Daron Tooch

Daron Tooch is known for his work in managed care litigation, recovering hundreds of millions of dollars for healthcare providers in civil actions and arbitrations against health plans.

Tooch successfully represented multiple hospitals challenging out-of-network payments by health plans, resulting in a $106 million verdict for Pomona Valley Hospital against Kaiser. Pomona Valley Hospital v. Kaiser Foundation Health Plan, KC069796 (L.A. Sup. Ct., filed Nov. 14, 2017).

Tooch was also lead trial counsel when a federal jury returned a verdict in favor of the hospital, awarding over $16 million. Northbay Healthcare Group v. Blue Shield of California, 17-CV-02929 (N.D. Cal, filed May 22, 2017).

Tooch’s team has been actively challenging health plans’ “white-bagging” policies.

“Ordinarily, hospitals use their own pharmacies to prepare medications for infusion therapy (e.g., chemotherapy),” Tooch said. “A number of health plans are now requiring them to use a special CVS pharmacy. The hospitals and some states consider this white-bagging policy to be dangerous to patient care because the hospital cannot be assured as to how the medications are compounded, stored or shipped, and that the process results in delays in care as the treating physician will often change the prescription on the date of infusion.”

Tooch’s team has been able to secure a number of injunctions against the health plans’ implementation of this policy.

“My biggest challenge is to help the client make sure it has the resources and resolve to take the case to trial when necessary,” he said.

Tooch also highlights the arbitration process under the Affordable Care Act (ACA), which limits providers’ ability to challenge low payments by health insurers. Tooch suggests that the legality of the ACA’s arbitration process may be challenged on behalf of one of his clients.

“Health plans are continually making the terms of their contracts more onerous (such as engaging in the practice of white bagging) and are paying lower rates,” he said. “At the same time, hospitals are facing higher costs. With Medicare and Medicaid paying insufficient amounts to cover the costs of treatment, providers have to be able to cover the deficits from their commercial payors. The victories in the cases we have handled are important to show the plans that their improper payment policies can be challenged and that providers can fight back.”

In terms of thought leadership, Tooch has authored client alerts and been quoted in publications discussing healthcare topics such as reimbursement rights, white-bagging, and the No Surprises Act. He is an active member of the American Health Lawyers Association and the California Society of Healthcare Attorneys.