The Future of Provider vs. Payor Disputes

May 2, 2017 4:30pm

Elizabeth Monohan
Assistant General Counsel
Humana Inc

Tony Rodriguez
Senior Counsel
Kaiser Foundation Health Plan

Kevin Feder
O'Melveny & Myers LLP

Jeffrey S. Gleason
Robins Kaplan


Geoffrey M. Sigler
Gibson, Dunn & Crutcher LLP

  • Lawsuits with out-of-network providers and the confusion over contracts
  • Disputes between MCOs and third party payors
  • Hospital suits against MCOs
    • Handling suits from hospitals who believe they were underpaid
    • Fights over emergency room payments
    • Handling improper overnight stays and other types of overbilling
  • Emerging trend of health plans being the plaintiff rather than the defendant