Nelson Hardiman is a leader in reimbursement litigation for healthcare providers ranging from large hospitals to individual physicians. Because our talented litigators have a firm grasp on federal and state healthcare regulatory law, we frequently represent both providers who are suing to obtain payment and providers defending claims that they have been overpaid for health care services.
We are one of the most experienced firms in Southern California handling Medicare and Medi-Cal administrative proceedings. We litigate against insurance companies in state and federal court and in arbitration proceedings. We represent hospitals suing health plans and defend physician practices against reimbursement litigation by insurers. We obtain drastic reductions of overpayment claims, with a track record of success built on in-depth knowledge of the agencies, their reimbursement policies, and our integration of problem-solving skills and expert resources. While we fiercely litigate on behalf of healthcare providers, Nelson Hardiman also works hard to resolve disputes with federal healthcare programs and healthcare payors. We meet regularly with decision-makers and administrative agencies to reach consensus on reimbursement-related disputes.
Our Work Includes:
- Administrative Hearings We have handled hundreds of Medicare and Medi-Cal administrative proceedings.
- Arbitration Recovered millions of dollars in unpaid/underpaid claims on behalf of a large hospital provider involving numerous local and out-of-state managed care plans concerning thousands of disputed facility claims.
- Ambulatory Surgery Center (ASC) Represented an ASC in out-of-network “fee forgiveness” action against a major insurance company, pursuing more than $3 million for claims improperly denied based on claim that surgery center “forgave” patient contribution as inducement for using out-of-network facility.
- Civil Fraud Defended hospitals in complex federal and state FCA actions involving claims for allegedly non-reimbursable, unnecessary or inflated services and costs.
- Hospital Reimbursement Achieved a favorable settlement recovering hundreds of thousands of dollars for a client hospital in a “reasonable and customary” dispute involving an out-of-network capitated medical group payor.
- Laboratory Reimbursement Obtained a favorable settlement of all claims for a client laboratory group in arbitration brought against a managed care plan to recover underpaid/unpaid pathology services and testing.
- Overpayment Investigations Supervised internal investigations of federal healthcare benefit over-payments and voluntary disclosures to the U.S. Department of Health & Human Services’ Office of Inspector General and the Center for Medicare and Medicaid Services.
- Provider Reimbursement Helped a client hospital provider recover from a national insurance company refusing to pay for services based on insured’s alleged preexisting condition.