Sam Blackmar brings healthcare industry expertise and litigation experience to Nelson Hardiman. Sam has represented physicians, healthcare facilities, physicians’ associations and hospital systems in reimbursement arbitration and litigation in state and federal courts. Sam has also advised healthcare providers on a wide range of topics including regulatory compliance, board investigations, revenue cycle management, and payor disputes.
Sam has worked extensively in the behavioral health reimbursement industry where he has guided mental health and addiction treatment facilities through a broad range of reimbursement-related issues. Specifically, Sam shepherded facilities through payor audits and investigations, developed appeals strategies for denied claims and overpayment recoupments, and advised clients on compliant clinical practices given the ever-evolving standards to which behavioral healthcare providers are held.
Healthcare Litigation Background
Prior to joining Nelson Hardiman, Sam represented physicians, mental health and addiction treatment providers, emergency room doctors and large hospital systems in reimbursement litigation. Sam has experience in State and Federal Court as well as in all major arbitration forums. Sam is well versed in ERISA preemption, usual customary and reasonable rate disputes, clinical standards, coding-related issues, mental health parity, participating provider agreement disputes, Knox-Keene Act Health Plans among others.
Sam also helps clients with government investigations, employment disputes, corporate compliance, complex business litigation, zoning and land use disputes, and FDA compliance.
Deep Commitment to Access to Healthcare
Sam believes that an efficient healthcare ecosystem is critical to patients’ access to care. Sam also understands that the financial incentives at play in healthcare inevitably lead to disputes that require competent advocacy. Sam attended law school with the goal of using a legal education to meet the needs of healthcare stakeholders and ultimately improve the ability of Americans to get the healthcare they need without going bankrupt. In his role at Nelson Hardiman, Sam leverages his behavioral health and litigation experience to assist clients in both litigation and regulatory
University of California, Irvine, B.A. Cum Laude; Phi Beta Kappa
Georgetown University Law Center, J.D.
State Bar of California
United States District Court for the Central District of California
American Health Law Association (AHLA)
Southern California Health Law Association
- Represented major hospital systems in successful arbitration and litigation against healthcare service plans, Medicare Advantage plans, and commercial payors to ensure fair claims payment
- Helped clients collect millions of dollars in unpaid claims from commercial insurance companies
- Represented clients in recoupment and overpayment disputes involving Tricare, FEHBA and commercial payors
- Successfully represented Behavioral Health Treatment facility in land-use dispute with the city, allowing the facility to continue operating
- Guided independent pharmacy through a California Board of Pharmacy Investigation, resulting in no citations or accusations
- Represented independent pharmacy in managing the theft of controlled substances by a former employee and mandatory DEA and Board of Pharmacy Reporting
- Advised clients on DEA security and dispensation compliance
- Represented employers in wage and hour disputes, EEOC complaints, and wrongful termination matters
- Advised eye-drop manufacturer on the propriety of eye-drop formulation, including excipient ingredients
Class Action Litigation
- Represented emergency room physician network in RICO and Anti-trust reimbursement litigation against major payors and third-party cost containment companies
- Represented class of healthcare providers in a range of ERISA matters, including preemption issues and benefits disputes
- Successfully overturned zoning violation
Healthcare Industry Experience
- Advised healthcare providers on designing and implementing administrative procedures to ensure maximum collections and exhaustion of administrative remedies
- Resolved medical records audits and pre-payment review flags for behavioral health providers
- Advised behavioral health providers on compliant marketing practices, records maintenance, HIPAA procedures, documentation, licensure, and coding