Mohr v. Oxford Health Insurance, Inc.

Plaintiffs are suing Oxford Health Insurance, Inc. and OptumRx, Inc., in the Southern District of New York, on behalf of a class of patients who purchased prescription drugs pursuant to an Oxford plan, alleging that Oxford and Optum engaged in a fraudulent and deceptive scheme to artificially inflate the prices of prescription drugs. Specifically, under the relevant health plans, the cost shares (copayments, coinsurance, and deductible payments) paid by patients should be based on the amount actually paid to pharmacies. Oxford and Optum are alleged to have secretly calculated cost shares using an inflated price causing patients to overpay and, in many instances, pay more than the pharmacies were actually paid. Plaintiffs allege that Defendants’ conduct violates the Employee Retirement Income Security Act of 1974 (ERISA) and the Racketeering Influenced and Corrupt Organizations Act (RICO).

Class: Certain participants in Oxford health plans who were overcharged for prescription drugs.

Status: Defendants’ Motion for Summary Judgment was granted on February 22, 2022