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A Primer on Health Care Administrative Claims Data and Its Use in Litigation

  • October 30, 2020
  • Lisa J. Cameron , Brattle Group , Boston, MA
  • Sohini Mahapatra , Brattle Group , Boston, MA

Abstract

Health care administrative claims datasets can play an important role in many litigation contexts. Currently, these large and complex datasets are being used to address key questions arising in government investigations, antitrust cases, disputes over health care company valuations, and merger analyses. Moreover, we can expect these datasets to figure prominently in upcoming COVID-19 litigation. While several articles discuss litigation-related uses of these datasets, they uniformly assume that readers already have a strong understanding of the information that these datasets contain. In contrast, this article provides the reader with a primer on the health care administrative claims datasets that are most frequently used in litigation. We explain how these datasets are generated and summarize the information that they contain. We also describe how these rich but complex datasets are used to assess liability and/or damages in a variety of litigation contexts.

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