Litigation Support & Policy Analysis (LSPA)

Litigation Support & Policy Analysis

We bring rigorous experience in health economics methodology to the complexities of health care litigation and policy analysis. Led by Director Cara Scheibling and CEO John Schneider, PhD, our in-house experts and consultants have extensive knowledge and experience providing health economics analysis, epidemiology, and marketing and analytics advice and testimony in support of a wide range of healthcare litigation and policy applications. We are extremely knowledgeable in data sources, health insurance claims, and patient medical records.

Our expansive knowledge and experience in HEOR analytics, statistical analyses of data, syntheses of medical and economic literature, and simulation modelling add value to our litigation work. Our specific areas of expertise are listed below, and include substantial depth in a wide range of litigation, regulatory, and policy areas.

Focus: Reasonable Value

In health-related litigation, it is often necessary to determine “reasonable value,” which is akin to “fair market value” in economics and, unlike list prices, is not distorted by mark-ups and discounts. Watch our video to learn how we apply this in cases:

Areas of experience and expertise include:

  • Review and analysis of past medical claims & bills to determine reasonable & fair market value.
  • Review and analysis of future care and life care plans to determine reasonable & fair market value.
  • Analysis of health insurance claims data in contract disputes and damages calculations.
  • Advanced data analytics and simulation modelling to calculate damages related to claims denial, withheld payments, contract disputes, and contract breach.
  • Economic analysis and economic impact of regulatory policies
  • Economic analysis for cases related to antirust and trademark infringement.
  • Survey research to support policy analysis.
  • Economic analysis of damages in cases related to contract breach, reputational harm, lost revenue, and delay to market.
  • Forensic economics to support a variety of litigation matters.

Examples of LSPA Engagements

  • Calculating reasonable fair market value of medical care expenses on past medical bills and life care plans
  • Using benchmarking data and cost structure data to determine reasonable value in contract disputes
  • Assessment of rationality of health care business arrangements
  • Calculation of economic losses in health-related antitrust, trademark, and reputational harm cases
  • Building statistical models to calculate actual versus expected rates of utilization, disease incidence, etc.

