Elizabeth Hutchins

Elizabeth focuses her practice on disputes between healthcare payors and providers. She has led a number of payor/provider disputes related to the reimbursement/payment of healthcare services, which involve analyzing high volumes of healthcare claims/billing data to quantify damages. She has worked on both defensive and affirmative matters involving in-network and out-of-network reimbursement, payment disputes, coding disputes, and pass-through billing matters.

Her work on these matters involves the following services:

• Analyze healthcare claims benefit adjudication data to understand the disputed claims set and provide the client with an understanding of the types of claims in dispute and identify claims not subject to the dispute.
• Perform complex data analyses on the full population of disputed claims, including profiling the claims and providing damages/exposure estimates.
• Develop statistical sampling plans/frameworks for cases that require a claim-specific review (e.g., medical coding reviews).
• Work with clinical team to perform medical claims review.
• Provide litigation consulting support, including damages/exposure modeling, data management / operational support, including preparation of claims data and document productions, requests for data from client/opposing parties, and other ad hoc data-related analyses to support legal team.
• Provide expert witness support and testimony in arbitration and trial settings.

Elizabeth’s professional experience includes the following:

• Contracted Rate Dispute Between a Government Administrative Contractor and a Class of Providers: Provided consulting and expert witness support in a contract dispute between a Medicare/Medicaid administrative contractor and a class of physician providers. Re-priced professional claims against applicable Medicare fee schedule to calculate damages, accounting for various reductions for claims not at-issue. Developed expert reports.
• Contracted Rate Dispute Between Healthcare Payor and Hospital System: Provided consulting and expert witness support on a contractual dispute in litigation over alleged improper application of contracted reimbursement rates for hospital Medicare Advantage claims. Designed a statistical sampling plan, performed in-depth claims review, including analysis of contract documentation and claims data from both payor and hospital system to identify legal defenses and assess financial exposure.
• Contracted Rate Dispute Between Healthcare Payor and Physician Group: Provided consulting and expert witness support on a contractual reimbursement and pass-through billing dispute in a $100 million dispute with 500,000 services at-issue between a large commercial payor and a provider of radiology services. Analyzed healthcare claims data, quantified damages, and developed expert reports.
• Out-of-Network (OON) Rate Disputes Between Healthcare Payor and Hospital System: Provided consulting and expert witness support in an OON dispute between a large commercial and Medicare Advantage plan in a $75 million dispute with a health system in a complex arbitration with seven populations at-issue, including affirmative and defensive claims. Designed a statistical sampling plan, developed analytical models to quantify fair market value for out-of-network claims, and contributed to the development of over 10 reports for two Ankura experts.
• OON Rate Disputes Between Healthcare Payor and Provider: Provided privileged consulting and expert witness support on a multimillion-dollar dispute between a large national commercial payor and an anesthesiology provider related to the reimbursement rate for professional services. Calculated damages based on fair market value using benchmark data produced by the parties and developed expert reports.
• OON Rate Dispute Between Healthcare Payor and Provider: Provided privileged consulting support on a more than $500 million dispute between a large commercial payor and a group of anesthesiology, radiology, emergency room, and hospitalist claims to assess whether claims were subject to a large national arbitration or subject to federal or state statutes under the No Surprises Act. Calculated exposure.

Outside of healthcare, Elizabeth has been involved with numerous disputes and investigation matters, including commercial litigation matters and consumer class actions, as well as forensic accounting matters, including revenue restatements and tax controversy matters.