HAWAII HEALTH CARE LAW ATTORNEYS

HELPING CLIENTS WITH COMPLEX HEALTH CARE LAW MATTERS

Quality and dependable health care is an extremely important part of our society. However, the laws and regulations that govern the various healthcare programs in the United States can be extremely complicated. Health care expenditures are well into the trillions of dollars each year and federal and state programs are often administered by a massive bureaucracy that can be difficult to navigate. This can be true for both patients as well as medical professionals, both of whom may be extremely vested in the way that health care benefits are administered.

Fortunately for people with legal issues related to the health care system, the Hawaii health care lawyers of Davis Levin Livingston are dedicated to helping people resolve these issues as favorably as possible. Cases aimed at improving the quality of health care delivered to our citizens comprise an important part of Davis Levin Livingston’s commitment to litigating cases, which have important social effects.

Some of our recent cases include the following:

• Settlement of a case which stopped a local doctor from fraudulently selling generic drugs to Medicaid patients, but charging the government for brand-name rates
• Litigation of a case against Kaiser Hospitals in California to stop Kaiser’s practice of dispensing double dose pills and a pill splitter to its patients
• Representing an anesthesiologist who refused to bill the government and supervise nurse practitioners while she was on-call and off the hospital grounds

If you need to discuss your case with a health care law attorney in Hawaii, contact Davis Levin Livingston online or by phone at (808) 740-0633 for a free consultation. 

Representing a Variety of Issues Related to Health Care Law

At Davis Levin Livingston, we represent various parties who have legal issues related to health care, including patients, doctors, hospitals, and healthcare administrators.

Among the types of matters we handle include:

• Health Care Fraud: According to the Federal Bureau of Investigation (FBI), health care fraud costs the United States government some $80 billion per year. We represent whistleblowers who come forward to report such fraud to the government, as well as consumers who believe their provider is engaging in fraudulent conduct.
• Health Insurance Litigation: Our firm represents health care consumers who are being denied coverage or reimbursement by their health insurance companies.
• Health Care Program Disputes: We represent healthcare providers in matters where they are seeking payment or reimbursement for services rendered and are having difficulty obtaining it from a particular program or entity.
• General Health Care Litigation: In the healthcare setting, disputes are bound to arise. We represent all parties to these disputes in general civil litigation

Health Insurance Litigation

Proving Negligence in a Medical Malpractice Case

Negligence can be difficult to prove within a health care setting. When a physician or other treatment provider acts within the normal limits of behavior, they are generally found not negligent. This means that if ten other physicians encountered the same set of symptoms, it is likely that each of these physicians would act in the same way. Just because a patient becomes iller after attempted treatment, this does not mean that the treating physician is automatically liable.

To prove there was an injury because of negligence, their first must be an injury. Even if a patient receives the wrong medication because a nurse wasn’t paying attention, if the wrong medication caused no harm to the patient, there is no cause for a personal injury claim to be filed.

When an Insurance Company Won’t Pay

As an individual, it is possible that you need medical treatment that your insurance company is refusing to pay for. We help patients get the treatment that they need, by working with the insurance company to get your treatment covered. When the insurance company won’t come to a settlement, it’s possible to get involved in litigation to settle the matter. If you need life-saving treatment and can’t get your insurance company to approve it, it’s time to sit down and meet with an attorney that can discuss your case with you.

For health care providers, getting stuck with unpaid medical bills can put a medical practice in financial crisis. If you are a health care provider who is not being paid for services rendered, we can help. We work with insurance companies to try and get medical bills paid per the coverage guidelines of the patient treated.

Fraud Is Everywhere in the Health Care Industry

If you believe your health care provider has been behaving in a fraudulent manner, if you have noticed claims for services that were not rendered on your benefits statement, we can work with you. We have worked with people who want to come forward about insurance fraud, whether they are a patient or an employee within an office. When you believe your doctor or employer is not being truthful in their billing, you can meet with a Hawaii health care litigation attorney at our office to discuss your concerns.

Health Care Facility Compliance Assistance

If you are a health care facility facing litigation because of a lack of compliance, we have the skills you need to get your facility back on track. Compliance can be a complex matter, and we work closely with administrators of your facility to figure out where the lack of compliance lies. Responding to claims of a lack of compliance is the best way for you and your facility is the best way to fight off potential litigation.

