We help healthcare professionals and medical practices navigate the complex credentialing procedures necessary to participate in third-party payer networks, including Medicare, Medicaid, and private insurers (e.g., Aetna, Blue Cross/Blue Shield, US Healthcare, etc.). We also represent practitioners in connection with insurance company claims of overpayment and upcoding, as well as de-credentialing, re-enrollment, placement on the Preclusion List, and related proceedings and administrative actions.
Among recent matters, our lawyers have:
- Brought about the successful reinstatement of physicians following the revocation of their credentials to participate in an insurance network
- Negotiated multiple settlement agreements with various insurance providers regarding alleged overpayments to a practitioner
- Successfully prosecuted an injunction requiring an insurance company to reinstate a provider and to reimburse well over $150,000 for claims previously denied
- Represented physicians in disputes regarding payment with insurance providers