Health Care Disputes

Weaver evaluates financial and reimbursement aspects of disputes between providers and payors across in‑network, out‑of‑network and ERISA‑governed claims. We have extensive experience performing:

• Statistical sampling for large claim populations, reimbursement calculations and complex disputes
• Digital forensics, fraud investigations and data analytics including anomaly detection, trend analysis, large-scale data analysis and recovery of electronic records
• Payor and reimbursement disputes (including out-of-network and ERISA-related matters), including economic and statistical sampling methodologies, benchmarking, billing compliance and financial impact assessments
• Medical claims reviews to identify overpayments, underpayments or anomalies, quantify damages, detect errors or fraud and identify issues with claims or reimbursement practices

We assist health care organizations and their counsel to evaluate the financial aspects of partnership disputes involving the valuation of ownership interests, partner separations and changes in control. Our work includes:

• Partnership valuation disputes including fair market valuations and goodwill assessments for transactions, buyouts and disputes or alleged misconduct
• Family law matters extending to valuation, income analyses, tracing and characterization analyses, and expert reports
• Post-merger and acquisition support reviewing partnership agreements for compliance and valuation implications

Weaver supports counsel in disputes involving intellectual property, proprietary technology and health‑care‑related innovations. Our work includes:

• Evaluating the financial impact of alleged infringement involving medical devices, software or proprietary clinical processes
• Assessing economic damages related to misappropriation of trade secrets or confidential business information
• Analyzing licensing agreements, royalty structures and compliance with contractual terms
• Valuing intellectual property or intangible assets in contested matters

We guide health care organizations through financial distress with clarity, experience and actionable insights. When financial challenges arise, stakeholders turn to Weaver for objective analysis and steady guidance. We help providers, payors, lenders, investors and counsel understand their options, protect value and navigate complex restructuring paths. We frequently:

• Assess financial health before and throughout bankruptcy or restructuring processes
• Analyze claims and transactions involving providers, payors and vendors
• Evaluate solvency and cash flow including reviews of management decisions leading up to distress
• Support complex litigation involving fraudulent transfers, preferences and alleged fiduciary breaches

Weaver assists counsel in resolving financial and operational disputes arising from contractual relationships within the health care sector. Our work includes:

• General service agreements evaluating compliance and quantifying losses
• Management service agreements analyzing funds, fee structures and compliance; quantifying the financial impact of breaches or noncompliance
• Violation of noncompete or nonsolicitation agreements assessing financial damages
• Medical malpractice assessing economic damages, including lost earnings and valuations of projected medical and related costs

Health care organizations and government programs face increasing scrutiny over billing practices, compliance and use of funds. Weaver conducts performance audits and compliance investigations to help stakeholders evaluate whether services were delivered, billed and reimbursed in accordance with applicable requirements. We frequently:

• Conduct performance audits of Medicaid claims billed by providers and paid by state Medicaid programs
• Evaluate whether services were billed and paid in accordance with applicable state and federal Medicaid laws, regulations, rules, policies and contractual requirements
• Identify improper payments, billing irregularities and compliance gaps
• Quantify financial exposure and recommend corrective actions