry, orthopedics, neurology, psychiatry, psychology, dentistry, acupuncture, physical therapy, surgical procedures, pain management and chiropractic;
• various forms of diagnostic testing including imaging studies, neuropsychological testing, electrodiagnostics, range of motion and muscle strength testing, pulmonology tests and sleep studies; and
• durable medical equipment and orthotics.

Our team has extensively researched and worked with state and federal laws regarding the corporate practice of medicine, fee-splitting, kickbacks, self-referrals, patient brokering and licensing laws for medical professionals, hospitals, ambulatory surgery centers and multidisciplinary practices.

In addition, we have creatively and successfully used civil litigation to advance the interests of insurance clients as they aggressively combat fraud. These efforts have included developing a nationally recognized expertise with the Racketeer Influenced and Corrupt Organizations Act (RICO), which we have successfully used in many cases for insurers.