Michael Furey was quoted in an article, "Confidential Documents Suggest Horizon Misled Public on how it Picked Hospitals for OMNIA Program," which was published in The Star-Ledger and on NJ.com. The article discusses confidential reports and related documents that have been obtained in connection with a lawsuit brought by three New Jersey-based hospitals alleging Horizon Blue Cross Blue Shield of New Jersey breached its obligations by limiting its selection of Tier 1 hospitals to the largest hospital systems. In June 2018, the Supreme Court of New Jersey affirmed an order granted by the trial court in response to a motion filed by Advance Local Media LLC, which intervened in the lawsuit, to obtain these confidential materials. The plaintiff hospitals submitted a brief in support of Advance Local Media's application.
According to the article, the confidential materials suggest that Horizon invited two of the largest and most expensive hospital systems to join the exclusive OMNIA network—even before Horizon hired a consultant, McKinsey & Co., to evaluate hospital quality and cost. "They had already decided they wanted Barnabas and Hackensack to be the partner hospitals. They told the Legislature and the public they selected the best hospitals in the state who provided the lowest cost care, and they said they did it on the basis of what McKinsey told them," said Furey, who represents the three plaintiff hospitals, Centrastate Medical Center, Holy Name Medical Center and Valley Hospital. "But we uncovered they were already having these discussions in 2013 and early 2014 before they began the selection process," he continued.
The article also reports that Horizon and McKinsey developed six criteria, each weighted differently, to select Horizon's preferred hospital partners. Leadership and quality each account for 25 percent of the score – a fact, Horizon officials have argued in legal documents, that demonstrates its commitment to choosing the best partners. Quality measures earned more weight in later versions of McKinsey's report. Furey contended that other categories benefit larger hospitals and hospital chains. Services "across the care continuum" reward hospital chains, because what one hospital may lack in specialty or outpatient care can be complemented by another in the same system, he said. "Consumer attractiveness" favors the big-name institutions that can afford to wage aggressive marketing campaigns. In addition, the article cites, based on the confidential materials, that cost was ultimately not considered in selecting Tier 1 hospitals. Horizon officials, according to court records, said they did not judge hospitals based on what they charge now because OMNIA intends to create a "value-based" payment model, which rewards hospitals for keeping people well. However, Furey said Horizon is still paying hospitals the old-fashioned way, so cost should matter.
Judge Christopher Droney (ret.) authored the article, "Tips for Effective Appellate Arguments," for the "Expert Opinion" column of the Connecticut Law Tribune.
Day Pitney Alert
Partners Kevin J. Duffy and Richard H. Brown authored the article, "Shouting FIRE! (or Worse) on Social Media: The Interplay of the First Amendment and Government Involvement in Efforts to Limit or Remove Social Media Content," which was published in the Intellectual Property & Technology Law Journal.
On March 19, Partner and General Counsel Elizabeth J. Sher presented a webinar, "A Delicate Balance: Conflicts, Waivers and Consents," for NITA's studio71.
Judge Christopher Droney (ret.) and Matthew Austin co-authored the article, "The Investigation and Enforcement Landscape Under the Garland Department of Justice," for the New York Law Journal.
Of Counsel Alan G. Greer is a recipient of the 2021-2022 Albert Nelson Marquis Lifetime Achievement Award.
Judge Christopher F. Droney (ret.) authored the article, "Strategy Moving Forward: Post COVID-19 Advice for Mediations," for the "Expert Opinion" column of the Connecticut Law Tribune.
The American Law Institute has elected 41 new members, including Day Pitney Partner Christopher F. Droney, who will bring their experience to ALI's work of clarifying the law through restatements, principles and model codes.
Day Pitney Partner and General Counsel Beth Sher was featured by Law360 Pulse in a Q&A article discussing her new position as President of the Association of the Federal Bar of New Jersey.
Day Pitney Counsel Steven A. Cash was quoted by The Hill, discussing how on the recent release of documents and new investigations into the Trump administration by the Department of Justice, the Justice Department's Office of Inspector General and Congress could potentially pose a challenge for the Biden administration.