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Lori Pines

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Professional Experience

Partner: Weil, Gotshal & Manges LLP; Current

: Current; Co-lead counsel on behalf of UnitedHealth Group (“United”) in a case that challenged fundamental notions concerning the delivery of managed care in the United States. In McRaney, the patient-subscribers alleged that United misrepresented the scope of its health care coverage and that United interfered in the patient-physician relationship by discouraging physicians from imparting complete and accurate information to patient-subscribers. As reported widely in the national press, the case, part of a MDL proceeding in the Southern District of Florida, alleged fraud-based RICO claims subject to treble damages; claims for breach of disclosure obligations, misrepresentation, and breach of fiduciary duty under ERISA as well as state-law conspiracy and unjust enrichment claims. Ms. Pines and the WGM team, working in conjunction with defense counsel for other managed care organizations involved in similar suits in the MDL, defeated the efforts by many of the country's top plaintiffs' class action lawyers who sought to obtain certification of a class of tens of millions of patient-subscribers. This early, critical procedural win on class certification led to the collapse of the entire litigation, which sought billions of dollars in RICO and ERISA damages. Ms. Pines was the lead negotiator of the highly favorable settlement, in which United ultimately paid a nominal amount of money ($5,000) to settle the named plaintiffs’ claims. Currently representing United and its affiliates in a complex litigation brought by a group of individual and associational plaintiffs including the American Medical Association, in which the plaintiffs seek to challenge on a classwide basis the propriety of United’s reimbursements to providers and plan participants for out-of-network services. The case is in active discovery. Also currently representing United as co-lead counsel in a major AAA arbitration proceeding involving breach of contract and fiduciary duty allegations brought by a physician-owned HMO that contracted with United for administrative and operational services. Ms. Pines also represented United in Shane et al v. United et al., a nationwide class-action lawsuit in which a class of approximately 500,000 physicians allege that the nation's largest managed care organizations, including United, have violated, among other things, RICO, ERISA and state prompt pay statutes, by improperly reimbursing physicians for services rendered to patients who are members of the managed care organizations. Specifically, the physicians alleged that United, on its own and as part of a conspiracy with its co-defendant managed care organizations, systematically denied, delayed and diminished payments due to physicians by utilizing inappropriate cost criteria and by engaging in improper claims handling practices, such as "bundling" and "downcoding." Represented Arthur Andersen in all aspects of an arbitration filed by Andersen Consulting – the largest arbitration proceeding ever filed before the International Chamber of Commerce (“ICC”). Successfully argued that Arthur Andersen had not breached its member firm interfirm agreements with Andersen Consulting and that Arthur Andersen had the right to use the Andersen name. Also successfully represented Arthur Andersen in defeating Andersen Consulting’s action seeking a temporary restraining order and preliminary injunction in aid of arbitration. Co-lead counsel for Gen3 Partners, Inc. in a suit alleging illegal competition, disclosure of proprietary business information, and violation of non-solicitation covenants. Following a very favorable preliminary injunction decision for Gen3 Partners, the case settled. Litigation counsel for Times Mirror Magazines, Inc. (until its sale) in a lawsuit involving classwide allegations of price-fixing by magazine publishers. A favorable settlement was eventually reached. Lead counsel for L’Oreal/Cosmair USA (Redken Laboratories Inc.) in a series of distributorship termination disputes in various state court and AAA arbitration proceedings throughout the country. All settled on highly favorable terms for Cosmair. Represented GE Capital in a 1997 adversary proceeding involving an upstate utility’s (Rochester Gas & Electic Co.) attempts to terminate or void a multi-million dollar power purchase agreement due to unforeseen changes in the energy markets and based on alleged breaches of the contract by the builder of the plant, which was financed by GE Capital. Following a hearing in the federal bankruptcy court in which Ms. Pines actively participated, a favorable settlement was reached. As co-lead counsel for Kalvin-Miller International Inc., Ms. Pines drafted and argued a case-ending summary judgment motion in which Kalvin-Miller prevailed against a shareholder who had refused to return stock certificates to the company, which were owed pursuant to a put-call agreement. Participated on behalf of Westinghouse Electric Corp. in a six-month jury trial in state court in South Texas which settled before the end of the trial on favorable terms to Westinghouse. The plaintiff in the suit was Houston Light & Power. The case was oneof the longest civil trials in the country that year (1995-96). Actively participated in defending Westinghouse Electric Corporation in a three-month jury trial in federal court in the Western District of Pennsylvania involving claims of fraud, breach of contract, and civil RICO. Drafted directed verdict motion in which four of the five claims against Westinghouse were dismissed. Ran all aspects of Westinghouse’s opposition to Duquesne’s appeal of the jury verdict, which was unanimously affirmed by the Third Circuit Court of Appeals. Represented Random House in its appeal of a jury verdict declaring that the look of its dictionary infringed the trade dress of Merriam-Webster’s dictionary. Appeal was successful on all counts as the Second Circuit overturned the decision in the lower court, and declared (without remand to the district court) that Random House was not liable for trade dress infringement.

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