A doctor who had been audited by a health insurer decided, with his prior counsel, to engage in an arbitration proceeding regarding alleged “over-payments” to the health insurer. The doctor lost the proceeding and was ordered to pay a very substantial refund to the health insurer. The doctor subsequently discovered, from speaking with our firm, that he was never obligated to pay a refund to the health insurer, should have resisted the audit, and not agreed to arbitrate.
The doctor hired us to attempt to reverse the effects of the adverse ruling in the arbitration and to defend proceedings in Supreme Court to enforce the arbitration award. We marshaled the facts, the law, and various principles regarding health insurer audits and scheduled a high-level meeting with the health insurer’s counsel and director of special investigations.
After making various arguments to the insurer, we negotiated both the go-forward billing and payment arrangements between the doctor and the health insurer, resolved a group of unpaid claims that represented significant money due to the doctor, and successfully resolved all issues regarding the prior audit.
Our firm has successfully avoided audits of our physician clients, taking a unique and effective approach to these matters that differs from how other law firms approach these issues. For more information, please contact us at 800 745 1755.
Evan S. Schwartz
Founder of Schwartz, Conroy & Hack
800-745-1755
ESS@schwartzlawpc.com