Managed Care

For more than a decade, the Health and Managed Care Litigation practice group at Wiedner & McAuliffe has successfully defended companies involved in the health and managed care industry. Our attorneys have numerous years of experience in representing managed care companies in lawsuits arising out of the relationship between preferred provider organizations, healthcare providers, insurers, and third party participants in the growing sector of managed healthcare. Our lawyers have significant experience in defending our clients against personal injury, commercial claims and putative class actions throughout the United States. Our Health and Managed Care Litigation practice group has substantial litigation experience in defending payors, payor clients, administrators and insurers against breach of contract, quasi-contract and fraud-based claims brought by PPO medical providers for discounted payment, non-payment and delayed payment. Wiedner & McAuliffe frequently defends cases involving contractual and quasi-contractual disputes between providers and insurers, payors, or third party administrators. Wiedner & McAuliffe’s attorneys are familiar with the billing and coding rules developed by the American Medical Association and Medicare and have successfully defended claims involving discounted or eliminated charges claimed by providers pursuant to coding guidelines. Wiedner & McAuliffe’s attorneys also defend clients against claims based on pre-certification of medical procedures and issues involving medical necessity. In addition to litigation, our lawyers also assist managed care clients in reviewing and drafting contracts and counsel clients on regulatory compliance in the healthcare industry.

Wiedner & McAuliffe’s attorneys are knowledgeable regarding every aspect of the law impacting companies in the managed care industry. Our lawyers understand the healthcare and insurance industry. We regularly handle cases that require an in-depth understanding of the interplay between tort and contractual liability as well as federal and state statutory requirements. Our attorneys are well-versed in federal preemption arguments to take full advantage of the protections available under state and federal statutes. We understand the importance of identifying the state and federal laws that provide the best defenses as well as identifying the most favorable forum at the outset of the case.

Wiedner & McAuliffe is committed to providing clients with outstanding service and innovative fact-specific solutions for each case. We place a strong emphasis on developing an effective strategy for case resolution at the outset of a claim and pursue the earliest opportunities to achieve the preferred outcome. We are committed to providing clients with frequent and open communication to ensure that our clients are closely involved in our defense strategy. We are also committed to resolving claims in a timely and cost-efficient manner.