The attorneys of Abramson & Abramson devote a large portion of their practice to representing physicians, fellows, residents, medical students, and healthcare professionals in connection with licensing, credentialing (hospital and insurance), claims of irregular behavior, and various other healthcare-related and healthcare professional-related disputes. Having handled due process hearings before state licensing boards and hospitals, Medicare and Medicaid reimbursement and provider credentialing issues, defense of state and federal criminal proceedings and Federal False Claim Act penalty cases, the firm has significant experience navigating this complicated landscape.
As part of this practice, we represent:
- Physicians in disputes regarding payment with insurance providers
- Physicians in disputes with hospitals regarding credentialing, re-credentialing, and employment agreements
- International Medical Graduates (IMGs) in connection with disputes and issues with the Educational Commission for Foreign Medical Graduates (ECFMG)
- Physicians and medical students in disputes with the National Resident Matching Program (NRMP), including the defense of Match Violator allegations
- Physicians in disputes with the National Board of Medical Examiners (NBME) and the United States Medical Licensing Examination (USMLE) Program, including the defense of allegations of irregular behavior
Representative engagements include the following:
- Obtained an injunction against the Educational Commission for Foreign Medical Graduates, resulting in the reinstatement of the physician’s ECFMG certificate
- Negotiated a settlement on behalf of a physician who became embroiled in a dispute with a hospital over medical office space
- Defended a physician alleged to have engaged in irregular behavior, resulting in no adverse action taken against the physician by ECFMG, NRMP or the Electronic Residency Application Service (ERAS), and no report to the Federation of State Medical Boards (FSBM)
- Defended clients in nearly two dozen Medicare and Medicaid fraud criminal trials
- More than two dozen hearings before federal, state and administrative agencies, including licensing, DEA participation, Medicare and Medicaid participation
- Defended and negotiated numerous Federal False Claims Act claims and proceedings
- Represented physicians in more than 25 disputes with hospitals involving credentialing, restrictive covenants, contract buy-outs, fair hearings and the like
- Caused physicians threatened with termination from a hospital staff to be retained, without any negative Practitioner Databank consequences
For most physician practices, insurance reimbursement is critical to financial success. When doctors and medical groups face battles with insurers to obtain full and fair payment for insurance claims, they not only risk loss of revenue, but they spend valuable time and resources attempting to collect on those claims.
We help healthcare practices recover revenues from wrongfully denied, reduced or delayed reimbursement from insurance companies. We also assist physicians and other healthcare professionals in avoiding the appearance of impropriety, including providing a strong defense in matters involving a variety of fraud and abuse, anti-kickback and False Claims Act audits, investigations and enforcement proceedings.
Among other matters, our lawyers have:
- Successfully prosecuted an injunction requiring an insurance company to reinstate a provider and to reimburse well over $150,000 for claims previously denied
- Negotiated multiple settlement agreements with various insurance providers regarding alleged overpayments to a practitioner
Billing and coding are extremely complicated areas of the law. Now more than ever, healthcare practitioners must be vigilant and avoid billing and coding mistakes that could inadvertently put their practices at risk for Medicare and Medicaid audits and fines, allegations of fraud, or expose them personally to licensing investigations, fines or even imprisonment.
We help physicians, healthcare professionals and physician practices avoid the appearance of impropriety by offering comprehensive litigation-prevention counsel. When fraud and abuse audits, investigations, or other proceedings arise, we draw on our trial and negotiation experience to provide a strong defense.
Among other matters, our lawyers have:
- Represented clients in dozens of Medicare and Medicaid fraud criminal trials
- Represented clients before federal, state and administrative agencies in numerous hearings involving licensing, DEA participation, Medicare and Medicaid participation, and other issues
- Defended clients in—and negotiated favorable solutions to—a broad range of Federal False Claims Act claims and proceedings
MEDICARE AND INSURANCE PROVIDER CREDENTIALING
We assist healthcare providers with enrollment and re-enrollment In Medicare and in credentialing disputes with Medicare, CMS, and its contracted partners.
What is at stake when a medical student, medical school graduate or medical professional receives a letter informing them that they are alleged to have engaged in irregular behavior? Put simply, everything. A finding of irregular behavior can result in disciplinary action taken by the Educational Commission on Foreign Medical Graduates (ECFMG®), the National Board of Medical Examiners (NBME), the National Residency Match Program (NRMP) and other gatekeepers to a career in medicine.
We represent medical students, residents, interns, fellows and practitioners facing the full range of administrative and legal actions. When representing our clients, we advocate that no finding of irregular behavior be made, or, where appropriate, that the punishment accompanying such a finding be proportionate and fair. In all proceedings, we are mindful to preserve the record for potential subsequent judicial review.
Our attorneys have:
- Represented numerous physicians in disputes regarding board certifications and certification eligibility
- Obtained an injunction against the Educational Commission for Foreign Medical Graduates, resulting in the reinstatement of a physician’s ECFMG certificate
- Defended a physician alleged to have engaged in irregular behavior, resulting in no adverse action taken against the physician by ECFMG, NRMP or the Electronic Residency Application Service (ERAS)
- Represented International Medical Graduates in disputes with the Educational Commission for Foreign Medical Graduates (ECFMG)
- Represented physicians in disputes with the National Board of Medical Examiners (NBME) and United States Medical Licensing Examination (USMLE)
- Represented medical students in opposing residency program Match commitment waiver requests, resulting in NRMP’s denial of the residency program’s request, thus requiring the program to permit our client to train in its program
- Represented medical students seeking waiver from their Match commitment, resulting in NRMP granting the request and making no finding of a Match Violation
- Represented physicians accused of having unfair advantage on the American Board of Internal Medicine (ABIM) Board Certification Examination, resulting in no finding of improper or irregular behavior, no loss of board eligibility, and permitting the physician to retake the examination that revealed an anomalous result
- Represented an IMG accused of submitting a falsified document to ECFMG before ECFMG’s Medical Education Credentials Committee (MECC), resulting in a finding of no irregular behavior
- Represented IMG and successfully obtained exception to ECFMG rule requiring first-hand, primary source verification where IMGs medical school diploma could not be primary source verified
- Obtained reconsideration and reversal of IMGs permanent bar from obtaining ECFMG Certification
- Represented medical students and medical school graduates accused by the USMLE Program of irregular behavior for soliciting and/or providing examination content via social media and message boards
- Represented examinees accused of having Step 2 CS exam content prior to the examination, resulting in no finding of irregular behavior and release of exam score
If you have a healthcare litigation matter, contact our attorneys to learn your legal options.