Brian M. Taylor

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.

Appellate Litigation

Boutin Jones Inc. served as counsel in the U.S. Court of Appeals for the Ninth Circuit for an international seller of agricultural commodities and its insurance provider, in their lawsuit against a Honduran company and its principals for failure to pay for over $7 million of U.S.-grown rice and corn. The district court dismissed the case for lack of personal jurisdiction. Boutin Jones succeeded in obtaining a reversal from the Ninth Circuit in a published decision holding that the parties’ course of dealing was sufficiently connected to California to permit the district court to exercise personal jurisdiction over all three defendants. Shareholders Brian Taylor and Michael Chase were the primary Boutin Jones attorneys on this appeal.