Friday, January 21, 2022
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Healthcare Litigation, Licensing, and Credentialing


For more than three decades, a large part of the firm's practice has been dedicated to representing Physicians and other Healthcare Professionals and entities in connection with licensing, credentialing for hospital and insurance companies, due process hearings, Medicare and Medicaid reimbursement issues, defense of state and federal criminal proceedings and Federal False Claim Act penalty cases.
This commitment to the representation of healthcare professionals has led the firm to become extensively involved in civil matters for healthcare and other professionals who find themselves in need of advice and guidance.  The firm's work in these matters has led many professionals to seek the firm's assistance in partnership and shareholder disputes involving restrictive covenant enforcement and defense, and actions against hospitals and insurance companies where these entities are attempting to exclude the healthcare provider from participation on staff or in network.  We have listed below a sample of the firm's experience in representing medical and other professionals.
  • Representing physicians in disputes regarding their board certifications and certification eligibility
  • Representing physicians in disputes regarding payment with insurance providers
  • Representing physicians in disputes with management companies in connection with concierge physician services
  • Representing medical practices and facilities in disputes with employee physicians
  • Representing physicians in disputes with hospitals regarding credentialing, re-credentialing, and employment agreements
  • Representing physicians, physician's assistants, nurses, and podiatrists in matters before the State Boards of Medicine, Osteopathy, Nursing, and Podiatry
  • Representing foreign medical graduates in disputes with Educational Commission for Foreign Medical Graduates (ECFMG(r))
  • Representing physicians in disputes with the National Resident Matching Program (NRMP)
  • Representing physicians in disputes with the National Board of Medical Examiners (NBME) and United States Medical Licensing Examination (USMLE)
  • Representing providers of medical services in matters before administrative law judges
     Samples of matters:
  • More than 20 Medicare and Medicaid fraud criminal trials
  • More than two dozen hearings before federal, state and administrative agencies, including licensing, DEA participation, Medicare and Medicaid participation
  • Many years of experience in defending and negotiating Federal False Claims Act claims and proceedings
  • More than 25 matters in which the firm has represented physicians in disputes with hospitals involving credentialing, restrictive covenants, contract buy-outs, fair hearings, and the like
  • In the past 6 years, tried to completion multiple partnership and shareholder separation disputes
  • In 2006, the firm, in two separate cases, brought about the successful reinstatement of physicians where their credentials to participate in an insurance network had been revoked
  • In 2006, the firm successfully prosecuted an injunction requiring an insurance company to reinstate a provider and to reimburse well over $150,000 for claims previously denied
  • In 2006, the firm caused physicians threatened with termination from a hospital staff to be retained, without any Practitioner Databank consequences
  • In 2007-10, the firm negotiated multiple settlement agreements with various insurance providers regarding alleged overpayments to a practitioner
  • In 2010, the firm successfully obtained an injunction against the Educational Commission for Foreign Medical Graduates, resulting in the reinstatement of the physician's ECFMG (R) certificate
  • In 2011, the firm successfully negotiated a settlement on behalf of a physician who became embroiled in a dispute with a hospital over medical office space
  • In 2012, the firm successfully defended a physician alleged to have engaged in 'irregular behavior', resulting in no adverse action taken against the physician by ECFMG (R), NRMP, or the Electronic Residency Application Service (ERAS)

****All cases are different, and past success is no indication of a future result*******



111 Presidential Boulevard, Suite 228, Bala Cynwyd, PA 19004  *  (610) 664.5700  *
1801 Market Street, Suite 1100, Philadelphia, PA 19103 
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