Judged Newsletter

Sign Up for THE DAILY JUDGED VERDICT. Our daily newsletter covers law firm salaries and everything you want to know about changes affecting law firms from people in the know. Sign Up Now!

Fetured Job Of the Day
Fetured Job Of the Day

Tax Attorney with 3-5 years of credit transactions experience

Washington, D.C. office of our client seeks tax attorney with 3-5 year...
+ read more

Date Posted: May 23, 2018

Employer:   BCG Attorney Search

Salary: Not Specified


Los Angeles
1875 Century Park East, Suite 1600
Los Angeles, California - 90067-2517



Other Offices

+Los Angele... +Los Angele... 
+San Franci... 

Staff Size : 39
Update this Info

News Brief Find out if this Firm is Hiring

No Reviews

Overall Quality of this Firm

For every category, 1 is the worst possible and 10 is the best possible answer.

Rate This Firm

Law Firm News


Dear Clients and Friends:

Many of our hospital clients are experiencing specific types of payment problems with PacifiCare that we wish to bring to your attention. In light of the issues described below, we encourage you to review your accounts receivable and contracts.

Medical Bill Review
PacifiCare has recently instituted a program – called Medical Bill Review -- to disallow and deny certain charges in order to reduce the claim below the stop loss threshold or to reduce the stop loss payment. Rather than amend its contracts with providers, PacifiCare has unilaterally changed the manner in which claims are reimbursed under its hospital contracts. Like other health plans, PacifiCare is improperly attempting to apply Medicare guidelines to deny these charges. We have been successful in having these charges paid in numerous arbitrations.

It has come to our attention that PacifiCare is denying payment for certain types of implants by improperly applying a narrow definition as to what constitutes an implant. Many hospital contracts do not define what items constitute an implant. PacifiCare's definition of what constitutes an implant is much narrower than the UB-92 Manual definition of an implant. We believe it is improper for PacifiCare to unilaterally adopt a narrow definition of implants without defining that term in the contract. Our firm has been successful in litigating this issue in a number of arbitrations.

Most Favored Nation Provisions
In many new contracts, PacifiCare and United Healthcare ("UHC") are requiring hospitals to ensure that the rates PacifiCare/UHC negotiates with the hospital are as low as the lowest rates in the hospital's contracts with other health plans. PacifiCare/UHC is also insisting that the hospital agree that a third party auditor review all of the hospital's contracts and claims to ensure that PacifiCare/UHC is receiving the lowest rates. We believe that this practice is improper for a number of reasons:

First, such a practice may require the hospital to breach the confidentiality provisions of its contracts with other health plans. PacifiCare certainly would not want its contract rates to be disclosed to other health plans.
Second, there may be HIPAA issues if PacifiCare's auditor were to review claims relating to other health plans.
Third, the practice may be anti-competitive or otherwise constitute unfair business practices. PacifiCare certainly would not disclose the rates it pays other hospitals, or agree to a provision that states that it will pay the hospital the highest rate it pays other hospitals in the area.
Fourth, the rates that hospitals negotiate with different health plans depend in large part on volume and utilization of services.

Primary Practice Areas

Real Estate,Healthcare and Hospital Law General Business Matters, Joint Ventures, Managed Care, Fraud and Abuse, Health Care Financing, Third-Party Payment Programs, Medical Staff, Licensing and Certification Issues, Administrative Law and Regulatory Litigation, Civil Litigation, Long-Term Care.

Update this Info

Top Performing Jobs
Managing Director, Litigation Finance Investments


Title            ...

Apply Now
Contract Associate


Seeking lawyer with at least 2 yrs experience in complex real estate transaction...

Apply Now


Our Syracuse, NY office seeks an Associate with 3-5 years experience defend...

Apply Now
JDJournal - Send Tips
Mid-level Litigation Attorney with motions experience


Seattle office of our client seeks mid-level litigation attorney with 3-5 years ...

Apply Now
Environmental /Land Use Attorney with 2-3 years of experience

USA-CA-San Francisco

San Francisco office of our client seeks environmental /land use attorney with 2...

Apply Now
Litigation Attorney with 2-5 years of insurance defense experience


Jacksonville office of our client seeks litigation attorney with 2-5 years of pr...

Apply Now
Dear Judged

Dear Your Honor,
Dear Judge,

Do you ever experience any physical danger in the courtroom?  You do deal with all those criminals, right? 


Concerned Bailiff's Mommy

+ more Judged Dear
+ write to Your Honor
Law Firm NewsMakers

News Corp. Considers Splitting


The Attorney Profile column is sponsored by LawCrossing, America`s leading legal job site.

Summary: This is a great question. There are many factors that impact a candidate’s ability to lateral from an overseas law firm to a top U.S. law firm.
Search Jobs Direct from Employer Career Pages

Enter your email address and start getting breaking law firm and legal news right now!

Every Alert

Alert once a day


BCG Attorney Search

You may search for specific jobs or browse our job listings.


(hold down ctrl to choose multiple)

Minimum Years of Experience:

Primary Area of Practice:

 Partner Level Job(s)

Search Now