K&L Gates LLP

In this episode, Gary Qualls discusses a recent development in payer litigation, regarding a provider’s recovery of Medicare Advantage payments pursuant to a Medicare Advantage contract. Specifically, a recent federal case from California is among the first to clarify that providers may sue a Medicare Advantage insurer under state law contract claims for underpayments without being required to exhaust administrative remedies and follow the federal Medicare Advantage administrative appeals process for each individual patient claim at issue.

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