… physicians, healthcare administrators, reimbursement specialists, health organization experts, health insurance experts, and other healthcare personnel — with broad, extensive experience and expertise in medical and administrative malpractice issues, physician practice operations, hospital management, health insurance and TPA issues, Medicare and Medicaid, medical billing and collections, fraud and abuse, managed care and other areas.

Expertise

Litigation Issues

Audit
Medical Standards of Care
Dental Standards of Care
Geriatrics and Nursing Home Care Standards
Long-Term Care Standards
Health Insurance
Health Insurer-Provider Relations
Managed Healthcare (HMO, PPO)
TPA (Third Party Administrator)
National Accreditation Guidelines
Medicare / Medicaid
Federal Employees Health Benefits Program
CDH (Consumer Driven Health Plans)
ERISA, COBRA, EMTALA, HIPAA
Physician / Hospital Joint Ventures
Qui Tam and Falsa Claims Act
Life Care Planning

Medical Malpractice
Medical Management
Billing and Collection
Industry Standards Adherence
Utilization Review
Medicare / Medicaid
Provider Credentialing and Contracting
Ostensible Agency
Provider and Member Communications
Patient Benefits Determination and Grievance and Appeal Procedures, including External Review
Financial Reimbursement Models
Compensation and Capitation
Referral and Certification
Subrogation and Third Party Recovery
Due Process Requirements
Class Action
Case Management

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