What We Do

Nelson Hardiman has successfully represented healthcare facilities, providers, professionals, life sciences and technology businesses in arbitrations. Our lawyers are well practiced in the different models of alternative dispute resolution (ADR) in healthcare, and employ ADR as the first line of defense to resolve claims effectively.

Because we know the healthcare system and the laws, regulations and agency guidelines that govern healthcare entities, we leverage arbitration and mediation to help our clients resolve claims fairly and cost-effectively. We also handle subsequent litigation that may arise in federal or state courts in the United States in enforcing arbitral awards or pursuing other lines of defense, contributing to the overall acceptance of ADR by the healthcare industry.

Our Work Includes:

• Arbitration Represented providers in payment disputes with managed care plans and commercial breach of contract and unfair competition arbitration.
• Deceptive Marketing Practices Defended an outpatient surgery center in arbitration with a surgeon alleging deceptive marketing practices in violation of the federal Lanham Act and breach of an exclusive services contract.
• Employment Represented a bariatric surgeon in arbitration bringing contract, tort, and Labor Code claims against a former employer/medical practice.
• Managed Care Represented IPA in arbitration against a laboratory, defending against numerous claims and legal theories seeking more than $1.5 million for lab testing performed after termination of the parties’ agreement.
• Medical Malpractice Defended healthcare professionals against medical malpractice claims in binding arbitrations.
• Provider Reimbursement Recovered millions of dollars in unpaid/underpaid claims on behalf of a large hospital provider in arbitration involving numerous local and out-of-state managed care plans concerning thousands of disputed facility claims.
• Provider Reimbursement. Obtained a favorable settlement of all claims for a client laboratory group in arbitration brought against a managed care plan to recover underpaid/unpaid pathology services and testing.

Nelson Hardiman’s team of seasoned litigators and former federal prosecutors zealously protect healthcare and life sciences entities and individuals threatened by business litigation and commercial disputes. We harness our in-depth knowledge of the healthcare industry and related business operations to align our winning litigation strategies with your business objectives.

Recognized leaders in healthcare law, we blend our national reputation for business expertise and deep experience with underlying regulatory issues to tackle the most complex issues in healthcare. We defend mergers and acquisitions, and litigate contract, operational and intellectual property disputes. We channel our passion and focus for healthcare and life sciences to fiercely defend our clients’ business interests. We fight to win.

Our Work Includes:

 Business Litigation Represented a hospital system in a contract dispute over the sale of one of California’s biggest Catholic hospital systems.

• Complex Business Litigation Represented a national health system in a contract dispute with another health system and its management company involving the unsuccessful purchase of five financially distressed nonprofit hospitals.
• Hospital Business Dispute Successfully resolved a breach of contract dispute involving two national hospital systems, after obtaining favorable rulings on motions in limine just days before trial. The complaint sought millions in damages resulting from a failed acquisition of six California hospitals.
• Merger Cases Defended Section 7 cases in US District Court, made Hart-Scott-Rodino and related filings, handled extensive Second Requests, HSR filings, and Civil Investigation Demands.
• Multi-party Business Lawsuit Represented 40 medical marijuana dispensaries and obtained favorable settlements in a multi-party lawsuit filed by the City of Los Angeles.
• Trade Name Dispute. Represented an outpatient surgery center or ASC in an action against a competing ASC for trade name infringement.
• Unfair Competition Obtained terminating sanctions on behalf of client against business competitor for unfair competition and declaratory relief.

Nelson Hardiman’s marquee False Claims Act (FCA) practice has a national reputation for protecting healthcare systems and related entities sued by whistleblowers and/or the federal government under the FCA. Our market-leading litigators defend healthcare entities from charges of submitting false claims for medical services and items to Medicare and other federal healthcare programs in violation of the FCA.

Our legal team blends a wealth of government experience in healthcare fraud with extensive knowledge of complex statutory, regulatory and agency requirements. We harness the dogged determination of dedicated trial lawyers to decisively resolve FCA claims. Our tenacious stance and industry knowledge make Nelson Hardiman the go-to law firm for defending healthcare whistleblower lawsuits.

Our Work Includes:

• Civil Fraud False Claims Act experience includes defending hospitals in complex federal and state FCA actions involving claims for allegedly non-reimbursable, unnecessary or inflated services and costs.
• False Claim Act Won dismissal of lawsuit brought against a hospital when a former patient of the hospital filed as a Relator on behalf of the United States, alleging the hospital defrauded Medicare $35M by billing its facility charge when patients visited their surgeons for follow-up care.
• False Claims Act Won an FCA case decisively on summary judgment for a large Southern California hospital when two whistleblowers from a rival laboratory alleged the hospital’s kidney transplant program had submitted millions of dollars in Medicare claims for duplicative and unnecessary histocompatibility testing for transplant candidates.
• False Claims Act Undermined Relator’s FCA allegation by obtaining favorable deposition testimony demonstrating physician was not involved in an alleged conspiracy to admit psychiatric patients using California involuntary procedure.
• False Claims Act Represent a leading national hospital system in FCA dispute relating to claims for short stay admissions.

