Overview
Overview
O’Hagan Meyer’s Payer Disputes & Managed Care Litigation team handles complex reimbursement, benefits, and contract disputes involving healthcare providers, managed care organizations, health plans, insurers, and related entities. Our lawyers possess sophisticated litigation capabilities coupled with extensive experience in healthcare operations, insurance, and managed care disputes.
We represent our clients in a wide variety of matters, including:
- Coverage determinations, claim denials, and underpayment disputes
- Reimbursement methodology challenges, audits, and audit appeals
- Overpayment recoupment actions
- Medical necessity and benefits disputes
- Provider network participation and termination issues
Our team excels at handling large-scale document discovery, layered contract interpretation, and fact-intensive disputes concerning payment practices, utilization review determinations, and coverage obligations. We guide clients through audits, investigations, regulatory proceedings, and litigation involving contested reimbursement decisions, provider network arrangements, and payer-provider relationships.
Clients value our combined experience in healthcare litigation, insurance coverage disputes, managed care litigation, and complex commercial litigation, which enables us to evaluate disputes through both contractual and operational lenses. Our attorneys regularly defend payment denials, network termination decisions, and recoupment actions, as well as class action lawsuits involving benefits administration, reimbursement practices, and medical necessity determinations.
On the insurance and managed care side, our experience with claims handling, coverage determinations, utilization review, and payment obligations provides a practical framework for analyzing reimbursement decisions and denial rationales. On the provider side, we represent hospitals, health systems, physician groups, and other healthcare entities in billing disputes, audit responses, reimbursement litigation, and related regulatory matters. This cross-disciplinary perspective informs litigation strategy and dispute resolution at every stage of a matter.
Our practice also draws on the firm’s broader commercial litigation, insurance defense, and class action capabilities to address both individual disputes and systemic reimbursement and managed care challenges. With a national platform, we are well-positioned to handle multijurisdictional matters involving payer networks, provider systems, and evolving healthcare reimbursement models, and our streamlined staffing and efficient case management help contain costs while delivering results.