Related Posts

  • Count the cost of disability caused by COVID-19
    June 8, 2021
    Count the Cost of Disability Caused by COVID-19
    Focusing only on cases and deaths hides the pandemic’s lasting health burden on people, societies and economies. The COVID-19 pandemic is well into its second year, but countries are only beginning to...
    CONTINUE READING...
  • Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities
    July 1, 2020
    Online Simulation Model to Estimate the Total Cost...
    Tobacco product waste (TPW) is one of the most ubiquitous forms of litter, accumulating in large amounts on streets, highways, sidewalks, beaches, parks, and other public places, and flowing into stor...
    CONTINUE READING...
  • Telehealth and Telemedicine in the Post-Pandemic Era
    June 18, 2020
    Telehealth and Telemedicine in the Post-Pandemic E...
    In many ways the arrival of the COVID-19 pandemic globally was met with sub-optimal levels of preparedness on the part of health care providers and provider systems, such as integrated delivery networ...
    CONTINUE READING...
  • Estimating QALY Losses Associates With Deaths in Hospital (COVID-19)
    May 15, 2020
    Moving Beyond 'Lives-Saved' From COVID-19
    This blog covers the presentation given as part of the ISPOR pre-conference plenary session on HEOR in the era of COVID-19 which was held on 14 May 2020.
    CONTINUE READING...
  • Economic Cycles and Product Development in Life Sciences
    May 11, 2020
    Economic Cycles and Product Development in Life Sc...
    Economic Cycles and Product Development in Life Sciences May 11, 2020 By John Schneider, PhD and Mirela Sima, MD, MBA The humanistic and economic consequences of the 2020 COVID-19 pandemic wi...
    CONTINUE READING...
  • Electronic Medical Records: Potential Issues in Litigation and Biomedical Research
    April 27, 2020
    Electronic Medical Records: Potential Issues in Li...
    In this blog entry we explore some of the potentially important issues surrounding the role of EMRs in litigation, where the discovery of medical documents and records increasing involves digitally st...
    CONTINUE READING...
  • COVID-19: Update on Epidemiology & Costs
    April 14, 2020
    COVID-19: Update on Epidemiology & Costs
    We define epidemiology broadly, including an up-to-date review of the key published medical literature on COVID-19. Following that, our discussion of costs focuses in part on the direct medical costs ...
    CONTINUE READING...
  •
    March 13, 2020
    The Coronavirus: How Bad is it, Really?
    By: The Avalon Health Economics Team March 13, 2020 Within a few months we’ve gone from worrying about holiday shopping to worrying about global pandemics and watching the world shut down ar...
    CONTINUE READING...
  •
    February 10, 2020
    What is the Reasonable Value of Future Medical Car...
    Cara Scheibling and John Schneider, PhD February 7, 2020 A common challenge in economics and business is determining the fair-market value of products and services that have not yet “e...
    CONTINUE READING...
  •
    June 19, 2019
    Healthcare Use Cases for Blockchain Technology
    This blog was written by John Schneider, PhD, Katherine Dick, Cara Scheibling Recently, the crypto-currency company Bitcoin has been in the news, mainly for its combination of volatility in valuation...
    CONTINUE READING...
  •
    December 6, 2016
    Will an Unravelling of the Affordable Care Act Res...
    In recent years, there has been a shift in U.S. health care markets to a broader, population-based perspective when assessing the costs and benefits of medical innovation. Cost effectiveness analysis ...
    CONTINUE READING...
  •
    September 14, 2015
    Physician Shortages in the U.S.: Disentangling Myt...
    Much of the public media and even a substantial part of the medical literature operates on the assumption that there is a shortage of physicians in the U.S., including those specializing in primary ca...
    CONTINUE READING...
  •
    August 13, 2015
    Fad Diets and Nutrition: What’s all the Fuss about...
    In recent years, the food industry has seen a boom in the “free from” category, including a myriad of ingredients such as high fructose corn syrup, artificial flavors, toxic pesticides, artificial hor...
    CONTINUE READING...
  •
    May 12, 2015
    The New Era of Cost Control in Healthcare: What Sh...
    In recent years, there has been a small but measurable slowdown in the rate of increase in health expenditures, both here in the U.S. and abroad. The slowdown is largely attributable to a higher lev...
    CONTINUE READING...
  •
    December 31, 2014
    How Should Health Care Providers Measure and Marke...
    There was a time when we did not spend a lot of time worrying about the quality of the health care services we received. Our families went to the doctor who was known as a “good doctor” and we receive...
    CONTINUE READING...
  •
    November 24, 2014
    The Long Reach of a Devastating Virus
    As a follow-up to our previous blog (October 2014), we are revisiting the topic of Ebola because this public health crisis has drawn attention to two very important public health issues: (1) the eve...
    CONTINUE READING...
  •
    October 28, 2014
    Health Care Reform in Sub-Saharan Africa
    The recent Ebola epidemic in Africa has served as a reminder of the vulnerability of public health systems in handling unexpected health problems, especially when basic access to care and day-to-day h...
    CONTINUE READING...
  •
    September 5, 2014
    Environmental Health Update: Ending our Love Affai...
    For over 50 years, the food industry has used Expanded Polystyrene (EPS) food service products for a variety of food and beverage service needs. EPS, commonly known as Styrofoam, is cheap and durable,...
    CONTINUE READING...
  •
    August 25, 2014
    What are the Health Consequences of Psychiatric Ho...
    Over the past 50 years, 95% of the country’s state psychiatric hospital population have been closed down, leaving fewer than 200 hospitals to provide care to those living with mental illnesses (Fisher...
    CONTINUE READING...
  •
    August 18, 2014
    The Costs of Antibiotic Resistance and the Need fo...
    After suffering from a nasty cold for more than a few days, many of us think about checking in with our doctor just to be sure that it’s not something worse. The result on those visits is, all too oft...
    CONTINUE READING...
  •
    August 18, 2014
    Return-on-Investment of Workplace Health Promotion...
    Recent healthcare reforms in the U.S. and abroad have emphasized the value of meaningful and effective preventative care and health promotion. Corporations are taking note, and, as a result, there has...
    CONTINUE READING...
  •
    July 7, 2014
    E-Cigarettes and Tobacco Policy
    1. What is an E-Cig? The “e-cig” is an electronic cigarette that is used to simulate the experience of smoking that has a cartridge with a heater that vaporizes liquid nicotine instead of burning tob...
    CONTINUE READING...
  •
    July 6, 2014
    Nutrition Policy & Food Labeling in the U.S.: A Re...
    The Organic and natural food industry has boomed in the last few decades, moving from a small niche market to a $30 billion dollar industry. Across the United States, people are growing more concerned...
    CONTINUE READING...
  •
    February 6, 2014
    Current Topics in Public Health: Heroin’s Revival...
    Heroin has a new face. According to statistics from the National Institute on Drug Abuse, it’s a white male in his 30s and 40s. Surprisingly, heroin use has grown in recent years, sounding alarms amon...
    CONTINUE READING...
  •
    January 15, 2014
    Value-Based Purchasing for Hospital Services in th...
    The Center for Medicare and Medicaid Services (CMS) Value-Based Purchasing (VBP) program is an incentive-based repayment plan linked to the quality of care hospitals provide to Medicare patients. With...
    CONTINUE READING...
  •
    December 2, 2013
    Reshaping the Clinical Laboratory in the Era of Pa...
    In recent years there has been renewed attention devoted to coordination of medical care services across the continuum of care, particularly in the area of prevention, monitoring, diagnostics, and dis...
    CONTINUE READING...
  •
    October 22, 2013
    How Big a Problem is Health Care Fraud and Abuse, ...
    According to the National Health Care Anti-Fraud Association (NHCAA) and the Blue Cross and Blue Shield Association, the estimated annual costs of health care fraud in the U.S. are more than $70 billi...
    CONTINUE READING...
  •
    August 2, 2013
    U.S. Health Care Costs: Disentangling Underlying T...
    During the health reform discussions leading up to the passage of the Affordable Care Act (“ACA”), there was a lot of talk about the costs of health care services in the U.S. Some argued that the legi...
    CONTINUE READING...
  •
    July 20, 2013
    Women and the Affordable Care Act
    Women make about 80% of the health-care decisions for their families, utilize more health care than men, and are the more likely to be the care givers when a family member becomes sick. Females of all...
    CONTINUE READING...
  •
    June 20, 2013
    Health Care Costs and Value: An International Pers...
    During the recent debates over the Affordable Care Act (“ACA,” or Obamacare) a commonly raised issue was that U.S. health care does not offer much in the way of “value for money.” The argument, genera...
    CONTINUE READING...
  •
    June 18, 2013
    Tobacco Butts and Litter Costs
    Tobacco product litter is one of the most ubiquitous forms of litter, accumulating in increasingly large numbers on streets, highways, sidewalks, beaches, storm water drains, waste treatment plants, p...
    CONTINUE READING...
  •
    June 18, 2013
    Training the Health Economics and Outcomes Researc...
    The health care landscape in the U.S. has been changing rapidly in the past 20 years, a phase of evolution that began with the reluctance of private employers to continue to fund double-digit growth i...
    CONTINUE READING...
  •
    March 21, 2013
    The Declining Health of the Local Market: When and...
    A large proportion of our nation’s health care infrastructure is located in urban markets with declining population. For example, according to the U.S. Census, cities with the largest population decli...
    CONTINUE READING...
  •
    March 21, 2013
    Nobody Pays Retail: A Primer on Valuing Medical Ca...
    In most markets and in most industries, the prices paid by consumers (or businesses, in the case of business-to-business transactions), are not randomly made up by sellers. To be sure, in less competi...
    CONTINUE READING...
  •
    March 21, 2013
    Using Publicly-Available Health Care Databases to ...
    In the United States, a variety of “usual, customary and reasonable” (UCR) databases are used by health care entities to benchmark their fees (in the case of health care providers) and to create prosp...
    CONTINUE READING...

