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Managed Care + ERISA Litigation

Managed care organizations and health insurers face unique regulatory, legal, and economic challenges. Navigating the evolving landscape of state and federal health benefits law requires far-reaching experience and a real understanding of the managed care and health insurance business. Robinson+Cole lawyers have both.

Our Services

We regularly represent managed care and health insurance clients in a wide range of matters, including the following:

  • ERISA compliance and health claim litigation
  • Out-of-network provider reimbursement
  • Utilization review requirements
  • Mental Health Parity and Addiction Equity Act compliance
  • Fee forgiveness litigation
  • Litigation involving PBMs
  • Pharmacy benefit manager disputes
  • Administrative hearings before state and federal regulators
  • Disputes under prompt pay statutes
  • Medicaid-managed care
  • Medicare Part D
  • Market conduct litigation
  • State licensure
  • Antitrust government investigations

Effective Case Management

We have represented managed care and health insurance clients for more than three decades as counsel in litigation, arbitration, corporate, and regulatory matters that include the following:

  • National managed care organizations operating public and private sector health plans
  • Insurers in the individual and small group markets
  • Pharmacy benefit managers
  • Excess loss carriers
  • Third-party administrators
  • Self-funded employer groups

Our lawyers have significant experience in defending against class action litigation, providing regulatory compliance counseling, and participating in the contract negotiation process. In addition, we regularly collaborate with the firm's non-lawyer lobbyists in developing regulatory and political solutions to our clients' needs.

Experience


Successful Defense of Medicaid Managed Care Plan in Provider Reimbursement Arbitration

Represented a Medicaid managed care organization in an AHLA arbitration brought by a behavioral health provider alleging years of systemic underpayment. The arbitrator dismissed all claims in their entirety based on failure to exhaust contractual remedies and lack of entitlement to higher reimbursement rates, eliminating more than $1.5 million in claimed exposure.

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Summary Judgment Win in ERISA + Mental Health Parity Benefits Litigation

Obtained summary judgment for a national health insurer in federal court in an ERISA action challenging behavioral health benefit denials. The court upheld the insurer’s medical necessity determinations and plan exclusions and rejected Mental Health Parity Act claims, dismissing all core liability theories.

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Obtained Asylum for Prominent Activist

As a pro bono attorney, successfully obtained asylum in the U.S. for a prominent LGBTQ+ activist from Bangladesh.



Publications


March 2026

The Current State of the No Surprises Act Litigation

For the Defense
October 31, 2025

Adjudicative Angst: Administrative Law Judges and the Fairness Paradox at the Heart of SEC v. Jarkesy

Boston College Law Review

Volume: 66 Issue: 7 Page/Article: 2397-2437

New Antitrust Guidance Provides Ground Rules for Labor Markets—Or Does It? teaser
February 5, 2025

New Antitrust Guidance Provides Ground Rules for Labor Markets—Or Does It?

Manufacturing Law Blog
March 2026

The Current State of the No Surprises Act Litigation

For the Defense
October 31, 2025

Adjudicative Angst: Administrative Law Judges and the Fairness Paradox at the Heart of SEC v. Jarkesy

Boston College Law Review

Volume: 66 Issue: 7 Page/Article: 2397-2437

New Antitrust Guidance Provides Ground Rules for Labor Markets—Or Does It? teaser
February 5, 2025

New Antitrust Guidance Provides Ground Rules for Labor Markets—Or Does It?

Manufacturing Law Blog
July/August 2024 | Volume 3, Issue 7

Ninth and Second Circuit Courts of Appeals Rule that Preauthorization Process Does Not Impose Independent Contractual Liability on Issues of First Impression in Both Circuits

DRI Life, Health & Disability News, "The Brief Case"

Re-publishing of ERISA Claim Defense blog post. 

Legal Update: Section 503-1 Precludes Claim Administrators From “Overturning and Remanding” Claims on Administrative Appeal, According to Second Circuit teaser
June 9, 2022

Legal Update: Section 503-1 Precludes Claim Administrators From “Overturning and Remanding” Claims on Administrative Appeal, According to Second Circuit

June 2022

Emergency Laws and Private Rights of Action

For the Defense

Pat writes that “(t)he impact of the COVID pandemic on all aspects of life and society is virtually impossible to overstate.” The article focuses on a small aspect of the pandemic, “but one that is highly significant to healthcare plans and employee benefit litigators.” Early in the pandemic, Congress passed two laws – the Corona Virus Aid, Relief, and Economic Security Act (CARES Act) and the Families First Coronavirus Relief Act (FFCRA) - requiring health insurers and health plans to cover COVID testing services and pay testing providers either a negotiated rate or a posted “cash price.” As some providers have “sought to use the pandemic for their own enrichment,” this profiteering has led to a number of cases, and just-now developing case law, regarding exactly what rights, and what obligations, were established by the CARES Act and the FFCRA. The article addresses a central question that arises from this legislation – namely,  whether it “gives health care providers a private right of action to enforce payment obligations placed on health plans and health insurers.” View the article.

