Our attorneys have extensive experience representing healthcare providers in a wide variety of disputes. We have successfully represented hospitals and hospital affiliates in complex state and federal litigation involving governmental payment rates, managed care contracts, partnership and joint venture agreements, non-competition agreements, liability insurance coverage, stop-loss insurance, non-contracted emergency care, and complex class actions.
We’ve represented clients in several areas of the healthcare industry, including hospitals, medical groups, medical device and life science companies, rehabilitation centers, and extended and elder care facilities.
Our lawyers’ representative services include:
- Challenging health plans’ and insurers’ improper payment practices
- Implementing creative strategies for dealing with payor insolvencies and liquidations
- Litigating complex state and federal regulatory issues
- Litigating breach of contract claims (including under managed care contracts)
- Litigating unfair competition claims
- Professional licensing investigations and regulatory proceedings
We have a proven track record of successful outcomes in complex healthcare litigation, class action suits, and multidistrict litigation. We have significant success in insurance/government program recoveries, regulatory matters, recoveries against health plans, unfair competition, and licensing. A selection of our most notable successes is included below.
Healthcare Litigation: Insurance/Government Program Recoveries
- Served as lead class counsel for 630 California hospitals in a challenge to a major insurer’s accounting and administration of a $1 billion group insurance program. The litigation recovered $51 million for the hospitals in a court-approved settlement.
- Served as lead plaintiff attorney in a California state court class action representing a class of hospitals challenging Medi-Cal hospital outpatient rates. This case, along with a federal case, resulted in a $350 million payment to California hospitals and a 40 percent prospective rate increase.
- Served as lead counsel for 110 California hospitals and the state trade association in a complex coverage dispute with their liability insurer arising out of an antitrust lawsuit. The hospitals recovered more than $12 million from the liability insurer after winning on summary adjudication.
Healthcare Litigation: Regulatory
- Represented the California Hospital Association in major litigation, including the successful defense of an antitrust class action and in lawsuits relating to the implementation of nurse staffing regulations.
- Represented providers in a variety of regulatory matters, including matters before the California Medical Board, the Department of Managed Health Care, and other regulatory agencies.
Healthcare Litigation: Recoveries Against Health Plans
- Successfully prosecuted an eig[AD3] [AV4] ht-figure contractual bonus claim against Medicare Advantage plan on behalf of a large Los Angeles County hospital and its affiliated medical group.
- Served as lead counsel for Long Beach Memorial and two other MHS hospitals in litigation against Blue Shield. The hospitals contended that Blue Shield breached 19 managed care contracts by “disallowing” charges for stop-loss computation purposes. After the hospitals obtained a court ruling that Blue Shield is legally obligated to pay claims as uncontested due to its failure to provide specific reasons for denying the charges, the matter was successfully resolved.
- Served as lead counsel for Long Beach Memorial (Miller Children’s Hospital) in litigation challenging Blue Shield’s underpayments for neonatal intensive care. The litigation established that Blue Shield, using a questionable activity tool, had failed to pay for care delivered at high levels of acuity. The matter was resolved in a manner satisfactory to the hospital (payment terms confidential).
- Obtained a multi-million-dollar settlement for nonprofit hospitals in a reimbursement matter.
- Obtained a landmark ruling by the California Court of Appeal on behalf of Coast Plaza Doctors Hospital. The court held for the first time that a hospital could bring claims against a health plan for failing to pay for treatment of its insureds in violation of Section 1371 of the Knox-Keene Act.
Healthcare Litigation: Unfair Competition
- Successfully defended a nonprofit hospital against claims by an imaging company that the hospital violated an alleged non-competition agreement. After successfully forcing the imaging provider into arbitration, the matter was resolved in 2015 to the hospital’s satisfaction (settlement terms confidential).
Healthcare Litigation: Licensing
- Successfully defended a medical licensee at an evidentiary hearing before an administrative law judge where the state attorney general had challenged her license.
- Successfully defended a major dental provider in a regulatory matter.
Some of our representative healthcare litigation clients include:
- American Medical Response
- Crossover Health
- Envision Healthcare
- Golden State Orthopaedics
- Long Beach Memorial