Glenn Agre pursues claims against commercial health insurers on behalf of employers, healthcare providers, state enforcement authorities, and whistleblowers. We do not represent health insurance companies. That independence allows us to bring the full weight of our litigation capability against insurers that overcharge the self-funded plans they are hired to administer, suppress reimbursement owed to the providers who deliver patient care, divide geographic markets to eliminate competition, and overcharge government-sponsored health benefit programs. When those practices are challenged, the resulting litigation implicates federal statutes such as ERISA, the Sherman Act, the False Claims Act, and RICO, as well as state antitrust, fiduciary duty, and common law tort theories. We handle all of them.
Because we are not conflicted by insurance industry relationships, we can take on the carriers and pursue every viable theory of liability across every available forum. Healthcare disputes require counsel who can master the economics of plan administration, trace the flow of funds through self-funded benefit structures, quantify damages across populations of claims, and present those findings persuasively to judges and juries. Glenn Agre’s trial-tested commercial litigation team, deep experience with large-scale antitrust matters, and capacity for multi-forum prosecution allow us to pursue the full chain of responsibility wherever those claims can be brought.
That combination of independence, substantive depth, and courtroom strength, in a firm built for high-stakes plaintiff-side advocacy, is what our clients’ most consequential healthcare disputes require.
ERISA Fiduciary Duty and Prohibited Transaction Claims
When employers entrust the administration of their self-funded health benefits plans to commercial health insurers, those insurers assume fiduciary obligations under ERISA. Insurers breach those duties when they steer claims to affiliated providers, inflate the costs passed through to the plan, engage in undisclosed self-dealing, or put their own financial interests ahead of plan participants. Glenn Agre’s attorneys have the experience to pursue the full range of resulting claims, including ERISA breach of fiduciary duty, prohibited transactions, and related statutory and common law theories, on behalf of employers across industries.
Out-of-Network Provider Reimbursement and Price-Fixing Disputes
Out-of-network healthcare providers including surgeons, medical practices, and health systems, are routinely subjected to coordinated efforts by commercial health insurers and third-party repricing companies to suppress reimbursement rates below what those providers are owed for the care they deliver. These arrangements amount to price fixing, and challenging them requires counsel willing to stand opposite the largest insurance companies in the country. Glenn Agre’s attorneys have represented dozens of out-of-network surgical practices and medical providers against the large commercial health insurers for conspiring to depress payment to providers, underpay claims, and slow-walk reimbursement.
False Claims Act and Whistleblower Litigation
Health insurers that administer publicly funded benefit plans are subject to the federal False Claims Act and its state counterparts when they submit false or fraudulent claims for reimbursement from government programs. Glenn Agre’s attorneys have represented whistleblowers and have worked closely with state enforcement authorities to investigate and prosecute those claims.
Antitrust Litigation Against Health Insurers
Health insurers that divide geographic markets, coordinate pricing, or otherwise suppress competition harm the employers, health systems, and healthcare providers that depend on a competitive insurance market. Glenn Agre’s attorneys have represented dozens of health systems, healthcare providers, and other companies pursuing antitrust claims against commercial health insurers. Glenn Agre’s attorneys have also represented state Attorneys General investigating and prosecuting antitrust, breach of contract, and breach of fiduciary duty claims against commercial health insurers.
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