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Dedicated Client Representation

Lacey & Lyons has a team of attorneys that focus on healthcare law and litigation. We represent a range of clients - from large clinics and hospitals to individual patients.

Our experience representing hospitals and physician groups includes mergers, acquisitions, the purchase and sale of practices, joint ventures between medical facilities, affiliation agreements for hospitals and medical groups, integrated delivery system formation and extended care facilities.

We work diligently and strive to meet our health care clients’ goals. Our team offers advice about medical claims, including billing practices, over payment, reimbursement and risk funds. We also have experience handling employment-related challenges and can handle dispute resolutions for healthcare industry organizations.

In many healthcare claims, alternative dispute resolution services are an attractive alternative to traditional litigation, which can be costly and result in a trial or appeal. We can assist in overcoming conflicts that relate to health plans, insurance, non-government and managed care reimbursements, non-compete covenants, medical intellectual property and fund discord claims.

Payor-Provider Medical Disputes

Lacey & Lyons has experience representing medical providers in a variety of payor disputes. We work with the following types of providers: hospitals, ambulatory surgery centers, freestanding diagnostic facilities, behavioral health providers, nursing facilities, treatment facilities, adult care facilities, continuing care clinics, dialysis providers, home health and hospice agencies, clinical laboratories and physician groups.

We have experience handling the following types of payor disputes:

  • Disputes against commercial insurance payors, such as:
    • State and federal court lawsuits that relate to contract term interpretations
    • ERISA and non-ERISA claims
  • Disputes against managed care organizations, including:
    • Disputes with Medicare Advantage Organizations (MAO) over Medicare Advantage (MA) contract interpretation issues that arise
    • Conventional care disputes including the rate of payment and right of payment disputes
    • Lawsuits that challenge whether PPOs satisfy PPO definitions under state statutes
    • Lawsuits where state laws require reimbursements for certain types of medical services
  • Payor vs. out-of-network provider disputes, including:
    • ERISA and non-ERISA claims
    • Copays and other types of cost-sharing waivers
    • Experimental or investigational treatments
    • Customary, reasonable and unusual charges
  • Disputes against state Medicaid agencies, such as:
    • Cost report challenges
    • Agency payment denials
    • Agency recoupment efforts
    • Enrollment disputes
  • False Claims Act disputes
  • Appeals of State Medicaid audits and CMS Medicare
  • Medicare disputes before the Medicare Administrative Contractors, Departmental Appeals Board, medicare Appeals Council and the Federal Administrative Law Judges

Schedule a Consultation

Our attorneys have extensive experience handling a wide variety of complicated healthcare disputes and litigation. Whether you are a business, company, organization or an individual that needs assistance defending your rights, our attorneys are standing by to assist you.

Lacey & Lyons adhere to the highest legal standards, focusing on integrity and producing high-quality work. We treat each client like family, focusing on building long-term working relationships. Contact us today to schedule a case evaluation.

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