Today’s healthcare industry environment presents unique challenges for both the provider and payor. The environment is overlaid with increasingly complex rules, regulations and laws, plus the scrutiny of federal and state agencies and regulators. Providers and payors confront constant risk to maintain operations that meet both contractual as well as compliance requirements.

Stout’s Healthcare Disputes team has extensive experience working with healthcare providers (hospitals, radiology clinics, home health, and hospices), payors (both commercial and governmental entities), and their respective counsel to address a broad range of matters from reimbursement contractual compliance, including commercial contracts, Medicare and Medicaid, to False Claims Acts, Anti-Kickback Statute, Stark-Law-related matters, intellectual property matters, as well as litigation and settlement support.

Select Areas of Expertise

• Billing and Reimbursement
  • Damages quantification and liability estimation
  • Litigation and settlement valuation of underlying allegations
  • Data aggregation and statistical analysis of underlying claims and patient records
  • Detailed review of billing and reimbursement data
  • Expert witness services
• Pharmaceutical and Medical Device
  • Damages quantification and liability estimation
  • False Claims Act/qui tam defense
  • Forensic data collection and analytics
  • Contract disputes
  • Expert witness services
• Fraud and False Claims
  • Noncompliance of contacts
  • Medicare and Medicaid reimbursement fraud
  • Quantification of company’s crime policy
  • Fraudulent representation of healthcare transactions revenue
  • Pharmacy network exclusion and billing fraud
  • Economic damages analysis relating to collusion