Mediated a variety of healthcare claims including payment disputes between healthcare providers and insurers, health plans.
Professional liability claims against physicians, dentists, and other healthcare providers, liability claims against hospital and other medical facilities.
Compensation disputes between medical groups and medical foundations, false claim qui tam lawsuits.

Healthcare

1900 Avenue of the Stars

Suite 200

Los Angeles, CA 90067

Tel. (310) 201-0010

Fax (310) 201-0016

Representative Cases:


Mediated a variety of healthcare claims including payment disputes between healthcare providers and insurers, health plans.

Professional liability claims against physicians, dentists, and other healthcare providers, liability claims against hospitals and other medical facilities, employment disputes, and compensation disputes between medical groups and medical foundations, false claim/qui tam lawsuits.

New doctor alleged to have allowed physician's assistant and clinic to use his MediCare billing privileges. Clinic fraudulently billed patients' charges. Complete medical review and audit resulted in approximately $500,000 demand for repayment by MediCare billing extrapolation. Doctor pursued entire appeals process to Federal Court. Demand with interest now $800,000. 

Multi-party breach of contract regarding chiropractic clinics.

Subcontractor claimed that health plan failed to make payments under provisions of capitation agreement.

Medicare claimed $863,000 overpayment to physician which included extrapolation methodology in connection with auditing billings and pursuing overpayment recoveries. Physician pursued administrative remedies.

Plaintiff ambulance company contracted with defendant Medicare/Medicaid to provide services.  Defendant put Plaintiff on 100% pre-payment review. Plaintiff filed Chapter 11, then Chapter 7 bankruptcy. Bankruptcy Trustee seeks to recover money withheld claiming violations of Administrative Procedures Act and turnover. Defendant USA alleges failure to exhaust administrative remedies and sovereign immunity.

Physicians and other professional providers alleged that managed care organizations’ reimbursement and contracting practices violated RICO, ERISA and state laws.

Hospital alleged that health plan failed to pay reasonable and customary rates for emergency services, in violation of Health & Safety Code.

Professional medical providers claimed wrongful non-payment or underpayment of claims, raising issues of distinction between emergency and trauma claims, length of stay, stop loss calculations, financial responsibility of delegated entities, and DOFR interpretations.

Claimed failure to timely diagnose bladder cancer resulting in wrongful death.

Plaintiff alleged medical malpractice against surgeon who performed multiple, unsuccessful shoulder surgeries. Ultimately, shoulder could not be repaired. Major damage claim.

Dentist alleged to have performed multiple unnecessary and substandard procedures.

Claimed failure to appropriately inject pain management substance, monitor and treat infection complications.

Multiple claims by physicians and hospitals alleging wrongful non-payment or underpayment of claims under contracts with health plans.

Home healthcare provider attacked by dog. Serious injuries.

Plaintiff physician provider submitted Medicare claims for services rendered to patient-beneficiaries. Post-payment review with extrapolation to random sampling resulted in a claim of overpayment to plaintiff of nearly $1 million. Plaintiff pursued the entire Medicare Appeals process and ultimately filed a complaint in federal court for review of the Medicare Overpayment Determination. Throughout the proceedings, plaintiff had been paying down the claim, but at mediation a substantial accounting discrepancy was discovered.

Licensed healthcare provider purchased, acquired and operated numerous multi-state medical clinics and facilities. As part of an expansion of clinic operations, the healthcare provider entered into various agreements with plaintiff, an unlicensed individual. Plaintiff alleges breach of contract, common counts and fraud. Issues included individual liability for a corporate debt, assumption of the obligation to plaintiff by a third party, statutes of limitation, unlawful consulting agreements and mismanaged corporate assets.

Plaintiff employed as nurse at skilled care facility which included room and board. Plaintiff claimed inadequate privacy, no right to engage in normal private pursuits, inadequate overtime compensation, sleep time violations, illegal meal and lodging deductions, meal and rest period violations among other things.

Handicapped plaintiff claimed Federal ADA violations by residential medical facility including non-compliant doors, bathrooms, service counters, parking lot signage, parking spaces.

Handicapped plaintiff claimed Federal ADA violations by major motor vehicle membership company including barrier to access, non-compliant doors, bathrooms, service counters, parking lot signage, parking spaces, service cubicles.

Wrongful termination based on age discrimination and retaliation by a long-term sales representative against a major pharmaceutical manufacturer.

Residential caregiver for the elderly who alleged inadequate staffing and no right to engage in normal private pursuits entitled him to Federal overtime, sleep time, no deductions for meals and lodging, liquidated damages, prejudgment interest, California minimum wage overtime, Private Attorney General Act compensation, penalties, attorney's fees and costs.

Breach of contract, open book account of physician to recover unpaid medical treatment to patient for obtaining surrogates to conceive patient's child.