The Firm represents several Preferred Provider Organizations, Independent Practice Associations and Physician Practice Partnerships, which have negotiated contracts with many Health Maintenance Organizations, including Blue Cross Blue Shield, Oxford, U.S. Health Care, Aetna, Group Health Incorporated, Sanus, Cigna, Kemper, Chubb, U.S. Life Insurance, just to name a few. Some of these contracts were based on a fee-for-service fee schedule but many were capitated risk sharing relationships or bundled service agreements with Health Maintenance Organizations, which included both the physicians and hospital service components. The Firm has created Management Service Organizations that negotiate provider contracts and manage the physicians’ practices under these contracts. The Firm has also assisted a medical society in its sponsoring of a state approved Medicaid Managed Care program and receipt of a grant from New York Stare in order to facilitate the provision of Medicaid services.

The Firm represents health care providers of all specialties before Health Maintenance Organizations, Third Party Payors and the various governing bodies of Medicaid and Medicare, including but not limited to audits, fraud (civil and criminal), over-utilization and sanction and exclusion proceedings involving claims of both fiscal and quality of care issues. We represent our professional clients with regard to Medicare before HCFA authorities, the New York State Department of Social Services and the New York State Department of Health Bureau of Prescription Control, as well as other agencies and peer review organizations. The Firm provided counsel for professionals in matters that have impacted the method in which Medicaid authorities take action with regard to providers, including actions which invalidated complete audit protocols. One such action involved the dropping of charges of several million dollars of alleged overpayments.