Boutin Jones INC., Attorneys at Law

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Brian M. Taylor / Shareholder

Detailed Practice Description

Brian has been practicing almost exclusively in the health care arena since 2002. He devotes his practice to advising hospitals, health systems, medical foundations, IPAs, physicians, dentists and suppliers on a variety of business, regulatory and litigation issues.

Brian is on the Board of the California Society for Healthcare Attorneys and on the Board of Sutter Medical Center Foundation. He is also the former Chair of the Sacramento County Bar Association Health Law Section.

He advises clients in the complexities of managed care contracting, revenue cycle management and regulatory compliance. Brian is particularly active in complex contractual disputes between health care providers and health care service plans. He represents clients in a broad range of lawsuits, among them actions involving ERISA plans, out-of-state payers, leased network PPOs, reasonableness of charges, coding for services, fee-for-service contract terms, capitated reimbursement, risk arrangements, hospital liens, uninsured/indigent policies and unfair competition.

Brian has extensive experience defending providers’ charging practices, including defense of clients in false claims act litigation, opposing requests for refunds from payors, as well as comparing hospital charge structures. He has worked closely with experts in the development of hospital peer groupings, based on their size, payer mix, revenue, service lines and geography, and also in the different data available to compare hospital charges.

He is highly knowledgeable about state laws and regulations concerning providers’ rights and health plans’ obligations, including California’s Knox-Keene Act, as well as the workings of state agencies that regulate insurance companies and health care service plans. Brian has handled numerous other complex business disputes including sales of commodities, trademark, trade secret and construction matters.

Brian also advises clients in various regulatory and compliance issues including licensing, HIPAA, STARK and anti-kick-back laws.

The Basics

I help healthcare providers enter contracts that make sound business sense and at the same time comply with complicated healthcare regulations. I routinely handle disputes surrounding how items and services are billed and paid. I also represent roviders in complex contracts and advise on complying with regulations such as STARK, anti-kick back and CMS rules. I work with health care providers as they interact with regulatory agencies, such as the Department of Health Services, the Office of Statewide Planning and Development, Medicaid and Medicare.

Delivering for Clients

I love to build things, fix things and do home improvement projects. This includes everything from fixing motorcycles and cars, redoing kitchens, building patios, landscaping yards and installing hot tubs. The ability to figure things out mechanically uses logic skills similar to what I use to help figure out problems for clients.

  • Practices
  • Healthcare
  • Litigation
  • Education
  • University of the Pacific, McGeorge School of Law, J.D.
  • Brigham Young University, English, B.A.
  • Honors
  • Sacramento Business Journal Best of the Bar, 2017
  • Sacramento Magazine Top Lawyer, 2015 – 2016
  • Northern California Super Lawyer, 2009-2010, 2013-2014
  • Graduated law school with distinction, Dean’s Honor Roll
  • Bar Admissions
  • California
  • Federal District Court, Eastern District of California
  • Professional Associations and Memberships
  • State Bar of California
  • Sacramento County Bar Association, Former Chair, Health Law Section
  • Former Member, American Health Lawyers Association
  • Member California Society for Healthcare Attorneys
  • Board Member California Society for Healthcare Attorneys
  • Education Committee, California Society for Healthcare Attorneys
  • Northern California HFMA
  • Former Student Member, American Inns of Court
  • Board Member Sutter Medical Center Foundation

Articles and Presentations

Articles

2012

Summary of California Managed Care (produced for hospital clients)

2009

“California Supreme Court Extends Ban on Balance Billing of Non-Contracted HMO Members,” McDonough Holland & Allen Health Care Law Bulletin

2008

“What is New in Balance Billing,” McDonough Holland Allen Health Care Law Bulletin

Presentations

2016

“Legal Issues When Plans Sell Their Networks: Leased Network PPOs, Other Payors and ERISA Plans,” California Society for Healthcare Attorneys Fall Seminar
“Business Law Update for CPAs,” co-presenter with B.J. Susich
“Managed Care Laws and Trends in Payor/Provider Disputes,” Health Financial Management Association Road Show

2015

“Preparing Experts,” Barristers, Sacramento County Bar Association
“Managed Care Laws and Trends in Payor/Provider Disputes,” Health Financial Management Association Road Show

2013

“Patient Privacy in the US,” Capitol Law Group, 2013 Annual Meeting

“Legal Issues When Collecting From Patients,” Health Financial Management Association Patient Finance Services Meeting

2012

“Legal Issues When Plans Sell Their Networks: Leased Network PPOs and ERISA Plans,” Bay Area Healthcare Contractors Association

“Advanced Primary and Secondary Payer Obligations under COB,” client in-house presentation

“Payor and Provider Disputes,” California Society of Healthcare Attorneys Fall Symposium, Co-Presenter

2009 to 2010

“Primary and Secondary Payer Obligations Under COB,” Health Financial Management Association Patient Finance Services Road Show

2008 to 2009

“Balance Billing – Legal Developments in Collecting From Patients,” Health Financial Management Association Patient Finance Services Road Show

Representative Experience

Healthcare

Represented hospital in high stakes arbitration regarding challenges to the hospital’s anesthesia charging practices.

Advised hospitals regarding the process for transportation, duplication and storage of hardcopy medical records for use in new electronic health records platform. Assisted client with the California Department of Public Health’s approval of such process.

Advised clients regarding obligations for collecting delinquent and non-delinquent patient cost shares in California.

Represented a hospital in high stakes challenge to its charging practices and charge structure for particular departmental charges.

Advised healthcare provider regarding request for refunds from payor’s “special investigations unit.”

Advised healthcare supplier regarding compliance with both state and federal anti-kick back laws.

Represented hospitals in disputes regarding value of services provided to members of non-contracted health plans. These disputes involved analysis of the health plans’ payment methodologies, compliance with statutory and regulatory requirements, comparison of the hospitals’ charges to peer hospitals, revenue requirements (including capital replacement needs), pricing and payer mix.

Represented a health care system in a $50,000,000 dispute regarding hundreds of thousands of underpaid physician and hospital claims, which had issues relating to calculation of stop-loss, delegation of risk to a third party, payment of co-pays, division of financial responsibility between the plan and a third party, coordination of benefits, ERISA plans, FEP claims, Medicare claims, timely filing of claims and timely appeal of claims.

Represented a healthcare system in dispute alleging $15,000,000 in alleged overpaid claims.

Represented provider in challenge to a Medicare Fiscal Intermediary’s determination to suspend provider’s right to submit claims for reimbursement.

Represented a hospital against a capitated IPA seeking payment for ancillary services.

Defended a hospital against a health plan seeking reimbursement for amounts paid by the plan out of the hospital’s capitation.

Represented a physician group in a dispute with a health plan regarding expansion of the medical group and addition of health plan capitated members.

Defended hospitals and physicians in a multimillion-dollar case regarding coding of services, including application of Medicare Guidelines, National Correct Coding Initiative and Outpatient Code Editor, including application of UB-92 Editor and industry standards.

Represented a physician group in merger negotiations.

Represented a provider in a continuity-of-care dispute following termination of a contract with a health plan.

Represented hospital in disputes with health plan over payment for services after the bankruptcy of an intermediary risk-bearing organization.

Represented a hospital system in a dispute regarding designation of COEs.

Advised clinics of obligations to refund overpayments made to clinics due to coding errors.

Represented a physician group in a failed merger. The litigation was successfully resolved through mediation.

Represented hospitals in discussions with a state legislature over an assembly bill regarding notification of health plans of post-stabilization services.