• Merger: Represented VEP Healthcare Inc. in Its Merger with US Acute Care Solutions
• Acquisition: Advised large medical groups on multi-million-dollar, multi-state acquisitions.*
• Addiction Treatment Facility Compliance: Developed policies and procedures for substance abuse providers relating to marketing, referrals, and payor relationships to ensure compliance with federal and state regulations.*
• Claim Underpayment: Obtained a favorable result on behalf of a provider against a county-organized health system that systematically down-coded and underpaid thousands of claims. The case led to a string of newspaper articles and the resignation of several individuals.*
• Coding Dispute: Served as co-counsel in Florida to a nationwide group of radiologists against major health plans concerning a significant coding dispute.*
• Hospital Provider Dispute: Represented a pathologist who staffed a pathology department at a hospital in Portland, Oregon. The doctor had a contract with the hospital, which was supposed to give him data so he could bill for a certain type of service. They repeatedly delayed providing the data and, once they did, shut it off without warning due to alleged patient complaints. Shortly after we instituted arbitration, we mediated the case and the hospital offered $50,000. One week before arbitration, they conceded liability but only offered $300,000. Mr. Selesnick aggressively arbitrated the case in Portland and received an award that will total nearly $1.3 million with attorneys’ fees and costs.*
• Managed Care Liability: In Centinela-Freeman Emergency Medical Associates v. Health Net of California, our clients – a large medical group – staffed the emergency room at multiple hospitals. La Vida, an Independent Physician Association (IPA), sent many patients to the ER, but was struggling financially and failed to reimburse the ER doctors before going out of business. Mr. Selesnick and his team sued every major HMO in California, alleging that they knew that La Vida could not pay its bills. The trial court sustained the HMOs’ demurrer to the ER doctors’ complaint without leave to amend, finding that the HMOs could delegate their responsibility to IPAs with immunity. In a unanimous published decision, the Court of Appeals reversed the trial court and held in favor of the ER doctors. Finding the HMOs’ conduct demonstrated negligence and showed a degree of “callousness,” the court ruled that negligent delegation is a viable cause of action in California. This case is currently pending before the California Supreme Court.*
• Managed Care Liability: In Prospect Medical Group v. Northridge Emergency Medical Group, et al. (2009), 45 Cal.4th 497, one of California’s most controversial decisions, we convinced the California Supreme Court to hold that patients cannot be billed when their HMOs fail to pay, and affirmed the provider’s right to seek reasonable reimbursement.*
• Nationwide Physicians’ Claim: Represented a health care company on behalf of approximately 50,000 physicians in a $94 million nationwide claim against a major payor.*
• OIG Investigation: Represented a large provider in an Office of Inspector General (OIG) coding investigation, obtaining a total dismissal for his client.*
• Provider Reimbursement: In Centinela-Freeman Emergency Medical Associates, et al., v. Hispanic Physicians IPA Medical Corporation, Mr. Selesnick represented an emergency physician group against a managed care organization. The IPA systematically underpaid or completely denied payment for emergency services provided by our client to its members. On the eve of trial, the judge ordered the parties to participate in a mandatory settlement conference. The parties were able to settle a portion of the claims. However, to provide our clients with a business solution going forward, settlement of a portion of the claims became contingent on arbitrating a case rate for all services. In arbitration, each party was to propose a rate to be paid for each patient visit by any member of the IPA to any of the 10 hospitals in which our clients provide emergency services. The arbitrator found in favor of the emergency providers.*
• Provider Reimbursement: In this seminal case (one of the health care industry’s most significant decisions), Bell v. Blue Cross of California (2005), 131 Cal.App.4th 211, we successfully argued that health plans are responsible for reimbursing a reasonable portion of out-of-network emergency service providers’ costs.*
• Recoupment Requests and Audits: Represented numerous substance abuse treatment facilities in recoupment requests and audits from major payors.*
• Regulatory Dispute: Defended the American College of Emergency Physicians, State Chapter of California, Inc., against an action brought by payor advocacy groups to change the reimbursement procedure when handling non-contracted emergency service providers.*
• Seven-figure Recoupment Request: Represented a urinalysis laboratory in a seven-figure recoupment request, and resolved the matter favorably without litigation.*
• Substance Abuse Treatment Litigation: Represented a provider in an action brought by a major insurer alleging illegal kickbacks in exchange for the referral of specimens to a toxicology laboratory.*
• Unfair Business Practice: As amicus curiae, successfully defended the government’s right to seek legal remedies against health plans for unlawful behavior. The rehearing in People v. Wellpoint (2010), 180 Cal.App.4th 138, denied 2010 Cal.App.LEXIS 86 as well as 2010 Cal. LEXIS 3215, a suit in which the California Court of Appeal upheld the City Attorney of Los Angeles’s right to sue health plans for unfair business practices.*

* Represents experience from a previous law firm.