April 28, 2022

Misrepresentation in the Life, Health, and Disability Insurance Application Process (ABA, 3d ed. 2022)

This comprehensive publication provides practitioners in the area of life, health, and disability insurance with a national survey of each of the fifty states, the District of Columbia, and the federal circuits regarding misrepresentations in applications as well as the applicable case law interpreting relevant statutes and developing the common law regarding misrepresentations. In addition, it addresses the evolving issues related to misrepresentations in the context of the Employee Retirement Income Security Act (ERISA). Patrick was responsible for writing/updating the New York State chapter as well as writing/editing the Second Circuit chapter (including the states of New York, Connecticut and Vermont).

October 1, 2021

It’s Always Been a Matter of Antitrust: Heightened Antitrust Enforcement for Healthcare System Consolidation

Villanova Health Law Blog

View the article.

May 5, 2021

Don't You Know That You're Toxic? CERCLA Section 113(H) Challenges, Sovereign Immunity, and Perfluoroalkyl Substances in Pennsylvania Drinking Water in Giovanni V. Navy

Villanova Environmental Law Journal Blog

View the article.



July/August 2024 | Volume 3, Issue 7

Ninth and Second Circuit Courts of Appeals Rule that Preauthorization Process Does Not Impose Independent Contractual Liability on Issues of First Impression in Both Circuits

DRI Life, Health & Disability News, "The Brief Case"

Re-publishing of ERISA Claim Defense blog post. 

Legal Update: Section 503-1 Precludes Claim Administrators From “Overturning and Remanding” Claims on Administrative Appeal, According to Second Circuit teaser
June 9, 2022

Legal Update: Section 503-1 Precludes Claim Administrators From “Overturning and Remanding” Claims on Administrative Appeal, According to Second Circuit

June 2022

Emergency Laws and Private Rights of Action

For the Defense

Pat writes that “(t)he impact of the COVID pandemic on all aspects of life and society is virtually impossible to overstate.” The article focuses on a small aspect of the pandemic, “but one that is highly significant to healthcare plans and employee benefit litigators.” Early in the pandemic, Congress passed two laws – the Corona Virus Aid, Relief, and Economic Security Act (CARES Act) and the Families First Coronavirus Relief Act (FFCRA) - requiring health insurers and health plans to cover COVID testing services and pay testing providers either a negotiated rate or a posted “cash price.” As some providers have “sought to use the pandemic for their own enrichment,” this profiteering has led to a number of cases, and just-now developing case law, regarding exactly what rights, and what obligations, were established by the CARES Act and the FFCRA. The article addresses a central question that arises from this legislation – namely,  whether it “gives health care providers a private right of action to enforce payment obligations placed on health plans and health insurers.” View the article.

April 28, 2022

Misrepresentation in the Life, Health, and Disability Insurance Application Process (ABA, 3d ed. 2022)

This comprehensive publication provides practitioners in the area of life, health, and disability insurance with a national survey of each of the fifty states, the District of Columbia, and the federal circuits regarding misrepresentations in applications as well as the applicable case law interpreting relevant statutes and developing the common law regarding misrepresentations. In addition, it addresses the evolving issues related to misrepresentations in the context of the Employee Retirement Income Security Act (ERISA). Patrick was responsible for writing/updating the New York State chapter as well as writing/editing the Second Circuit chapter (including the states of New York, Connecticut and Vermont).

October 1, 2021

It’s Always Been a Matter of Antitrust: Heightened Antitrust Enforcement for Healthcare System Consolidation

Villanova Health Law Blog

View the article.

May 5, 2021

Don't You Know That You're Toxic? CERCLA Section 113(H) Challenges, Sovereign Immunity, and Perfluoroalkyl Substances in Pennsylvania Drinking Water in Giovanni V. Navy

Villanova Environmental Law Journal Blog

View the article.


News


April 7, 2026

Ray Carta and Rita Nerney Discuss Current No Surprises Act Litigation

Managed Care + ERISA Litigation group members Raymond J. Carta and Rita E. Nerney informed readers that the “extensive litigation between out-of-network providers and insurers” rages on in their article, “The Current State of the No Surprises Act Litigation,” published in DRI’s For The Defense March 2026 issue. They point out that “…federal courts have coalesced around the determination that the NSA does not permit lawsuits by out-of-network providers to confirm MSA awards from the IDR  [independent dispute resolution] process…” and that the “current administration has promised new agency guidance to streamline the IDR process in early 2026.” Read the article.

For The Defense
January 22, 2026

Stephanie J. Oppenheim Hosts Pro Bono Record Clearing Clinic for Martin Luther King Jr. Day of Service

Stephanie J. Oppenheim Hosts Pro Bono Record Clearing Clinic for Martin Luther King Jr. Day of Service teaser
January 5, 2026

Robinson+Cole Promotes New Partners and Counsel in Strategic Practices and Markets

Firm names three partners and eight counsel in New York, Boston, Hartford, Providence, and Stamford
April 7, 2026

Ray Carta and Rita Nerney Discuss Current No Surprises Act Litigation

Managed Care + ERISA Litigation group members Raymond J. Carta and Rita E. Nerney informed readers that the “extensive litigation between out-of-network providers and insurers” rages on in their article, “The Current State of the No Surprises Act Litigation,” published in DRI’s For The Defense March 2026 issue. They point out that “…federal courts have coalesced around the determination that the NSA does not permit lawsuits by out-of-network providers to confirm MSA awards from the IDR  [independent dispute resolution] process…” and that the “current administration has promised new agency guidance to streamline the IDR process in early 2026.” Read the article.

