Paul has been involved in healthcare-related legal matters for over 20 years. Paul represented the nation’s first pharmacy benefit management company in many healthcare-related issues including the Health Insurance Portability and Accountability Act (HIPAA), pharmacy regulation, prescription drug formularies, and agreements with pharmaceutical companies. Paul acted as lead counsel in multiple federal court cases involving a comprehensive healthcare management and insurance reimbursement computer software system that included investigation into healthcare information technology developed and used by major healthcare and EMR information technology providers, major health insurers, HMOs and MCOs, and world-renowned hospitals and other health care providers. Paul also acted as lead counsel in an arbitration involving a major healthcare software system development project to bring it in compliance with HIPAA with alleged cost overruns and major system failures. In addition to Paul’s healthcare litigation experience, Paul has (a) advised hospital and digital medicine providers on HIPAA data security and privacy obligations, (b) drafted agreements with digital medicine/medical device distributors, healthcare providers and patients for online sales of medical devices, and (c) drafted numerous manufacturing, research and development and licensing agreements for medical device manufacturers and biotechnology/life sciences clients.
Paul is available to mediate a broad range of healthcare disputes, including disputes involving peer review, credentialing, privilege suspension/termination, compensation and other medical staff disputes, billing and collections disputes, medical practice corporations, limited liability companies and partnership disputes, medical and other health care provider contracts with hospitals and managed care organizations (MCO), healthcare insurance and Medicare/Medicaid coverage and reimbursement disputes, medical device and purchase and sale agreements, digital medicine, False Claims Act disputes, Health IT meaningful use disputes, medical malpractice and other health care provider malpractice disputes. The following is a representative sample of healthcare disputes in which Paul has served as a neutral:
- Healthcare insurance coverage and fraudulent claims disputes between Texas-based hospital and national health insurer involving tens of millions of dollars;
- Healthcare insurance coverage dispute between national health insurer and well-known Los Angeles-based hospital system;
- Healthcare insurance coverage disputes between major California health insurer and hospital provider involving over 25 patients with claims of excessive billing and alleged failure to show that services were reasonable and necessary.
- A dispute regarding breach of fiduciary duty in a surgical practice limited liability company.
- A dispute in which a medical/dental services finance company alleged that doctor engaged in fraud and false claims to obtain payment for services that were not performed.
- Dispute over alleged breach of license agreements involving surgical implants.
Mediator Paul E. Burns, Esq.
633 West 5th Street, 26th Floor
Los Angeles, CA 90071
Tel: 424-303-3066
Email: paul.burns@mediatorpaulburns.com