Managed Care Litigation: Anti-Assignment Clauses, Reimbursement Claims, State Law Claims

Providers frequently retain Mr. Stimson to defend them in federal and state administrative audits, investigations, and enforcement actions. He is uniquely equipped to defend providers in such matters as a former high-level HHS official. He has successfully guided an array of providers through revocations, payment suspensions, overpayment recoupments, Medicare debt collections, surprise billing investigations, civil rights investigations, Provider Relief Fund audits, and False Claims Act actions. Providers also look to Mr. Stimson as a trusted advisor on the regulatory issues adjacent to his litigation practice. Those issues include managed care contracting, the federal and state surprise billing laws, Medicare fee-for-service reimbursement, the Medicare Advantage program, HIPAA, and the federal rulemaking process generally. The insights that Mr. Stimson brings from his years at HHS as Acting General Counsel and Principal Deputy General Counsel are what sets him apart from other lawyers. At HHS, he was the lead in-house lawyer for administrative litigation. He personally drafted and cleared agency rules as part of the inter-agency process and was a liaison to both the Office of Counsel to the Inspector General and the U.S. Department of Justice.

Mr. Bernstein manages litigation from inception through trial, arbitration, and appeal and has successfully defended life, health, and disability claims brought in state or federal court against insurers, plan administrators, employers, and managed care organizations. He regularly represents HMOs; PPOs; third-party administrators; pharmacy benefit managers; and life, health, disability, and accidental death and dismemberment benefit plans. In addition, Mr. Bernstein represents insurance companies, managed behavioral health care claim administrators, chiropractic health care claim administrators, self-funded plan sponsors, and administrators in a variety of matters. His experience spans all areas of life, health, and disability litigation, including complex health care issues involving ERISA, FEHBA and Medicare preemption, payor/provider contract disputes, provider de-listing disputes, PBM antitrust claims, nonparticipating provider reimbursement claims, pharmacy benefit plan/provider disputes, and behavioral health claim disputes, including claims alleging violations of federal and state Mental Health Parity and Addiction Equity laws. Mr. Bernstein has written extensively about managed care litigation, health care issues, group benefits, and ERISA matters, and has presented on these topics at conferences and seminars around the country.