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 focuses her practice on regulatory and litigation matters in the health care and insurance industries. Ms. Hagemann has successfully navigated numerous commercial disputes, counselling a diverse group of health care providers, ranging from physicians to substance abuse treatment facilities and laboratories. She also advises health care and insurance industry clients faced with regulatory investigations and accusations.
Ms. Hagemann has litigated and arbitrated several actions against payors who have failed to adequately reimburse out-of-network providers. She has also tried cases involving breach of contract, regulatory violations, and professional negligence, co-chairing several trials to verdict or judgment.
Ms. Hagemann often counsels substance abuse treatment providers with regards to: reimbursement; payor audits; usual, customary and reasonable (UCR) rates; medical necessity; marketing arrangements; and industry referrals. In addition, she helps facility owner/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.
Ms. Hagemann 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, and the California Code of Regulations.
Additionally, Ms. Hagemann handles a broad range of regulatory issues for insurance companies, agents, brokers and other industry clients, including: compliance, formation of insurance brokerages, producer agreements, investigations and accusations, and mergers and acquisitions. She regularly represents clients at licensing and administrative hearings before Departments of Insurance nationwide.
Ms. Hagemann has worked as a volunteer for California Lawyers for the Arts in Santa Monica, as well as the Public Law Center in Orange County.
Ms. Hagemann earned her J.D. from Pepperdine University School of Law, where she was Business and Production Editor for the Pepperdine Law Review and a Fellow for the Center for Entrepreneurship and Technology Law. She received her B.A., with a double major in Philosophy and Music Humanities, from the University of California, San Diego, where she was a Regent's Scholar.
- 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 her client.
- Independent Physician Association Reimbursement Dispute: Represented a large group of emergency physicians in litigation against an IPA to recover payment for services at physicians’ usual and customary rates. The Independent Physician Association (IPA) wrongly withheld several hundreds of thousands of dollars refusing to pay usual and customary rates for Current Procedural Terminology (CPT) codes as billed. Ms. Hagemann 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. Ms. Hagemann 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.
- Recoupment Requests and Audits: Represented numerous substance abuse treatment facilities in recoupment requests and audits from major payors.
- 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.
- Seven Figure Recoupment Request: Represented a urinalysis laboratory in a seven figure recoupment request, and favorably resolved the matter without litigation.
Substance Abuse Treatment Facility Compliance: Developed policies and procedures for 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.
Substance Abuse Treatment Administrative Hearing: Represented detoxification facility in administrative action brought by the California Department of Health Care Services seeking revocation of client’s license.
- Legal News Line, August 4, 2016
- FierceHealthPayer, January 28, 2016
- Summary Judgment Granted in Federal CaseMealey's Litigation Report, January 4, 2012
- Behavioral Healthcare Executive, February 13, 2017
- Compliance Today, March 2016
- California Healthcare News, February 4, 2015
- Daily Journal, December 26, 2014
- Behavioral Healthcare, June 12, 2014
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
- Medical Group Management Association (MGMA)Webinar, July 23, 2015
- The Do's and Don't's of Exhibit and Witness ListsHarrisMartin ConferenceOmni Los Angeles Hotel, January 29, 2010
- 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
- Adventist to Pay $118.7 Million Settlement in Whistleblower Lawsuit September 22, 2015
- Navigating Substance Abuse Treatment under Obamacare June 12, 2014