Ted Tucci is cochair of the Health Law Group and is a partner in the Litigation Section, where he chairs the firm's Health and Benefits Litigation Practice. Mr. Tucci has extensive experience in the representation of managed care organizations, pharmaceutical companies, and life, health, and disability insurers. Mr. Tucci's experience includes defending class action claims arising out of drug formulary systems, Medicaid claims, physician networks, and market conduct claims. His practice also involves counseling and representing insurers, managed care organizations, and other corporate clients in connection with employee welfare and benefits matters. He has defended numerous claims against ERISA fiduciaries, plan administrators, and officers and directors seeking payment of health and related benefits. Mr. Tucci's experience in this area includes litigating health benefits claims involving medical necessity, custodial care, experimental treatment, and misrepresentation claims. Such claims frequently require the removal of state court actions to federal court and the disposal of state law claims of unfair trade and insurance practices. Mr. Tucci is also heavily involved in the area of the detection and prosecution of health care fraud and abuse claims. His background in this area includes matters relating to provider fraud and abuse, such as upcoding, unbundling of services, and overutilization. Mr. Tucci also has experience in counseling and representing health industry clients in risk management, administrative law, and staff privileges matters. His experience includes acting as counsel for both hospitals and hearing committees in bylaw administrative proceedings involving staff privileges, peer review, and physician discipline issues. He has litigated the leading cases in Connecticut on matters involving restriction or termination of medical staff privileges, medical education, provider deselection, and ERISA preemption. He also has appeared before Connecticut's Office of Health Care Access on certificate of need and other regulatory matters and before the Connecticut departments of Health and Social Services on regulatory enforcement issues and reimbursement matters. Mr. Tucci has been listed in The Best Lawyers in America® in the area of Health Care Law since 2006 (Copyright 2011 by Woodward/White, Inc., Aiken, SC). Mr. Tucci has also been named to the Connecticut Super Lawyers® list in the area of Health Care since 2006 (Super Lawyers is a registered trademark of Key Professional Media, Inc.). Professional Associations - The Association of Life Insurance Counsel - American Bar Association, Life and Disability Insurance and Health Law Committees - American Health Lawyers Association - Connecticut Bar Foundation, Fellow - Defense Research Institute, Life, Health, and Disability Committee, Connecticut Liaison - Connecticut Defense Lawyers Association - Connecticut Health Lawyers Association Honors and Awards - Listed in Connecticut Super Lawyers® in the area of Health Care Law since 2006 (Super Lawyers is a registered trademark of Key Professional Media, Inc.) - Listed in The Best Lawyers in America® in the area of Health Care Law since 2006 (Copyright 2011 by Woodward/White, Inc., Aiken, SC) Experience - Representation of an eye-surgery center in Massachusetts regarding the sale of interest in the center. Mediated with private mediator and settled favorably with one of partners buying plaintiff's interest. - Defense of a national actuarial services organization against contract claims arising out of the alleged failure to forecast plan funding requirements and cost of living adjustments. - Recently obtained an important victory in a class action against a major managed care organization (MCO). The case challenges the MCO's legal right to seek subrogation recoveries as part of its administration of the Medicaid managed care program. The MCO used a third-party subcontractor to seek subrogation recovery in cases where injured Medicaid enrollees obtained tort recoveries or settlements. Plaintiffs alleged that the MCO violated the Connecticut Anti-Subrogation Act because it did not have statutory authority to seek repayment directly from enrollees. The court held that, as assignee of the Department of Social Service's (DSS) statutory rights, the MCO was permitted to seek repayment directly from its members. Therefore, there was no legal impediment to the MCO seeking repayment directly from its members. This ruling resolved the central legal issue in the case in the MCO's favor and dealt a significant blow to plaintiff's remaining claims. - Represented professional liability insurer seeking to rescind policy issued to reinsurance company as a result of claims made against reinsurer for improperly calculating collateral requirements and wrongfully failing to release collateral, which claims were known to reinsurer at time of professional liability renewal policy application. Class Action - Defended Medicaid member class action involving allegations of due process violations against health maintenance organization. - Defended provider class alleged that managed care organization ("MCO") and independent physicians association ("IPA") had failed to apply withhold correctly over 3 year period. Class further claimed that MCO and IPA breached their agreement with providers over that period and that class members were owed payment of full, undiscounted charges. Claims involved potential monetary exposure in excess of $25 million. Before class certification, initiated mediation which spanned 5 sessions over 18 months. Successfully negotiated settlement with class and IPA that resolved all claims in return for non-monetary changes in provider relations policies administered by the MCO and supervised by the IPA. Settlement involved no payment of monetary relief to class. Claims against MCO released in return for alterations in the operations of the MCO and IPA as well as the provision of increased information to the class. Prepared settlement documents for submission to court for approval and obtained approval after initial rejection by the court. - Defended hospitals