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Payer Litigation: What Do We Do Now?

PDF Orange County Bar Association
Newport Beach, CA
March 12, 2015

Andrew Selesnick spoke at the Orange County Bar Association (OCBA) Health Care Law Section’s March Meeting on “Payer Litigation: What do we do now?”

The payer-provider community has been grappling with recent appellate court rulings that are impacting how they conduct business. During this session, Andy provided an overview of current developments affecting reimbursement, overpayments, and measures of recovery.  He also offered best practices on how to effectively navigate through the thorny process of payer disputes and litigation.

Topics covered included:

  • An overview of the Children’s Hospital Central California v. Anthem Blue Cross, Centinela-Freeman Emergency Medical Associates v. Health Net, et al.,  and other significant cases affecting provider-payer litigation;
  • Analysis of reasonable value;
  • Measures of Recovery;
  • Effective Strategies to Mitigate Risks for Disputes and Litigation;
  • How to Develop a Practical Disputes and Litigation Plan;
  • And More!

At the conclusion of this session, attendees:

  1. Understood how to value provider services in the marketplace;
  2. Learned how to approach provider-payer litigation and how to develop a winning strategy;
  3. Received tips on payer litigation; and
  4. Recognized the potential pitfalls in the process and how to avoid them.

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