“Focused on Health Care from the Provider’s Perspective”
Attorneys at the forefront of health care insurance litigation
Axelrod LLP exclusively represents individual
healthcare provider clients.
We represent physicians, chiropractors, provider practice groups, hospitals, medical device and durable medical equipment suppliers, and provider contracting companies - against health insurers. We have been defending doctors and other health care providers against insurance company tactics for 20 years. Our attorneys create innovative legal strategies, not only in litigation, mediation and arbitration, but in internal appeals and transactional work, including negotiating participating provider agreements.
We win cases without destroying the underlying
Understanding the viewpoint of both sides, we are able to effectively resolve disputes involving complex health insurance matters, including medical necessity denials, experimental and investigational denials, recoupments and offsets, misrepresentation claims, and fraud and abuse charges. While preserving the delicate, continuing relationship between health care providers and insurers, we have made new law on behalf of our clients particularly in the areas of recoupments and offsets.
In Long Island Neurosurgical Associates, P.C. v. Highmark Blue Shield, the Court denied Highmark's motion to dismiss this ERISA action based on an anti-assignment provision. In this case, Highmark relied on a provision in its Administrative Services Agreement ("ASA") with a self-funded plan, not the Summary Plan Description ("SPD"). We argued, successfully, that because the ASA was not itself an ERISA plan document like a SPD it could not be used as the basis to challenge the assignment to the Plaintiff. The Court agreed.
Eleventh Circuit Court of Appeals affirms District Court decision holding that Blue Cross Blue Shield defendants are subject to per se standard of review in In Re: Blue Cross Blue Shield Antitrust Litigation (MDL 2406).
Axelrod LLP successfully resolved an action concerning termination of insurance coverage.
Court holds that Blue Cross Blue Shield defendants are subject to per se standard of review in In Re: Blue Cross Blue Shield Antitrust Litigation (MDL 2406).
“We represent health care providers against health insurers. We do not represent health care insurers. We consider it a conflict of interest to do so.”
Insurer Tactics"The Special Investigations Unit of Blue Cross Blue Shield of Rhode Island – led by a lead investigator (and former member of the FBI), a senior medical director, and in-house counsel – interrogated our client in his office. As characterized by the Court at trial, while the investigator called it a 'friendly chat,' it was 'really a fraud investigation in sheep’s clothing.'”
Blue Cross Blue Shield of R.I. v. Korsen, 945 F. Supp. 2d 268 (D.R.I. 2013)