against consumer class action alleging that medical records billing policies and practices violated state regulatory law and unfair trade practice act. Represented a consortium of hospitals accused of overcharging patients and attorneys for copies of requested medical records. Plaintiffs claimed that hospitals violated state statutes governing medical records requests and engaged in unfair and deceptive conduct in the operation of the hospitals' business. Succeeded in limiting the size and scope of the class based on statute of limitations. Negotiated binding settlement on class that included prospective injunctive relief only. Monetary payment was limited to relatively modest contribution to local charity. - Defended hospital that belonged to multi-hospital trade association in federal class action brought by state office of protection and advocacy for disabled individuals. Plaintiff sought to certify a class of all deaf and hearing impaired citizens in the state. Complaint alleged violations of state constitutional law and federal civil rights arising out of hospital's alleged failure to provide reasonable means for deaf and hearing impaired patients to communicate with treatment providers. U.S. Department of Justice, Civil Rights Division, intervened as plaintiff in the case. Through mediation with federal magistrate, negotiated a consent decree for prospective relief. Avoided costly discovery and class certification proceedings. - Defended consumer class action against managed care organization ("MCO") alleging that MCO improperly sought subrogation recoveries for medical costs paid in personal injury actions. Plaintiffs sought to certify a class of thousands, including all insureds from whom MCO sought or may in the future seek reimbursement of medical costs. After extensive class certification hearings, succeeded in limiting size of class certified to under 200 members. Claims were settled through private mediation on a favorable basis and approved through fairness hearing process to bind the class. - Defended Health Net of Connecticut against a class action lawsuit filed by three participating podiatrists and a podiatric medical association in Connecticut Superior Court. Plaintiffs alleged that the client violated the state unfair trade practices and unfair insurance practices statutes by unfairly discriminating against podiatrists by paying them a lower reimbursement rate than medical doctors for performance of the same foot and ankle related services. Robinson & Cole argued that Connecticut's unfair trade practices and unfair insurance practices statutes did not prohibit insurers from treating different types of health care providers differently, that podiatrists and medical doctors were not similarly situated such that they were required to be paid the same, and that recognizing these differences was not discriminatory. After extensive discovery, court granted Robinson & Cole's motion for summary judgment, holding that the state unfair insurance practices act was not intended to be an equal pay or pay parity statute and that reimbursing podiatrists and medical doctors at different rates for the same services does not constitute unfair discrimination. ERISA and Health and Benefits Insurance - Representation of Health Net against a medical doctor who has filed dozens of cases against Health Net over the past decade. Won summary judgment on breach of contract and unjust enrichment claims asserted by the nonparticipating provider on the grounds that he failed to comply with requirements for timely submission of claims. Preserved victory on appeal by persuading appellate court to affirm. - Defended disability insurer in an ERISA disability benefits claim in which the record contained surveillance evidence of the claimant's functional capacity. Obtained summary judgment where court held that insured had substantial evidence to terminate disability benefits where burden to provide evidence was on plaintiff, there was lack of medical information, and doctor failed to address contradiction between plaintiff's activities and her disability. - Defended leading disability income insurer in a case involving subjective disability claim. Obtained summary judgment on all counts for defendant based upon the "arbitrary and capricious" standard of review. In granting defendant's motion for summary judgment, the Court noted that the policy did not contain the discretion and deference language that typically triggers application of the arbitrary and capricious standard. Nonetheless, the Court was persuaded that the terms of the policy read together as a whole created the "functional equivalent of discretionary authority." - Represented health insurer acting as third-party administrator in a claim for mental health benefits. Successfully obtained summary judgment on behalf of health insurer by demonstrating that insurer was not a plan administrator and did not act as a fiduciary to the plaintiff, and thus was not a proper defendant in the plaintiff's ERISA action. - Represented aerospace manufacturer in a claim for disability benefits under the employee retirement plan. Convinced the Court that even though not expressly stated, pursuant to the only plausible interpretation of the Summary Plan Description, an employee was not entitled to receive benefits for a claim based on a disability that developed years after this employment ended. - Robinson & Cole defended a manufacturer in a case brought by 11 retired employees who claimed that employer's termination of their health benefit coverage violated ERISA because such benefits were contractually vested. Robinson & Cole avoided all deposition discovery by persuading plaintiff's counsel to engage in a voluntary document exchange. Based on such informal discovery, we then moved for summary judgment on all of plaintiffs' subsequent claims. The court granted the motion for summary judgment, which resulted in significant litigation cost savings for employer and eliminated potential liability to hundreds of other retirees. Health Law - Represent various hospitals as counsel for medical executive committee seeking to