Nelson Hardman fiercely defends healthcare providers from devastating allegations of healthcare fraud and abuse on a daily basis. We litigate, case-by-case, through victories and favorable resolutions, every facet of criminal investigations and charges, civil False Claims Act (FCA) fraud and abuse actions.

Few law firms can boast Nelson Hardiman’s experience in defending healthcare providers against allegations of fraud and abuse. Mark Hardiman, who leads Nelson Hardiman’s fraud and abuse practice area, is widely known among healthcare providers as the go-to defense lawyer for difficult and high-stakes Medicare and Medi-Cal fraud cases and is regarded as one of the most prominent fraud and abuse defense attorneys in California.

We have successfully represented countless individual physicians and healthcare facilities against fraud and abuse allegations in many of the leading cases filed in Southern California. And we have won significant victories at trial and on appeal and negotiated countless favorable settlements with federal and state regulatory agencies.

Our Work Includes:

• False Claims Act (FCA) Won an FCA case decisively on summary judgment for a large Southern California hospital when two whistleblowers from a rival laboratory alleged the hospital’s kidney transplant program had submitted millions of dollars in Medicare claims for duplicative and unnecessary histocompatibility testing for transplant candidates.
• Federal Civil RICO Lawsuits Represented multiple providers in major “civil RICO” lawsuits brought by out-of-state health insurance companies against California physicians accused of cooperating with dishonest clinic managers in performing unnecessarily.
• Whistleblower Litigation Advised a national health system in FCA litigation filed by a whistleblower alleging the health system submitted false Medicare claims for inpatient admissions that should have been billed as observation care (“short stay” claims) and/or false diagnoses to increase reimbursement.

Accelerated healthcare reform has transformed the landscape of practice for all healthcare providers and professionals. Nelson Hardiman has first-hand experience in adroitly handling labor and employment disputes that arise in this challenging new environment.

Our litigators defend against claims from all phases of the employment cycle, including peer review, wrongful termination, administrative proceedings, agency investigations and enforcement, licensing and other areas of regulation. From physician contract disputes to professional claims and medical staff issues, we combine business acumen with litigation strengths to provide our healthcare and life sciences clients with labor and employment representation they can count on.

Our Work Includes:

• Benefits Dispute Represented national provider of pharmacy services and patient in federal lawsuit brought against Blue Shield of California and the federal Office of Personnel Management (OPM) for denial of IVIG treatments provided to a federal employee under the Federal Employee Health Benefits Act (FEHBA).
• Contempt Prevailed in a trial on behalf of a provider of assisted living services to the developmentally disabled against a former employee for wrongfully poaching clients.
• Contract Dispute Represented a bariatric surgeon in bringing contract, tort, and Labor Code claims against a former employer/medical practice.
• ERISA Advise numerous healthcare providers on ERISA litigation.
• Medical Staff Defended a medical executive committee’s decision to suspend a physician before a judicial review counsel (JRC), and defended the decision of the JRC before the hospital’s governing board.
• Peer Review Represented a physician in a dispute with a hospital in Riverside County concerning the hospital’s failure to reappoint the physician to the medical staff. Following threats of litigation, the hospital reappointed the physician.
• Unpaid Wages and Healthcare Privacy Laws Successfully represented a pro-bono client and obtained a favorable settlement in a suit against the client’s former employers for unpaid wages and violations of healthcare privacy laws.
• Wrongful Termination Represented an ambulance company in a lawsuit against its outsourced human resource provider and liability insurer due to their failure to defend and indemnify the ambulance company in an underlying wrongful termination lawsuit brought by former employees.
• Wrongful Termination Defended a San Bernardino medical group in a wrongful termination action brought by a former physician employee.

Nelson Hardiman is a leader in reimbursement litigation for healthcare providers ranging from large hospitals to individual physicians. Because our talented litigators have a firm grasp on federal and state healthcare regulatory law, we frequently represent both providers who are suing to obtain payment and providers defending claims that they have been overpaid for health care services.

We are one of the most experienced firms in Southern California handling Medicare and Medi-Cal administrative proceedings. We litigate against insurance companies in state and federal court and in arbitration proceedings. We represent hospitals suing health plans and defend physician practices against reimbursement litigation by insurers. We obtain drastic reductions of overpayment claims, with a track record of success built on in-depth knowledge of the agencies, their reimbursement policies, and our integration of problem-solving skills and expert resources. While we fiercely litigate on behalf of healthcare providers, Nelson Hardiman also works hard to resolve disputes with federal healthcare programs and healthcare payors. We meet regularly with decision-makers and administrative agencies to reach consensus on reimbursement-related disputes.

