Bar & Court Admissions
- State Bar of California
- U.S. District Court for the Central District of California
California Society for Healthcare Attorneys
Los Angeles County Bar Association (Health Care Law Section)
Pepperdine University School of Law, J.D.
University of California, San Diego, B.A.
Kelly M. Hagemann
Kelly Hagemann is a senior associate in M&R's Orange County office, where she focuses her practice on litigation and regulatory matters in the health care industry. Kelly has successfully handled numerous commercial disputes on behalf of a diverse group of health care providers, ranging from physicians to substance abuse treatment facilities and laboratories. Likewise, she advises health care clients faced with regulatory investigations and accusations.
Having litigated and arbitrated several actions against payors who have failed to adequately reimburse in-network and out-of-network providers, Kelly has also tried several cases involving breach of contract, regulatory violations, and professional negligence. In addition, she often counsels substance abuse treatment providers concerning usual, customary, and reasonable (UCR) rates, reimbursement, payor audits, medical necessity, marketing arrangements, and industry referrals. In addition, Kelly helps facility owners/operators and their laboratories with facility licensing, administrative hearings, and the development of fraud and abuse compliance programs and procedures, litigating in state and federal courts where necessary.
In terms of regulatory matters, Kelly regularly advises providers on compliance with applicable federal and state regulations, including the Affordable Care Act, Medicare, Medicaid and Medi-Cal, Knox-Keene, the Stark Act, the Anti-Kickback Act, the corporate practice of medicine, HIPAA, HITECH, and the Confidentiality of Medical Information Act. There is more. Kelly assists with facility acquisitions, including legal due diligence and regulatory work, as well.
Kelly has worked as a volunteer for California Lawyers for the Arts in Santa Monica, as well as the Public Law Center in Orange County.
Mental Health and Substance Abuse Treatment Facility Compliance: Developed policies and procedures for mental health and substance abuse providers relating to marketing, referrals, and payor relationships to ensure compliance with federal and state regulations.
Substance Abuse Treatment Litigation: Represented provider in action brought by major insurer alleging illegal kickbacks in exchange for the referral of specimens to toxicology laboratory. Obtained dismissal of action.
Substance Abuse Treatment Administrative Hearings: Represented multiple detoxification facilities in administrative actions brought by the California Department of Health Care Services seeking revocation of clients’ licenses.
Arbitration: Represented a large physician group against a national laboratory corporation alleging breach of contract, fraud, and regulatory violations. The corporation was contracted to establish and manage the clients’ in-house pathology laboratory, but failed to comply with the Clinical Laboratory Improvement Amendments (CLIA), Stark Law, the False Claims Act, the anti-markup rule, and California’s False Claims Act. Obtained a favorable result for client.
Special Investigations, Recoupment Requests, and Audits: Represented numerous providers in recoupment requests and audits from major payors. Settled several seven-figure demands, obtained reimbursements for clients on outstanding claims, and extracted clients from Special Investigations Unit status.
Reimbursement Dispute: Represented emergency medical transportation providers in litigation challenging Medi-Cal reimbursement rates. The Department of Health Care Services set clients’ reimbursement rates without complying with federal and state requirements, and without considering clients’ costs to provide those services.
Independent Physician Association Reimbursement Dispute: Represented a large group of emergency physicians in litigation against an Independent Physician Association (IPA) to recover payment for services at physicians’ usual and customary rates. The IPA wrongly withheld several hundreds of thousands of dollars refusing to pay usual and customary rates for Current Procedural Terminology (CPT) codes as billed. Obtained a favorable settlement on the clients’ behalf, including payment of past amounts due, and structured agreed-upon contract rates going forward.
Professional Malpractice: Represented an attorney who was sued for malpractice, fraud, negligence, and elder abuse following modifications he made to a decedent’s trust and pour-over will. The beneficiaries of testamentary documents challenged modifications and alleged a conspiracy between the client and another beneficiary. Obtained a complete defense judgment for the client following a lengthy bench trial. The court found that the client practiced competently, the fraud and elder abuse claims were completely unfounded, and there was no conspiracy.
- Law360, January 1, 2019
- Legal News Line, August 4, 2016
- FierceHealthPayer, January 28, 2016
- Behavioral Healthcare Executive, February 13, 2017
- Compliance Today, March 2016
Past Speaking Engagements
- Best Practices: Online Marketing of Ambulatory Surgery Center (ASC) Services and Email Communications with PatientsBecker's ASC 23rd Annual MeetingChicago, IL, October 29, 2016
- Orange County Healthcare Financial Network (OCHFN)Orange County, CA, June 3, 2016
- EKRA Put to the Test Yet Again October 6, 2020
- Chain of Kickbacks Leads to Long-Awaited EKRA Enforcement Against Marketers, Recruiters, and Treatment Facilities September 23, 2020
- Under the Microscope: Substance Abuse Patient Referrals October 1, 2018
- Federal Legislation Expected on Sober Living Homes September 22, 2016
- DOJ Seeks to Block Two Major Health Insurance Mergers July 22, 2016
- CA Insurance Commissioner Urges U.S. Justice Department to Block Merger of Aetna and Humana June 24, 2016
- Health Net Payments Trickle in to Addiction Treatment Centers as CA Regulators Investigate Insurer June 9, 2016
- NY Hospital to Pay $2.2 Million for Allowing TV Crew to Videotape Dying Patient April 22, 2016
- Health Net Deepens Investigation of Addiction Treatment Centers April 21, 2016
- Health Net And Other Payers Ramp Up Audits Against Addiction Treatment Providers January 26, 2016