The Vega team and experts regularly work on complex matters involving the healthcare sector and our team has provided economic analyses in both litigation and regulatory investigations. We have experience applying economic theory and econometric modelling to both healthcare markets and healthcare policy topics. Our experts’ knowledge spans multiple industries and specializations, including the intersections of health economics and insurance, and health economics and policy.

Vega and members of its network have extensive experience working with large healthcare datasets, both those that are publicly available and those that have been produced during litigation. Vega regularly analyzes databases containing hundreds of billions of medical records and has state-of-the-art and secure computing facilities to process and manage sensitive healthcare data.

Example Engagements

  • BCBS Antitrust Case: A Vega expert was retained to provide an educational presentation to the Alabama Court regarding the key economic issues in the In Re Blue Cross Blue Shield Antitrust Litigation (N.D. Ala. MDL No. 2406). This class action was brought by providers and subscribers to enjoin an alleged ongoing conspiracy to allocate health insurance markets. The expert’s presentation included data visualizations that addressed key issues of the case, including an overview of the Alabama health insurance market, defendants’ market share, and financial statistics. 

  • Health Insurance Pricing Models: Vega supported an expert who performed an analysis using terabytes of sensitive medical data to investigate and recreate health insurance pricing models.

  • Discovery Strategy: Vega was the designated consulting firm to receive and verify data produced by a large group of insurance companies. Our team assisted counsel by bridging the gap between the data produced in discovery and the expert analysis, ensuring the data was sufficient for the expert analysis anticipated in subsequent phases of the litigation.

  • Provider and Payor Reimbursement Disputes: In a case related to billing disputes, a Vega expert was retained by a physician group to evaluate claims made by a healthcare insurance provider regarding the physician group’s unnecessary treatment and upcoding. After revising the damages calculation based on the expert’s criticism, the insurance provider reduced its damages claim by more than 75%. 

  • Statistical Sampling Strategies in Billing Dispute: A Vega expert created potential sampling strategies for a case related to billing disputes, allowing extrapolation of chart review results from the sample to assess liability and damages issues.

  • Impact Analysis of Healthcare Policy: Vega was retained to evaluate the economic impact of a major healthcare policy change at the national level. The engagement involved performing an impact analysis from a health economics perspective to quantify the expected damages or benefits from the new policy.

  • Claims Data Analysis: In Aetna Inc. et al. v. Mednax Inc. et al. (E.D. Penn. No. 2:18-cv-0221), Vega was retained by defendants to review millions of claim records made available through discovery, identify data fields necessary to evaluate the disputes, and determine whether the produced data is sufficient to replicate the complaint’s analysis. Based on Vega’s analysis, the client was able to obtain additional information about how the insurance company extracted and selected data from various internal systems, which were previously undisclosed. 

  • Billing Dispute Related to Laboratory Testing: Vega sourced and supported an expert in a matter related to billing for laboratory drug testing services. The engagement involved analyzing the disputed payments and determining whether the funds could be traced if they passed through comingled accounts.

Experts

Farasat Bokhari

Senior Lecturer (Associate Professor) in the School of Economics and Centre for Competition Policy at the University of East Anglia

  • Antitrust & Competition
  • Insurance & Risk
  • Healthcare & Health Economics
Ethan Cohen-Cole

Senior Advisor at Vega Economics

  • Data Science & Statistics
  • Securities & Finance
  • Healthcare & Health Economics
  • Valuation
  • Consumer Finance
  • Financial Institutions
Gabriel Picone

Professor in the Department of Economics at University of South Florida

  • Healthcare & Health Economics
Jon M. Riddle

Principal and Senior Economist at ECONOMIC ASSOCIATES

  • Antitrust & Competition
  • Healthcare & Health Economics
  • Valuation
Kosuke Uetake

Assistant Professor in the Yale University School of Management

  • Antitrust & Competition
  • Healthcare & Health Economics
  • Marketing