Healthcare

Sedgwick’s Healthcare practice offers a comprehensive array of legal services for a rapidly changing healthcare industry. Sedgwick has earned the finest reputation for representing its healthcare clients in complex litigation, transactional, operational, legislative and regulatory matters. Our premier trial expertise has resulted in a proven track record of obtaining excellent results for the wide variety of health insurance and managed care industry clients that we serve. In resolving disputes, we manage cases efficiently by performing a thoughtful and candid assessment and analysis and by employing cost-effective strategies consistent with client priorities. We counsel clients in a manner that ensures their compliance with current and anticipated statutes and regulations, while at the same time remaining sensitive to clients’ business realities and constituent concerns. 

Our clients reflect the diversity of the industry as a whole, including healthcare payors (e.g., integrated health delivery systems, health plans, insurers, HMOs, PPOs, dental plans, self-funded ERISA plans, and mental and behavioral health plans), providers (e.g., hospitals, medical groups and IPAs), contracting entities (e.g., MSOs), and other involved organizations and entities. The fact that our Healthcare practice does not represent a single constituent group strengthens our ability to assist in the shaping of intergroup solutions. 

Sedgwick’s healthcare lawyers are a dynamic, marketplace-focused team that fully appreciates that healthcare is among the most regulated, fastest-paced industries in the country. We are highly experienced and innovative, and many of our attorneys have backgrounds in healthcare delivery and administration, government service and/or have served as in-house counsel to major managed care entities. Sedgwick is dedicated to provide creative legal solutions consistent with the business goals and objectives of our clients to help them meet the challenges they face. We believe our expertise, diversity and sophisticated knowledge of the healthcare industry makes Sedgwick the right choice for legal representation. 

Litigation and Other Contested Matters

Sedgwick is nationally recognized as a leading trial firm with decades of experience successfully representing healthcare clients in a variety of litigation matters ranging from class action litigation to arbitrations. We have been selected as a preferred litigation firm by several health insurance and managed care clients due to our reputation of delivering high-quality, cost-effective services with a team of skilled trial attorneys who understand the need for an early resolution of disputes but who can, and do, try cases to win when necessary.

With our clients playing an integral part of the decision making process, we determine what course of action will be in the client’s best interest and develop our case strategies accordingly. Our understanding of the business, legal and regulatory challenges confronting our clients enables us to provide practical legal guidance and achieve successful outcomes in litigation on behalf of our clients.

Sedgwick attorneys have extensive experience defending a myriad of healthcare claims, including the defense of Medicaid- and Medicare-related matters. Many cases involve the advancement of federal preemption defenses of state laws, including tort claims. We have been successful in obtaining defense judgments in numerous lawsuits seeking tort and contract damages alleging bad faith and unfair business practices. Sedgwick attorneys have significant experience in representing Medicare Advantage plans in administrative law judge appeals through the Social Security Administration and further appeals to the Medicare Council. 

In ERISA matters, we have successfully represented insurers, fiduciaries, administrators and self-funded plans in lawsuits involving employee benefit claims in trial and appellate courts. In ERISA non-benefit claims, our attorneys have substantial experience defending fiduciary duty claims that often involve allegations of prohibited transactions or breach of the duties of loyalty, prudence and diversification of plan asset investment. We also represent managed care clients in reimbursement disputes, underpayment claims, antitrust and RICO claims.

Counseling and Advice

Sedgwick’s healthcare attorneys effectively counsel clients in the principal substantive areas impacting the healthcare industry. Our attorneys assist clients in developing contracting policies and procedures and template and customized agreements for both commercial and Medicare products. We analyze and interpret proposed and newly enacted laws and regulations, as well as new court decisions influencing the healthcare industry. Sedgwick attorneys advocate on behalf of clients before state and federal agencies in non-contested healthcare matters, including regulatory filings, audits and investigations.

Representative counseling and advice issues include:

  • Regulatory compliance 
  • Risk assessment and management
  • Rate filings and hearings
  • Audits and investigations
  • Fraud and abuse
  • Provider contracting
  • Corporate strategic initiatives
  • Business transactions
  • Corporate restructuring
  • Regulatory approvals of transactions
  • Executive compensation and benefits
  • Administrative proceedings 
  • Provider terminations and insolvencies
  • Legislative initiatives
  • ERISA plan creation and administration
  • Peer review
  • Grievances and appeals 
  • Licensing
  • Coverage issues (including professional liability and E&O)
  • Antitrust matters

Appellate Matters

Sedgwick’s healthcare lawyers represent clients at every level of the appellate court system, both state and federal, up to and including the U.S. Supreme Court. Our appellate attorneys bring experience, savvy, tenacity and creativity to the table. All have practiced at the trial level, providing them with a firm grasp of the legal dilemmas that originate there. They apply a sensible “big picture” perspective to this practice as they plan and coordinate high-level appellate strategies. We both represent new clients who turn to Sedgwick after suffering adverse outcomes at the trial court level and defend trial court victories secured by our own outstanding litigators.

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