Our Work Includes:

• Administrative Hearings We have handled hundreds of Medicare and Medi-Cal administrative proceedings.
• Arbitration Recovered millions of dollars in unpaid/underpaid claims on behalf of a large hospital provider involving numerous local and out-of-state managed care plans concerning thousands of disputed facility claims.
• Ambulatory Surgery Center (ASC) Represented an ASC in out-of-network “fee forgiveness” action against a major insurance company, pursuing more than $3 million for claims improperly denied based on claim that surgery center “forgave” patient contribution as inducement for using out-of-network facility.
• Civil Fraud Defended hospitals in complex federal and state FCA actions involving claims for allegedly non-reimbursable, unnecessary or inflated services and costs.
• Hospital Reimbursement Achieved a favorable settlement recovering hundreds of thousands of dollars for a client hospital in a “reasonable and customary” dispute involving an out-of-network capitated medical group payor.
• Laboratory Reimbursement Obtained a favorable settlement of all claims for a client laboratory group in arbitration brought against a managed care plan to recover underpaid/unpaid pathology services and testing.
• Overpayment Investigations Supervised internal investigations of federal healthcare benefit over-payments and voluntary disclosures to the U.S. Department of Health & Human Services’ Office of Inspector General and the Center for Medicare and Medicaid Services.
• Provider Reimbursement Helped a client hospital provider recover from a national insurance company refusing to pay for services based on insured’s alleged preexisting condition.

Nelson Hardiman’s world class team has comprehensive knowledge of the legal system to win writs and appeals for healthcare providers. In dealing with healthcare agencies, our writ proceedings compel compliance with the law. Widely recognized for our appellate practice, we have won landmark decisions for physicians and hospitals. As a leader in healthcare law, Nelson Hardiman’s pioneering use of writ proceedings and our appellate victories have established precedents that challenge administrative actions and expand the rights of healthcare providers.

Writs

At the state level, Nelson Hardiman handles writs of mandamus and administrative mandate proceedings against state agencies. At the federal level, Nelson Hardiman masterminds writ proceedings for clients who have no other options.

Appeals

Nelson Hardiman has made significant contributions to the development of California healthcare law in state and federal appellate courts. We represent physicians and other healthcare providers in appeals concerning peer review, medical staff privileges, and rights against federal, state, and local government and third-party payors. Our highly skilled litigators have garnered precedent-setting appellate victories to resolve the legal challenges of healthcare providers.

Our Work Includes:

• Amicus Briefs We are frequently requested to file amicus briefs in leading healthcare cases.
• Claims Against Healthcare Network Persuaded the Ninth Circuit Court of Appeals that a physician may pursue state law claims against a healthcare network that had filed for bankruptcy. (Pomona Valley Medical Group, Inc. (2007))
• Hospital Appeal Reinstated a lawsuit against an insurance company (San Joaquin Hospital v. Pacificare)
• Landmark Appellate Victory Won a landmark victory in the California Supreme Court that established the precedent that a physician has a right to a hearing before being terminated or deselected by HMOs and insurance companies. (Potvin v. Metropolitan Life Insurance Company (2000))
• Physicians’ Rights Established the right of a physician to a hearing when his application for staff privileges was denied. (Hayes v. Cedars Sinai (2004))
• Physicians’ Rights Won a victory clarifying that the medical staff may not discipline a physician for wrongdoing unless they prove the allegations by a preponderance of the evidence. (Bode v. Los Angeles Metropolitan Medical Center (2009))
• Staff Privileges Established the right of a physician to maintain staff privileges at a hospital, while facing non-reappointment, until all internal remedies under the medical staff bylaws are exhausted. (Sahlolbei v. Providence Healthcare (2003))

Nelson Hardiman provides pro-active counsel, independent of in-house counsel, to consult on peer review matters, represent medical staff in hearings, conduct interviews and discovery before litigation, and provide legal representation of medical staff during litigation and on appeal.

We also consult with the Chief of Staff or designee on:

• Medical staff bylaws
• Medical board/NPDB reporting
• Peer review activities including interviews, meetings, selection
• Complaints of unprofessional conduct
• Disruptive physician incidents
• Fair Hearing and Judicial Review Committee hearings
• Election of officers
• License discipline
• Membership applications

Early involvement of dedicated medical staff counsel provides protection for future challenges to the peer review process.

For more information or to speak with an attorney, please call 877.246.6423 or submit a contact form: