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Practices
Healthcare
Sedgwick's Healthcare Practice Group offers a comprehensive array of legal services for a rapidly changing healthcare industry. Sedgwick traditionally has been known best for its premier trial expertise, particularly in the area of managed care litigation. However, in response to identified client needs, the group has expanded its emphasis to include transactional, operational, legislative and regulatory matters. In addressing these areas, we counsel clients in a manner that ensures their compliance with current and anticipated statutes and regulations, while at the same time remaining sensitive to clients' business realities and constituent concerns. In resolving disputes, we manage cases efficiently by performing thoughtful and candid case assessment and analysis and by employing cost-effective strategies consistent with client priorities.
Sedgwick's Healthcare Practice Group offers a comprehensive array of legal services for a rapidly changing healthcare industry. Sedgwick traditionally has been known best for its premier trial expertise, particularly in the area of managed care litigation. However, in response to identified client needs, the group has expanded its emphasis to include transactional, operational, legislative and regulatory matters. In addressing these areas, we counsel clients in a manner that ensures their compliance with current and anticipated statutes and regulations, while at the same time remaining sensitive to clients' business realities and constituent concerns. In resolving disputes, we manage cases efficiently by performing thoughtful and candid case assessment and analysis and by employing cost-effective strategies consistent with client priorities.
Sedgwick's Healthcare Practice Group is a dynamic, marketplace-focused team that fully appreciates that healthcare is among the most regulated, fastest-paced industries in the country. We are experienced attorneys, many with backgrounds in healthcare delivery and administration and/or who have served in-house as counsel to major managed care entities and professionals.
Our clients reflect the diversity of the industry as a whole and include: healthcare payors (e.g., integrated health delivery systems, health plans, insurers, HMOs, PPOs, dental plans, self-funded ERISA plans, and mental and behavioral health plans), providers (e.g., hospitals, medical groups and IPAs), contracting entities (e.g., MSOs), and other involved organizations and entities. The fact that our Healthcare Practice does not represent a single constituent group strengthens its ability to assist in the shaping of intergroup solutions.
Sedgwick's Healthcare Practice Group effectively counsels clients in the principal substantive areas impacting the healthcare industry. Our attorneys assist clients in developing contracting policies and procedures and template and customized agreements for both commercial and Medicare products. We analyze and interpret proposed and newly enacted laws and regulations, as well as new court decisions influencing the healthcare industry. We advocate on behalf of clients before state and federal agencies in non-contested healthcare matters, including regulatory filings, audits, and investigations.
Representative counseling and advice issues include:
-
Regulatory compliance
-
Risk assessment and management
-
Audits and investigations
-
Fraud and abuse
-
Provider contracting
-
Corporate strategic initiatives
-
Business transactions
-
Corporate restructuring
-
Executive compensation and benefits
-
Administrative matters
-
Provider terminations and insolvencies
-
Legislative initiatives (including HIPAA, ADA, Medicare Part D, MMA and others)
-
Peer review
-
Grievances and appeals
-
Licensing
-
Coverage issues, including professional liability, E&O, etc.
-
Antitrust matters
Contested Matters
Our attorneys have a solid understanding of the complex medical and legal issues that arise in contested healthcare matters. We have effectively represented large healthcare companies in multimillion-dollar disputes and complex class action suits. We have upwards of two decades' experience defending healthcare entities and individuals in professional malpractice matters and have extensive background in managed care litigation and complex healthcare business litigation. We are well-versed in healthcare issues pertaining to utilization review, reimbursement, bad faith, ERISA, hospital-physician risk pools, provider billing practices, credentialing, and alleged negligent medical care. Through the years, we have successfully litigated numerous cases on behalf of healthcare clients in trial courts and binding arbitration and have represented clients in mediation and other alternative dispute resolution. We have also represented clients in administrative proceedings before state regulatory agencies.
Representative contested matters include:
-
Breach of contract
-
Bad faith
-
HIPAA compliance
-
MMA
-
Medical malpractice
-
ERISA
-
Elder abuse
-
Unlawful business practices
-
Reimbursement disputes
-
Complex business litigation
-
Benefits and claims determinations
-
Privacy claims
-
Bankruptcy preference actions
-
Wrongful death
Appellate Matters
Sedgwick's Healthcare Practice Group represents clients at every level of the appellate court system, both state and federal, up to and including the U.S. Supreme Court. Our appellate attorneys bring much needed savvy, tenacity and creativity to the table. All have practiced at the trial level, providing them with a firm grasp of the legal dilemmas that originate there. They apply a sensible "big picture" perspective to this practice as they plan and coordinate high-level appellate strategies. We both represent new clients who turn to Sedgwick after suffering adverse outcomes at the trial court level and defend trial court victories secured by our own outstanding litigators.
Representative appellate matters include:
-
Substantive healthcare disputes
-
Managed care
-
ERISA
-
Insurance coverage and bad faith
-
Punitive damages
-
Business torts, including fraud and unfair competition
-
Malicious prosecution and anti-SLAPP motions
-
Preemption
Seminars and Publications
Our attorneys pride themselves in keeping our clients apprised of emerging healthcare issues. We regularly present seminars on cutting-edge topics for health-related professional organizations, as well as for our clients. Our attorneys frequently publish articles in leading healthcare and legal publications on substantive, timely healthcare issues. Additionally, we write, edit and publish the Healthcare Law Newsletter, a quarterly update for our clients that features articles by our attorneys on significant developments affecting the healthcare industry.
Our books and treatises include the Healthcare Liability Deskbook, published by The West Group, and State Law Challenges in Managed Care, which is published as part of the treatise, and Managed Care Litigation, a 2005 desk reference for managed care attorneys and executives published by BNA Books in conjunction with the ABA Health Law Section. Sedgwick also published the Handbook for Management and Resolution of Hospital Malpractice Claims to assist risk management personnel in resolving claims brought against their institutions.
Affiliations, Activities and Accomplishments
Sedgwick's Healthcare Practice Group's accomplished attorneys are actively engaged leaders in various healthcare legal organizations. Collectively, our attorneys hold leadership positions in and/or are members of the following organizations, among others: the American Bar Association, Health Law Section, American Health Lawyers Association, American Society for Healthcare Risk Management, Association of Business Trial Lawyers, California Society for Healthcare Attorneys, Federal Bar Association, and the Defense Research Institute.
Sedgwick's Healthcare Practice Group offers a comprehensive array of legal services for a rapidly changing healthcare industry. Sedgwick traditionally has been known best for its premier trial expertise, particularly in the area of managed care litigation. However, in response to identified client needs, the group has expanded its emphasis to include transactional, operational, legislative and regulatory matters. In addressing these areas, we counsel clients in a manner that ensures their compliance with current and anticipated statutes and regulations, while at the same time remaining sensitive to clients' business realities and constituent concerns. In resolving disputes, we manage cases efficiently by performing thoughtful and candid case assessment and analysis and by employing cost-effective strategies consistent with client priorities.
Sedgwick's Healthcare Practice Group is a dynamic, marketplace-focused team that fully appreciates that healthcare is among the most regulated, fastest-paced industries in the country. We are experienced attorneys, many with backgrounds in healthcare delivery and administration and/or who have served in-house as counsel to major managed care entities and professionals.
Our clients reflect the diversity of the industry as a whole and include: healthcare payors (e.g., integrated health delivery systems, health plans, insurers, HMOs, PPOs, dental plans, self-funded ERISA plans, and mental and behavioral health plans), providers (e.g., hospitals, medical groups and IPAs), contracting entities (e.g., MSOs), and other involved organizations and entities. The fact that our Healthcare Practice does not represent a single constituent group strengthens its ability to assist in the shaping of intergroup solutions.
Sedgwick's Healthcare Practice Group effectively counsels clients in the principal substantive areas impacting the healthcare industry. Our attorneys assist clients in developing contracting policies and procedures and template and customized agreements for both commercial and Medicare products. We analyze and interpret proposed and newly enacted laws and regulations, as well as new court decisions influencing the healthcare industry. We advocate on behalf of clients before state and federal agencies in non-contested healthcare matters, including regulatory filings, audits, and investigations.
