HEALTH CARE

Managed Care

Contracting

Compliance & Regulatory Matters

Disputes & Litigation

Fraud & Abuse

Operations

Corporate Matters

Real Estate Development & Construction

Business Services

Construction

Employment

Litigation

Public Law

Real Estate

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.