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Revenue Cycle
Managed Care
Litigation & Arbitration

Results

Delivering legal excellence since 2017

Our success

Since inception in 2017, Wolfe Pincavage has recovered over $200M for its clients.

Through complex claim appeals, litigation, arbitration, and administrative proceedings, Wolfe Pincavage has recovered over $200,000,000 for its clients. The firm has also implemented process improvements and negotiated favorable contract language that has enhanced its clients’ ability to protect their revenue.

Track Record

Recovered $11.1 million

from a large payor that failed to honor the terms of a letter of agreement that governed the reimbursement rate and terms and conditions by which out of network commercial claims would be processed and paid.

Recovered $10 million

for a health system from a large national health plan. The arbitration involved the health plan regularly down coding claims, denying inpatient care because the plan wanted the claims billed at an observation level of care, and improperly applying various policies and procedures to reduce payments to the health system.

Recovered $4.7 million

from a panel of three arbitrators for a hospital system from a large national health plan. The arbitration involved the health plan regularly down-coding claims and denying inpatient care because the plan wanted the claims billed at an observation level of care.

Venue

Successfully defeated state court appeal seeking to change venue of lawsuit after trial court denied motion to dismiss for lack of venue. After winning on appeal, the case settled favorably on the eve of trial.

Personal Jurisdiction

Successfully defeated an international health plans motion to dismiss for lack of personal jurisdiction and their appeal seeking to overturn the trial court order denying their motion to dismiss. After winning on appeal, the case settled favorably on the eve of trial.

Recovered $14 million

from a large commercial health insurer that systematically denied and underpaid a health system through improper claims practices including down coding, charge auditing, and various technical denials.

Recovered $10.7 million

from a major health plan that wrongfully applied an artificially low reimbursement rate to a health system’s out-of-network commercial claims and failed to properly adjudicate the health system’s Medicaid claims.

Recovered $2.7 million

for a hospital from a large PPO network, which allowed payors to access its network without complying with the reimbursement terms negotiated between the hospital and PPO network.

Recovered $675,000

for a health system from a plan that administers claims on behalf of inmates.  The plan failed to honor the contract rate that it negotiated with the hospital system. 

Recovered $2+ million

from a large Medicare Advantage organization, which improperly applied medical necessity criteria to systemically deny inpatient medical care. 

Recovered $675,000

from a large out-of-state Blue Cross Blue Shield licensee, which failed to fully pay for extensive inpatient medical care provided to a patient covered by a self-funded benefit plan.  

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Expertise

Our Firm

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