What is Health and Welfare Monitoring?
Chimicles & Tikellis (“C&T”) protects our institutional clients’ health and welfare fund assets against fraud and other wrongdoing through monitoring services and health and welfare litigation. At no cost to the client, C&T utilizes various resources and information systems to monitor the health & welfare fund’s drug purchases, Pharmacy Benefit Managers (PBMs) and other health service providers.In addition, C&T investigates potential claims and monitors pending litigation impacting health & welfare funds, providing periodic reports to its institutional clients concerning these matters.
What types of legal claims may be discovered as a result of monitoring?
After full consultation with the client, C&T will, on a fully-contingent basis, pursue legal action for the client on meritorious claims involving the clients’ health & welfare funds. Legal action by the welfare funds could include:
- Health care fraud actions by welfare funds to recover excessive charges due to misconduct by health service providers, Pharmacy Benefit Managers (PBMs), hospitals and other health care entities;
- Antitrust claims to recover excessive prescription drug charges and other costs due to anticompetitive conduct, price fixing, tying agreements, illegal patents, and other misconduct; and
- Cost-recovery claims where welfare funds have paid for health care treatment resulting from defective or dangerous drugs or medical devices.
How have clients benefited from monitoring and the resulting litigation?
For example, in Baycol, an action initiated in connection with the recall of the cholesterol drug Baycol, C&T represents various Health and Welfare Funds (including the Philadelphia Firefighters Union Local 22 Health and Welfare Fund, American Federation of State, County and Municipal Employees District Council 47 Health and Welfare Fund, National Conference of Fireman and Oilers Local 1201 Health and Welfare Fund) and a proposed national class of “third party payors” seeking damages for the sums paid to purchase Baycol for their members and to pay for the costs of switching their members from Baycol to an appropriate cholesterol-lowering drug. The Philadelphia County Court of Common Pleas certified a national class, and the parties recently reached a settlement in which Bayer agreed to pay class members a net recovery that approximates the maximum damages (including pre-judgment interest) suffered by class members.
Further, as counsel in major litigation over anticompetitive conduct by the makers of brand-name prescription drugs, C&T has helped clients to recover significant amounts of price overcharges for widely-prescribed drugs such as BuSpar, Coumadin, Cardizem, Relafen, and Paxil.