For The Defense
January 22, 2026

Stephanie J. Oppenheim Hosts Pro Bono Record Clearing Clinic for Martin Luther King Jr. Day of Service

Stephanie J. Oppenheim Hosts Pro Bono Record Clearing Clinic for Martin Luther King Jr. Day of Service teaser
January 5, 2026

Robinson+Cole Promotes New Partners and Counsel in Strategic Practices and Markets

Firm names three partners and eight counsel in New York, Boston, Hartford, Providence, and Stamford
November 6, 2025

Robinson+Cole Commends 62 Attorneys Recognized in 2025 Super Lawyers®

Recognition spans key regions and highlights the firm’s seasoned practitioners and emerging leaders in many business transactions and litigation practices
Robinson+Cole Commends 62 Attorneys Recognized in 2025 <i>Super Lawyers</i>® teaser
September 30, 2025

Robinson+C​ole Welcomes 2025 Fall Class

Robinson+C​ole Welcomes 2025 Fall Class teaser
June 12, 2025

Robinson+Cole Adds Over a Dozen Lawyers in New York, Including New Partner Michael Pass

May 7, 2025

Six Robinson+Cole Attorneys Named 2025 Stand-out Lawyers

Thomson Reuters
January 28, 2025

Stephanie Oppenheim Shares Insight on PA Clean Slate Law as part of MLK Day Expungement Clinic

January 13, 2025

Robinson+Cole Elects New Partners and Counsel for 2025


November 6, 2025

Robinson+Cole Commends 62 Attorneys Recognized in 2025 Super Lawyers®

Recognition spans key regions and highlights the firm’s seasoned practitioners and emerging leaders in many business transactions and litigation practices
Robinson+Cole Commends 62 Attorneys Recognized in 2025 <i>Super Lawyers</i>® teaser
September 30, 2025

Robinson+C​ole Welcomes 2025 Fall Class

Robinson+C​ole Welcomes 2025 Fall Class teaser
June 12, 2025

Robinson+Cole Adds Over a Dozen Lawyers in New York, Including New Partner Michael Pass

May 7, 2025

Six Robinson+Cole Attorneys Named 2025 Stand-out Lawyers

Thomson Reuters
January 28, 2025

Stephanie Oppenheim Shares Insight on PA Clean Slate Law as part of MLK Day Expungement Clinic

January 13, 2025

Robinson+Cole Elects New Partners and Counsel for 2025


Events


Past

No Surprises Act — IDR Developments and Related Litigation

Apr 30 2026
ACI 17th Annual Advanced Forum on Managed Care Disputes and Litigation Conference
Past

The No Surprises Act: More Surprises, Even More Litigation

Apr 29 2026
DRI 2026 Life, Health, Disability and ERISA Seminar
Past

No Surprises Act — IDR Developments and Related Litigation

Apr 30 2026
ACI 17th Annual Advanced Forum on Managed Care Disputes and Litigation Conference
Past

The No Surprises Act: More Surprises, Even More Litigation

Apr 29 2026
DRI 2026 Life, Health, Disability and ERISA Seminar
Past

Subrogation and Reimbursement Claims; ERISA Basics National Institute

Apr 15 2026
American Bar Association Joint Committee on Employee Benefits’ ERISA Basics National Institute
Past

No Surprises Act Update: Regulatory and Litigation Developments, Ongoing Compliance Challenges for Stakeholders

Nov 13 2025
Barbri Webinar
Past

Okay, Maybe a Few Surprises: An Analysis of Activity Surrounding the No Surprises Act After Texas Medical

May 1 2025
16th Annual Advanced Forum on Managed Care Disputes and Litigation
Past

Defending ERISA Health Claims in State Court: Nuts, Bolts, and Developments in Out-Of-Network Provider Litigation

April 9, 2025
DRI 2025 Life, Health, Disability, and ERISA Seminar
Past

Subrogation and Reimbursement Claims; ERISA Basics National Institute

Apr 15 2026
American Bar Association Joint Committee on Employee Benefits’ ERISA Basics National Institute
Past

No Surprises Act Update: Regulatory and Litigation Developments, Ongoing Compliance Challenges for Stakeholders

Nov 13 2025
Barbri Webinar
Past

Okay, Maybe a Few Surprises: An Analysis of Activity Surrounding the No Surprises Act After Texas Medical

May 1 2025
16th Annual Advanced Forum on Managed Care Disputes and Litigation
Past

Defending ERISA Health Claims in State Court: Nuts, Bolts, and Developments in Out-Of-Network Provider Litigation

April 9, 2025
DRI 2025 Life, Health, Disability, and ERISA Seminar