Medicare and Medicaid Reimbursement

Assisted clients on how to respond to growing demands to make their companies and products more sustainable, a goal increasingly being adopted by companies in the health care industry

Commented on EPA rulemaking s for a trade association representing a segment of in the health care industry 

Tracks regulatory developments for health care industry clients to provide early warning of significant new regulations or risks to a company's business, particularly concerning issues relating to FIFRA compliance for chemicals which claim to reduce Ebola, norovirus, and other viruses that are unlikely to have been explicitly testing in the original pesticide registration process 

Advised on methods of responding to regulatory agency and press concerns about the presence of "toxic" chemicals in products used by the health care industry

With assistance from  Kristi Gauthier,  Ed Hammond, Peter Domas and Bishop Bartoni, Kevin Hendrick and Nicole Tersigni successfully defended an insurance priority dispute, resulting in an extremely favorable judgment for firm client, United States Steel Corporation’s ERISA-governed Retiree Benefits Plan.  U. S. Steel Retirement Plan was joined as a third-party defendant in a pending dispute by a No-Fault Automobile Insurance carrier,  which had been sued by a healthcare service provider for unpaid patient attendant care fees.  The No-Fault Carrier claimed that the obligation to pay for these services under Michigan No-Fault law  fell to U. S. Steel Retirement Plan, which covered the patient (who was a former U. S. Steel employee).  Ed, Bishop, Kristi and Peter lent their expertise to Kevin and Nicole in interpreting alleged conflicting insurance priority provisions and explanations of benefits.  Kevin and Nicole crafted a legal argument that ultimately led to summary disposition in favor of U.S. Steel Plan, and against the No-Fault carrier, saving U.S. Steel Plan from payment of the healthcare fees, and also reimbursing U.S. Steel Plan for benefits it had earlier paid by mistake, out of priority.  As the No-Fault carrier had rejected the Case Evaluation award prior to the filing of cross motions for summary disposition, it also appears that attorney  fees are recoverable for our client.  Kristi and Ed on Employee Benefit law, Bishop on Michigan No-Fault law, and Pete on Health Care issues, proved to be unbeatable resources.

Managed Care and Health Care Industry Litigation - Practiced before state and federal agencies and the courts relating to Medicare and Medicaid reimbursement issues.

Formation of joint ventures among physicians.

Represented major corporation in various acquisition and divestiture transactions involving developing technology.

Represented non-profit hospital in a conversion to for-profit status.

Represented nephrology clinics in a merger into a publicly traded company.

Represented hospital in merger transaction.

Health Care Industry Litigation - Participated and litigated in several federal bankruptcy and state court receivership proceedings of hospitals.

Antitrust and Trade Regulation - Lead Counsel in an antitrust case which successfully put an end to a decade’s long boycott against one of the largest dental insurers in the country.

Managed Care and Health Care Industry Litigation - Counseled clients and litigated third party reimbursement and accounting for reimbursement issues.

Formation of and counsel to medical professional corporations.

Formation of joint ventures between hospitals and physicians.

Representation of medical billing companies.

Representation of medical staffs and hospitals on amendments to medical staff bylaws.

Representation of rehabilitation entities.

Represented parties in sales of medical practices to hospitals and in divestitures of medical practices from hospitals.

Antitrust and Trade Regulation - Reported antitrust decisions include the following: Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 815 F.2d 270 (3d Cir. 1987), rev’g, 632 F.Supp. 653 (M.D. Pa. 1986), cert denied, 484 U.S. 851 (1987); Pennsylvania Dental Association v. Medical Service Association of Pennsylvania, 745 F.2d 248 (3d Cir. 1984), aff’g, 574 F.Supp. 457 (M.D. Pa. 1983), cert. denied, 471 U.S. 1060 (1985).

Antitrust and Trade Regulation - Antitrust litigation experience includes representing clients in the insurance, health care, soft drink, construction, manufacturing, hardware and building materials industries.

Represented physician parties in corporate split-ups.

Managed Care and Health Care Industry Litigation - Litigated provider participation status under the Medicare program.

Managed Care and Health Care Industry Litigation - Litigated issues related to institutional providers’ Medicaid cost reports.

Counsel to mid-market health care companies including cancer treatment centers, dialysis centers, sleep labs, and ambulatory surgery centers providing lead counsel and coordinating legal counsel on a wide array of matters including corporate matters, operations, acquisition and divestiture transactions, joint venture projects, corporate governance, business planning and financial transactions, and legal compliance.

Represent healthcare insurers, third party administrators, managed care organizations and others in contractual, business and other disputes. Representation includes counseling clients and litigating issues regarding payments, accounting for payments, third party administration and self-insured health plan issues, fraud claims, among others