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Health Care Practice Group
Representative Work

Transactional

Our health care attorneys offer many years of experience in health care transaction and operation.

  • Represented client in acquisition of $22 million managed care facility for multi-institutional health care corporation.
  • Negotiated new contract valued at $6.6 million annually for physicians group with multi-state HMO organization.
  • Negotiated multi-hospital exclusion contract for ancillary services.
  • Represented acute care hospital facing immediate CMS decertification action; assisted in developing and successfully implementing remedial actions to avert decertification; successfully contested process and findings of noncompliance, thereby limiting required scope of remedial action.
  • Assisted client in preparing Program Flex proposal from State of California to perform elective angioplasty/stent placement in their Cardiac Cath Lab.
  • Represented medical staffs in physician disciplinary actions, settling several major peer review matters without necessity of hearing, and assisted with structuring and implementing department-wide review of performance.
  • Represented physician group in merger negotiations.
  • Developed comprehensive financial estimate policy for health care provider, in response to Assembly Bill 1045 legislation.

Litigation

Our health care litigators have recovered more than $100 million for our clients during the last five years in lawsuits and binding arbitrations.

  • Represented hospital system and individual providers in multiple class action lawsuits involving hospital pricing, hospital liens, charity care policies, and provider billing practices.
  • Represented providers in complex binding arbitrations against non-contracted payers for reimbursement of hospital charges.
  • Represented providers in disputes over continuity of care following term of contract and health plan’s continuity of care plans.
  • Defended health insurance plan in high stakes contract litigation involving charging and coding issues.
  • Represented numerous health care providers in lengthy binding arbitrations over payment of thousands of claims for medical services that were to be reimbursed at contract fee-for-service rates, separately from capitation payments, resulting in multi-million dollar award against major health plan.
  • Represented health care providers in complex contract disputes involving gastric bypass surgery charges, resulting in multi-million dollar recoveries from major health insurance plan.
  • Represented health care providers in binding arbitration hearings involving neonatal intensive care unit charges, coding, and level of care issues, resulting in multi-million dollar award against payers.
  • Defended provider in multi-million dollar case regarding coding of services, including application of Medicare Guidelines, National Correct Coding Initiative, Outpatient Code Editor, UB-92 Editor and industry standards.
  • Represented providers in complex contract disputes involving reimbursement for implants and transplants. 
  • Represented providers in complex arbitrations involving calculation of stop-loss, delegation of risk to third party, payment of co-pays, Division of Financial Responsibility between providers and plan, and plan and third party, and timely filing, resulting in payment of thousands of fee-for-service claims and millions of dollars in recovery.
  • Represented providers in litigation against ERISA plans, successfully avoiding Federal preemption and securing payment for health care services rendered to ERISA plan members.
  • Represented provider in dispute involving STARK and anti-kickback issues.
  • Represented providers in anti-trust and unfair business practices claims.

Ongoing Litigation Advice

  • Counsel health care entities, including hospitals, networks, medical groups and health systems, on all aspects of managed care contracting, policies and procedures for legal risk avoidance, and business office practices.
  • Counsel health care billing entities regarding billing and coding matters.