Gregory A. Brodek

Representative Matters

Hospitals and Health Systems

• Assisted hospitals and other providers with recoupment of payments in excess of $500 million.

• Represented numerous hospitals in connection with the formation of healthcare systems.

• Represented hospitals in the acquisition of a variety of medical practices.

• Advised hospitals in the formation of Medicaid strategies.

• Represented hospitals in the development of medical office complexes.

• Assisted hospitals and healthcare systems in maintaining their tax-exempt status and fighting state and local efforts to eliminate their tax exemptions.

• Has served as general counsel and special counsel to numerous hospitals and hospital systems.

Physicians and Physician Specialties

• Represented a Missouri pathology group in a dispute with a payor over the billing of the professional component of clinical pathology services, resulting in the payor agreeing to sign the previously negotiated and abandoned participation agreement.

• Represented a Missouri pathology group in litigation with payor in dispute over the billing of the professional component of clinical pathology services, which resulted in the client obtaining a $3 million settlement.

• Represented a Florida physician group practice with respect to a payor aggressively seeking to recoup purported overpayments for the professional component of clinical pathology services made to the group, resulting in the payor recovering considerably less than the amount it initially sought.

• Represented a Wisconsin pathologist physician group practice with respect to a payor aggressively seeking to recoup purported overpayments made to the group, resulting in the payor not recovering the overpayments.

• Counsel to statewide classes of pathologists in Illinois, Texas and Tennessee asserting class action claims in three separate class action arbitrations against health insurance companies arising out of improper reimbursement for the professional component of clinical pathology services provided to beneficiaries enrolled in the insurer’s health care plans.

• Represented 22 physician group practices in a dispute with a payor regarding the payor’s failure to compensate the group practices for the professional component of clinical pathology services.

• Represented an Illinois physician group in an arbitration on a claim of breach of contract against a payor for failure to pay for the professional component of anatomic pathology services. The action resulted in a going-forward resolution, including prospective contractual relief.

• Represented a statewide class of Illinois pathologists against a payor seeking payment of professional component fees. Secured a certified class and resolved the arbitration with payments to all class members and other prospective contractual relief.

• Represented an Illinois physician group in an arbitration on a claim of breach of contract against a payor for failure to pay for the professional component of anatomic pathology services. The action resulted in a lump-sum payment resolution.

• Class action arbitration in Tennessee on behalf of all pathologists against a payor on a claim of breach of contract where the payor unilaterally stopped paying for the professional component of clinical pathology based on its claim that it can make such a change as a “policy amendment,” which was successfully settled.

• Assisted numerous pathology groups in several states over point of service issues and appropriate coding concerns.

• Represented physician group practices with respect to a payor aggressively seeking to recoup payments made to the groups.

• Represented three physician groups in Tennessee regarding a payor's refusal to pay for clinical pathology services when billed by pathologists as is required under the contracts these pathologists have entered into with the payor.

• Represented four physician groups in Illinois regarding a payor's refusal to pay for clinical pathology services when billed by pathologists as is required under the contracts these pathologists have entered into with the payor.

• Representing physician groups on claims of breach of contract and deceptive trade practices against a payor for failure to pay for covered services (i.e., the professional component of clinical pathology services).

• Representation of the emergency department (ED) physicians in a putative class action against the Commonwealth of Massachusetts with respect to MassHealth’s failure to reimburse physicians for all services rendered in the ED, by bundling the procedure with the evaluation and management (E/M) service. Upon dismissal without prejudice of the class action, individual ED groups were instructed to go through the administrative appeals process. Our firm is assisting ED groups with each step of the administrative appeal process, including the resubmission of claims, and possible further litigation once the claims are denied.

• Represented a physician group practice in recovering underpayments made by a payor by paying the non-participating group practice physicians at participating provider rates.

• Resolved a class action brought by non-participating emergency medicine providers against a payor to address a unilateral reduction of fees paid to these non-participating providers.

• Represented physician group practices in recovering underpayments made by a payor.

• Resolved a class action brought by non-participating emergency room doctors against a Medicaid managed care plan for unilaterally electing to reimburse these doctors at Medicaid rates.