Recent Publications

Count the cost of disability caused by COVID-19. 2021

Estimating (quality-adjusted) life-year losses associated with deaths: With application to COVID-19. 2021

Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities. 2020

Enhancing Health Through Access to Nature: How Effective are Interventions in Woodlands in Deprived Urban Communities? A Quasi-experimental Study in Scotland, UK. 2019

The Economics of Reasonable Value and the Valuation of Medical Losses. 2019

What is the Reasonable Value of Future Medical Care? 2019

Evaluation of Health in Pregnancy grants in Scotland: a natural experiment using routine data. 2017

Assessing the impact of state “opt-out” policy on access to and costs of surgeries and other procedures requiring anesthesia services. 2017

Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida. 2017

Are financial incentives cost-effective to support smoking cessation during pregnancy? 2016

Cost impact of unexpected disposition after orthopedic ambulatory surgery associated with category of anesthesia provider. 2016

In-office magnetic resonance imaging (MRI) equipment ownership and MRI volume among medicare patients in orthopedic practices. 2015

The progressivity of health-care financing in Kenya. 2014

Organizational boundaries of medical practice: the case of physician ownership of ancillary services. 2012

Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs. 2011

Effects of health savings account-eligible plans on utilization and expenditures. 2011

Outcome measurement in economic evaluations of public health interventions: a role for the capability approach? 2010

International comparison of comparative effectiveness research in five jurisdictions: insights for the US. 2010

Converting to critical access status: how does it affect rural hospitals’ financial performance? 2009

Factors associated with Iowa rural hospitals’ decision to convert to critical access hospital status. 2008

The economics of specialty hospitals. 2008

Effects of specialty hospitals on the financial performance of general hospitals, 1997-2004. 2007

Effect of critical access hospital conversion on patient safety. 2007

Clinical practice guidelines and organizational adaptation: a framework for analyzing economic effects. 2006

Implementation of hospital computerized physician order entry systems in a rural state: feasibility and financial impact. 2005

What would be the effect of referral to high-volume hospitals in a largely rural state? 2004

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