Representative counseling and advice issues include:
-
Regulatory compliance
-
Risk assessment and management
-
Audits and investigations
-
Fraud and abuse
-
Provider contracting
-
Corporate strategic initiatives
-
Business transactions
-
Corporate restructuring
-
Executive compensation and benefits
-
Administrative matters
-
Provider terminations and insolvencies
-
Legislative initiatives (including HIPAA, ADA, Medicare Part D, MMA and others)
-
Peer review
-
Grievances and appeals
-
Licensing
-
Coverage issues, including professional liability, E&O, etc.
-
Antitrust matters
Contested Matters
Our attorneys have a solid understanding of the complex medical and legal issues that arise in contested healthcare matters. We have effectively represented large healthcare companies in multimillion-dollar disputes and complex class action suits. We have upwards of two decades' experience defending healthcare entities and individuals in professional malpractice matters and have extensive background in managed care litigation and complex healthcare business litigation. We are well-versed in healthcare issues pertaining to utilization review, reimbursement, bad faith, ERISA, hospital-physician risk pools, provider billing practices, credentialing, and alleged negligent medical care. Through the years, we have successfully litigated numerous cases on behalf of healthcare clients in trial courts and binding arbitration and have represented clients in mediation and other alternative dispute resolution. We have also represented clients in administrative proceedings before state regulatory agencies.
Representative contested matters include:
-
Breach of contract
-
Bad faith
-
HIPAA compliance
-
MMA
-
Medical malpractice
-
ERISA
-
Elder abuse
-
Unlawful business practices
-
Reimbursement disputes
-
Complex business litigation
-
Benefits and claims determinations
-
Privacy claims
-
Bankruptcy preference actions
-
Wrongful death
Appellate Matters
Sedgwick's Healthcare Practice Group represents clients at every level of the appellate court system, both state and federal, up to and including the U.S. Supreme Court. Our appellate attorneys bring much needed savvy, tenacity and creativity to the table. All have practiced at the trial level, providing them with a firm grasp of the legal dilemmas that originate there. They apply a sensible "big picture" perspective to this practice as they plan and coordinate high-level appellate strategies. We both represent new clients who turn to Sedgwick after suffering adverse outcomes at the trial court level and defend trial court victories secured by our own outstanding litigators.
Representative appellate matters include:
-
Substantive healthcare disputes
-
Managed care
-
ERISA
-
Insurance coverage and bad faith
-
Punitive damages
-
Business torts, including fraud and unfair competition
-
Malicious prosecution and anti-SLAPP motions
-
Preemption
Seminars and Publications
Our attorneys pride themselves in keeping our clients apprised of emerging healthcare issues. We regularly present seminars on cutting-edge topics for health-related professional organizations, as well as for our clients. Our attorneys frequently publish articles in leading healthcare and legal publications on substantive, timely healthcare issues. Additionally, we write, edit and publish the Healthcare Law Newsletter, a quarterly update for our clients that features articles by our attorneys on significant developments affecting the healthcare industry.
Our books and treatises include the Healthcare Liability Deskbook, published by The West Group, and State Law Challenges in Managed Care, which is published as part of the treatise, and Managed Care Litigation, a 2005 desk reference for managed care attorneys and executives published by BNA Books in conjunction with the ABA Health Law Section. Sedgwick also published the Handbook for Management and Resolution of Hospital Malpractice Claims to assist risk management personnel in resolving claims brought against their institutions.
Affiliations, Activities and Accomplishments
Sedgwick's Healthcare Practice Group's accomplished attorneys are actively engaged leaders in various healthcare legal organizations. Collectively, our attorneys hold leadership positions in and/or are members of the following organizations, among others: the American Bar Association, Health Law Section, American Health Lawyers Association, American Society for Healthcare Risk Management, Association of Business Trial Lawyers, California Society for Healthcare Attorneys, Federal Bar Association, and the Defense Research Institute.
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Activities
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