Carol B. Lewis
Senior Counsel
Senior Counsel
Areas of Focus
Overview
Carol is an experienced litigator in Crowell & Moring’s Health Care Group. She has represented and counseled clients in the managed health care industry, as well as clients in the life and disability insurance industries, for more than 30 years. Carol’s experience in managed health care litigation includes provider-payor litigation (e.g., contractual reimbursement disputes and out-of-network “usual, customary, and reasonable” litigation), bad-faith litigation, member direct-pay litigation, and ERISA litigation and class actions. She also has extensive experience in multiparty litigation involving fraud, unfair competition, and related business torts.
Career & Education
- Loyola Law School, Los Angeles, J.D., 1987
- University of Rochester, B.A., 1984
- California
- U.S. District Court for the Central District of California
- U.S. District Court for the Southern District of California
- U.S. District Court for the Northern District of California
- U.S. District Court for the Eastern District of California
Professional Activities and Memberships
- Member, American Bar Association
- Member, California Bar Association
- Member, Los Angeles County Bar Association
Representative Matters
- Successfully defended a health plan in the Southern District of California in an action brought by a major hospital seeking reimbursement of millions of dollars for alleged emergency services and care rendered to a single patient. Obtained judgment as a matter of law following closing arguments to the jury.
- Successfully brought personal jurisdiction challenges on behalf of an out-of-state health plan in multiple lawsuits brought by California-based providers seeking reimbursement for medical care provided to health plan members.
- Obtained complete dismissals in state and federal court on behalf of California and out-of-state health plans in complex provider and member lawsuits asserting ERISA, breach of contract, bad faith fraud, and unfair competition claims arising from the denial or alleged underpayment of benefits and related issues.
- Defended multiple health plans in six related cases in the Southern District of California brought by a substance abuse treatment provider alleging underpayment of UCR. Obtained dismissals of seven of the nine claims for relief alleged in the pleadings in each of the related cases, substantially narrowing their scope.
- Defended over three dozen health plans and self-funded employee benefit plans in a mass-pled federal court case brought by out-of-network substance abuse treatment providers alleging ERISA and unfair competition claims based on the alleged failure to honor assignments of benefits. Secured dismissals of claims against multiple clients based on the plans’ valid anti-assignment provisions.
- Defended health care plans in hundreds of member and provider lawsuits and arbitrations alleging ERISA violations, breach of contract, bad faith, unfair competition, and other tort claims based on alleged inadequate reimbursement and/or denial of benefits.
- Defended health plans in dozens of UCR lawsuits brought by out-of-network providers.
- Defeated application for TRO brought by ERISA plan participant against health plan arising from the denial of continued residential treatment center benefits.
- Obtained judgment after ERISA bench trial for health plan in a dispute brought by an acute psychiatric facility following the denial of continued residential treatment benefits.
- Defended health plan in putative class action alleging improper denial of plan benefits for excess skin removal following weight loss.
