Insurance Litigation
Our attorneys are regularly involved in multiple insurance litigation matters, typically representing physicians as insureds or under the premise that the physicians are systematically being deprived of payment by insurers, union benefit plans or federal or state agencies. Claim denials that are predicated on coding disputes, charting disputes, documentation disputes, examination under oath testimony, violations of the no-fault regulations, violations of the workers compensation regulations, violations of Health Maintenance Organization contractual obligations and scope of insurance coverage disputes are resolved through the production of overwhelming evidence that an initial disclaimer was inappropriate. Alternatively, such cases are resolved through actions for declaratory judgment and breach of contract commenced to compel insurance carriers to pay claims and honor the obligations that were part of their commitment under the contract of insurance with the respective, insured party.
Our attorneys handle all phases of insurance contract declaratory judgment litigation at the trial and appellate levels. In this regard our firm represents insureds and their healthcare providers in actions relying upon the Employee Retirement Income Security Act (ERISA) and we continue our 15-year history of representing medical practices in the defense of insurance fraud and No-Fault insurance fraud matters. At all times, our firm is typically involved in multiple No-Fault insurance fraud money laundering and other RICO claims involving healthcare indemnification. Our firm represents physicians, practice owners, management companies, lenders and employees in federal and state criminal, civil and administrative proceedings and litigation in the areas of health care fraud and compliance. We conduct or engage internal audits of health care entities and facilities to prevent future risk of enforcement and to defend civil and criminal allegations under the Racketeering Influenced Corrupt Organizations Act (“RICO”), New York State's anti-racketeering statutes and whistleblower actions under the Federal False Claims Act. In these regards, we typically find ourselves in litigation against the insurance industry.
No-Fault Litigation, while valuable in limiting inappropriate ownership and control of the medical practice is, in our opinion, often unwarranted. Insurers frequently make such allegations based upon limited or self serving due diligence. Utilizing independent, third-party fair market valuation consultants, we can demonstrate that the business relationships that exist in a medical practice are indeed within the standard of the particular specialty and services rendered, and provided in arm's-length, fair-market value fashion. While we often inherit fact patterns that appear incoherent and confusing, we find that a methodical forensic financial review of a health care provider practice can often provide form, value and structure to the business model. Of course, the most important effect here is that the defense of the no-fault corporate practice of medicine case now becomes palpable while the client's conduct becomes defensible.
To be sure, there are times when certain claims should settle, but we frequently find that a careful and thorough analysis of the practice provides for justifiable defense.