Reimbursement

Fenton Nelson is a leader in the representation of health care providers–from large hospitals to individual physicians–in reimbursement litigation.  We frequently represent both providers who are suing to obtain payment and providers defending claims that they have been overpaid for health care services.

With respect to Medicare and Medi-Cal (Medicaid) reimbursement, we are one of the most experienced firms in Southern California in handling Medicare and Medi-Cal administrative proceedings.  Collectively, we have handled literally hundreds of administrative hearings before Medicare and Medi-Cal administrative law judges, and have earned a reputation for unparalleled results in these hearings.  We have obtained drastic reductions of overpayment claims on behalf of physician groups, home health agencies, hospices, durable medical equipment suppliers, ambulance companies, and imaging centers. Our record of success has been built based on a hard-earned in-depth knowledge of the agencies and their rules, their reimbursement policies, and our integration of problem-solving skills and the highest quality expert resources.

We frequently handle litigation against insurance companies in both federal and state courts and in arbitration proceedings.  We have represented hospitals suing health plans and have defended many physician practices against reimbursement litigation by insurance companies. 

While we are glad to represent health care providers in court and administrative hearings, Fenton Nelson also believes that providers can often be better served by negotiating and resolving disputes with federal health care programs and private health care payors.  We meet regularly with decision-makers and administrative agencies to review and attempt to reach informal agreement on reimbursement-related disputes.