Health Insurance: Success In Defending Audit Litigation

A doctor who had been audited by a health insurer decided, with his prior counsel, to engage in an arbitration proceeding regarding alleged "overpayments" to the health insurer. The doctor lost the proceeding and was ordered to pay a very substantial refund to the health insurer. The doctor subsequently discovered, from speaking with counsel at Quadrino Schwartz, that he was never obligated to pay a refund to the health insurer, should have resisted the audit, and not agreed to arbitrate.

The doctor hired Quadrino Schwartz to attempt to reverse the effects of the adverse ruling in the arbitration and to defend proceedings in Supreme Court to enforce the arbitration award. Partner Richard Quadrino marshalled the facts, the law, and various principles regarding health insurer audits and scheduled a high-level meeting with the health insurer's counsel and director of special investigations.

After making various arguments to the insurer, Quadrino negotiated both the go-forward billing and payment arrangements between the doctor and the health insurer, resolved a group of unpaid claims that represented significant money due to the doctor, and successfully resolved all issues regarding the prior audit.

Mr. Quadrino has successfully avoided audits of his physician clients, taking a unique and effective approach to these matters that differs from how other law firms approach these issues. For more information, contact Richard Quadrino at 516-745-1122 or by email at