impose corrective action, suspension, reduction of medical staff privileges, or other peer review disciplinary action on practitioners. Representation includes medical staff bylaw compliance, administrative hearings, and negotiation of agreed settlements. - Represent various medical executive hearing and appellate review committees in peer review and practitioner disciplinary proceedings. Representation includes advice and counseling on hearing process and protocol issues, and legal guidance on the hearing deliberation process. - Represented hospital in claim of wrongful failure to certify resident's successful completion of surgical residency program. Defended case successfully through trial and on appeal, obtaining ruling from Connecticut Supreme Court, establishing discretion of hospital to make professional competence determinations, and rejecting claim of educational malpractice. - Represent hospitals and health care clients in regulatory and administrative proceedings before Connecticut Department of Public Health, Office of Healthcare Access and Office of Inspector General. Experience includes representation in certificate of need hearings, Medicare and Medicaid audits and fraud and abuse investigations. - Representation of Health Net of the Northeast, Inc., in negotiating novel settlement arrangement that included corrective action plan and contingent payment in response to enforcement action by Connecticut attorney general under the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act for alleged breach of protected health and financial information of members of health plan. Managed Care and Health Insurance - Representation of Health Net in negotiating favorable monetary settlement against unfair and deceptive trade practices brought by eight-person physician group arising from health plan's administration of bonus payment "pay for performance" program. Plaintiffs alleged that bonus program deceptively claimed to reward quality medical care but instead drove physicians to deliver cheaper care. - Representation of HIP Health Plan of New York in private realtor qui tam action brought by several hospitals alleging that managed care insurers violated New York's health care reform law by failing to pay the state the appropriate surcharge amount on payments made to hospitals for member services. Defendants moved to dismiss the complaint in its entirety based on plaintiff's failure to adequately plead a false claims act claim and a violation of the surcharge statute. Motion to dismiss was granted. - Representation of a publicly traded workers' compensation insurer as a plaintiff in an arbitration involving claims that a repricing error by a managed care network preferred provider organization (PPO) caused our client to overpay Texas medical providers by more than $3 million. Robinson & Cole negotiated a settlement prior to arbitration through which the client received 100 percent of its compensatory damages. - Representation as outside counsel for health insurer concerning its administration of the Connecticut Medicaid program, including matters relating to provider reimbursement and compliance with Connecticut's Freedom of Information Act requirements, an area in which Robinson & Cole litigated the leading cases involving Medicaid managed care organizations. - Appealed before Connecticut Supreme Court an issue of first-impression regarding reasonableness of utilization review criteria used to make medical necessity decisions for Medicaid recipients in the early prevention, screening, diagnosis and treatment (EPSDT) program. - Representation as Health Net of the Northeast's lead litigation and regulatory counsel when Health Net administered the Connecticut Medicaid program. As regulatory counsel, advised Health Net regarding its legal obligations to the Medicaid state agency and represented the client in numerous administrative matters. - Provide regulatory and risk management counseling to administrators of special needs plans for dually eligible Medicare/Medicaid enrollees. Publications & Presentations Articles - "A Guide to Connecticut's Certificate-of-Need Process," coauthored with Brian D. Nichols (June/July 2008), published in Connecticut Medicine Magazine - "A Discussion about Alternative Dispute Resolution in the Healthcare Field" (April, 2006), published in Connecticut Lawyer - "Forget About the Health Insurance Fraud Act?: An underutilized weapon in the fight against insurance fraud" (June 17, 2002), published in Connecticut Law Tribune Legal Update/Newsletters - ERISA Litigation Update, coauthored with Michael J. Kolosky (2/2003), Second Circuit Erodes ERISA Preemption - Life Insurance Litigation Update (2/2003), Court Rejects Annuity Class Action Presentations - "ACO Liability and Risk Management Issues: The Managed Care Perspective," copresented with Michael J. Kolosky, Jean E. Tomasco (5/2011), webinar - "Legal and Strategic Considerations in Defending Medicaid Audits," copresented with Michael J. Kolosky (4/27/2011) at Connecticut Community Providers Association - "Navigating Department of Social Services Financial Audits," copresented with Michael J. Kolosky (11/19/2010) at Connecticut Hospital Association - "Forecasting 2003: ERISA Fiduciary Risk Management Strategies" (Fall 2002) - "Municipal Regulation of Group Homes for Recovering Substance Abusers" (2/2001) presented at Connecticut Bar Association's Zoning Section - "State Regulation of Physician Offices as Surgical Facilities" (11/2000) presented at Connecticut Health Lawyers Association - "Connecticut Regulation of Medical Record Confidentiality and Patient Privacy" (1999), presented to management of health care industry client - "Antitrust Compliance in Provider Network Formation in Managed Care" (1997), presented to management of health care industry client News 6.08.11, Robinson & Cole Attorneys Present Webinar on Accountable Care Organizations (ACOs) 5.05.11, Robinson & Cole Attorneys Present Medicaid Audit Defense Seminar 12.15.10, Health and Benefits Litigators Win "Appropriate Care" Disability Insurance Case 12.06.10, Health Care Attorneys Talk Strategy with Hospitals |