QLG Stops Retaliation Regarding Provider's In-Network Status And Obtains Complete "Walk-Away" On Recoupment Claim

An independent health insurer, the largest in its state, demanded a post payment audit of past, paid claims regarding various medical facilities owned by a medical provider. The facilties’ owners hired Richard Quadrino to stop the audit and prevent recoupment of over $1.2 million that the provider knew the insurer was in the process of demanding.

The insurer played hardball, sending a certified letter giving a deadline for kicking the provider and its various facilities out of the health insurer’s network for an alleged failure to permit the audits. Quadrino Law Group fought back by starting a lawsuit in the insurance company’s home town, across the street from its headquarters. In fact, the judge, his family member, and legal staff all had local ties to the health insurer, which made the lawsuit seem like a tremendously uphill battle.

Richard Quadrino filed a motion for a preliminary injunction and the judge scheduled legal briefing and an evidentiary hearing and on ERISA issues being asserted in the lawsuit. After the legal briefs were submitted and reviewed by the judge, live testimony from various witnesses was about to start, with the introduction of items of evidence by Mr. Quadrino. After hearing from Mr. Quadrino and the insurer’s counsel in a lengthy courtroom session, the judge strongly suggested that the insurance company engage in settlement talks. After a series of meetings in the court’s meeting rooms, the case was settled with no money being paid back to the insurer at all and the contract rights of various facility locations of the provider remaining intact.

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