When your facility already has pending litigation against it, we work closely with compliance agencies to try and work out a settlement without having to go to trial. If you are ready to get your facility in compliance with all regulations and you want to avoid a trial, we will work hard to get you out of the legal mess that has been created so that you can get back to running your facility.

Health Care Program Disputes

The growth of managed care in recent years has added high levels of complexity to the business of caring for patients. Health insurance plans now often take an active role in evaluating treatment options and access to specialized personnel and services. The same insurance programs also sometimes refuse to pay medical providers after services are rendered.

When doctors, hospitals, and other healthcare providers have difficulty obtaining payment or reimbursement for services rendered, they turn to the experienced Hawaii health care program dispute attorneys of Davis Levin Livingston. With significant experience in litigating health care program disputes, our team is dedicated to ensuring a favorable resolution for medical providers. We serve clients in Honolulu and throughout the Hawaiian Islands.

Consumer Disputes

Disagreements between consumers and health insurers also have become more common as a provision of health care has grown increasingly complex in recent years.

Disputes can occur for a number of reasons, including:

• Denial of coverage for medical services that have been rendered
• Denial of authorization to see a specialist
• Denial of authorization for a hospital stay or medical procedure
• Erroneous charges for health care services
• Cancelation of health insurance without prior notice
• Failure to continue a policy when an insured individual has a change in employment

Disputes surrounding health care plans can include a variety of different parties, such as individual consumers, medical providers, employers, and insurers. Because disputes have become increasingly common, both consumers and medical providers should understand their rights and options for resolving a disagreement with a health care program or entity.

Role of the Affordable Care Act

Passage of the Affordable Care Act in 2010 added new complexity to health care program dispute law.

Significant changes from the massive insurance reform measure included:

• Requiring insurers to include certain benefits, including birth control, as part of health care programs
• Prohibiting denial of health care services based on existing conditions
• Requiring certain employers to provide health insurance to workers
• Allowing children to remain on parents’ health care plans until age 26

Initiating Health Care Program Disputes

Understanding exactly what a health plan covers and does not cover is important before initiating a formal dispute. Working with an attorney experienced in health care program disputes, consumers, and medical providers can determine whether a complaint is valid and likely to result in adequate compensation.

Before initiating litigation, parties can attempt to resolve a dispute using the following procedures:

• Speaking with customer service. An entity’s agents may be authorized to reverse incorrect charges or approve medical services that were denied originally. If an agent is unable to help, request a supervisor. In some cases, an agent may request additional documentation or ask that original documents be resubmitted.
• Obtaining a notice of denial. In an instance of denial of coverage or a refused authorization of services, the complaining party should request a letter giving formal notice of the decision and details about the entity’s decision.
• Requesting an internal review. When the complaining party is unable to resolve the situation through customer service, the entity’s internal review or appeal procedure is the next step. A formal request should be made that the entity reverse its decision about payment or services to be provided. Health insurance entities and programs must have rules and procedures in place for handling customer appeals, which may be referred to as consumer complaints or grievances. The entity’s “evidence of coverage” document should provide details on initiating an internal review and any applicable deadlines. The entity must respond to an appeal in the time period specified in the evidence of coverage document.
• Seeking arbitration. In some cases, health plan entities include voluntary or involuntary arbitration clauses in their agreements. In arbitration, the complaining party submits the details of the dispute to a neutral arbiter, who considers both sides and renders a decision.
• Seeking an external review. In most states, consumers may appeal a health plan entity’s decision through an external review program following an unsuccessful internal review. Availability of an external review may be determined by the specific type of health plan.
• Filing a complaint with the state department of insurance. Aggrieved parties also can file complaints with their state’s department of insurance regarding an action by a health plan entity.

Contact Davis Levin Livingston Today to Schedule a Free Consultation

Everyone deserves quality healthcare and medical professionals deserve to be treated fairly by their employers and the various government programs on which their livelihood depends. The experienced Hawaii health care lawyers of Davis Levin Livingston have the skill and legal acumen that is required to resolve often complex healthcare disputes. Health care law is an extremely specialized area of law, and any party with an issue related to it should contact our office for assistance as soon as possible.

Health Care in the News

• Record Recovery In Medical Lawsuit​​​

Call (808) 740-0633 or contact us online today. We serve clients in Honolulu and throughout all of the Hawaiian Islands.