• Representing a California physician group against a payor for downcoding and failing to pay for emergency medical services rendered to the payor's members.

Other Matters

• Represented client in an investigation by the Office of Inspector General for purported billing improprieties, resulting in the investigation being closed.

• Represented physician group practices with respect to a payor aggressively seeking repayments.

• Class action against a payor on behalf of independent physical therapists in Maine regarding breach of contract, antitrust and quantum meruit claims.

Admissions

• Maine

Education

• Drake University Law School, J.D., 1988
  - Order of the Coif

Professional Activities

• American Bar Association
  - Health Law Section
• Maine State Bar Association
  - Health Law Section
  - Business Law Section
• Penobscot County Bar Association
• American Health Lawyers Association
  - Health System Transactions Special Interest and Substantive Law Committee Regulations, Accreditation-Payment Special Interest and Substantive Law Committee

Honors and Awards

• Listed in Chambers USA: America's Leading Lawyers for Business, 2021-2024

Media Hits

• Quoted, "7 Ways Doctors Could Get Better Payment From Insurers," Medscape, January 25, 2022
• Quoted, "Seven Ways Doctors Could Get Better Payment from Insurers," Cardiology News, January 25, 2022
• Quoted, "Doctors Fight Unfair Payer Tactics; Is It Working?" Medscape, December 22, 2021

Selected Speaking Engagements

• Panelist, "Assessing the Impact of Surprise Billing Legislation on Providers and MCOs," 11th Annual Advanced Forum on Managed Care Disputes and Litigation, Virtual Conference, July 22, 2020

• Presenter, 2018 UCAOA Urgent Care Convention & Expo, Paris Hotel, Las Vegas, Nevada, May 8, 2018

• Speaker, "Texas Unencumbered #bizPT Conference," PTB Alliance, May 29-30, 2015
• Speaker, "Managing Payer Audits: Recommendations for Children's Hospitals Based on National Experience," Children's Hospital Association 2013 Forum Series, Chicago, October, 23, 2013
• Co-Speaker, "Payer Accountability Forum Teleconference," Teleconference, February 15, 2012
• Speaker, "Contracting Strategies with Eye Toward Enforcement," Private Practice Section of the American Physical Therapy Association, Washington, D.C., November 4, 2010
• Speaker, "Pathology Business and Billing Structure," Illinois Society of Pathology Spring Conference, Oak Brook, Illinois, May 9, 2009
• Speaker, Physician Entrepreneurs' Roundtable, Boston, February 26, 2009
• Speaker, "Payer Disputes: A Legal Perspective," Massachusetts College of Emergency Physicians (MACEP) Annual Emergency Medicine Coding and Reimbursement Fall Conference, Waltham, Massachusetts, November 21, 2008
• Speaker, "Ask the Experts: The Legal, Financial, and Risk Management Responsibilities for Boards," Maine Primary Care Association Health Center Board Development Workshop, Lucerne, Maine, May 30, 2007
• Co-Speaker, "Reconsidering Long Held Behaviors - Why Now/What Now?," College of American Pathologists, Pathology-Economic Issues, Orlando, Florida, October 14, 2006
• Speaker, "Monitoring of Reimbursement: What Effective Strategies Can Be Instituted to Avoid Being Short Changed," Maine Chapter of the American College of Surgeons, Northeast Harbor, Maine, May 30, 2003
• Speaker, "Contracting with Commercial Payors," Maine Medical Association 12th Annual Physician Practice Seminar, Bangor, Maine, May 28, 2003
• Speaker, "Beating the Devil You Know: Managing Managed Care Organizations," Medical Group Management Association (MGMA) Annual Conference, Las Vegas, Nevada, October 29, 2002
• Speaker, "Monitoring and Enforcing Commercial Payor Agreements," American Society of Medical Association Counsel (ASMAC) CLE, Kennebunkport, Maine, September 29, 2002
• Speaker, "Managed Care Contracts," Gastroenterology Practice and Endoscopic ASC's Creating Success 2002 Course, Knoxville, Tennessee, April 13, 2002