Plaintiffs allege that a dominant healthcare provider engaged in anticompetitive conduct to restrain trade, foreclose competition, and exercise market power to obtain supracompetitive reimbursement rates from commercial health plans. The alleged conduct resulted in overcharges to health plans contracting through third‑party network vendors, which were ultimately borne by individuals and employers through higher insurance premiums and in‑network payment obligations. Vega Economic’s was retained by plaintiff’s counsel to support two experts in the matter.
The first expert, a health economist, was retained to evaluate whether commercial payers experienced supracompetitive pricing as a result of the challenged conduct and, if so, to estimate the magnitude of those overcharges. The engagement also included assessing whether the alleged conduct caused common economic harm across affected payers and insured members, evaluating the existence of a classwide methodology for measuring pass‑through of overcharges, and, where appropriate, quantifying pass‑through rates and resulting damages.
The second expert, a health care actuary, was retained to opine on actuarial standards and regulatory requirements for health plan rate setting and premium development; the health care premium and rate setting process, including the relationship of historical health care costs to premium rates; the process of developing premium equivalents for self-funded employers; and the impact of health care costs on premium rates and premium equivalents.