We are watching as these same institutions acting criminally are now designated by our Federal agencies to lead in public policy and funding distribution.
'Kaiser Santa Rosa earned certification as a Primary Stroke Center in January of 2010. Problem is that only a few months earlier they were found to have the highest stroke mortality rate in Sonoma County in an independent report by the Niagara Health Quality Coalition'.
As Johns Hopkins used these Federal health trusts to expand overseas---Kaiser used them to expand nationally and today Hopkins and Kaiser are merging into one predatory, maximization of profits global health system.....with no regard to US Rule of Law.
Program and services
HealthChoice is the name of Maryland's statewide managed care program. Through HealthChoice, the state offers health services to eligible residents. Most of the services are provided through managed care organizations (MCOs). An MCO is a health plan with a group of doctors and other providers working together to provide health services to Medicaid members.
Kaiser Permanente is an MCO that is part of Maryland's HealthChoice program. Eligible HealthChoice enrollees can choose Kaiser Permanente as the MCO where they want to receive their health services.
Maryland's Department of Health and Mental Hygiene decides who is eligible to receive health services through HealthChoice. They will let us know who is eligible and if there are any changes in the eligibility of HealthChoice enrollees.
ONE WORLD ONE GOVERANCE has all Foreign Economic Zones globally operating under MANDATORY BINDING ARBITRATION----this replaces all courts and legal rights and this structure has been the rule of law in developing nations all along......it is just now being pushed on Americans as 1% global Wall Street takes the US to colonial status. We already know from citizens overseas as we do here in the US where these kinds of MANDATORY BINDING ARBITRATION processes are used----including our labor laws----that the system is rigged for CORPORATE DECISIONS. People never win -----corporations do.
Catch Up Post — Part 6
We’ll call this one the “George Halvorson, first reform your own organization” Edition.
An Elite Notary explains why it is so difficult to obtain legal representation in California in medical malpractice cases. Hint: it’s all about MICRA and mandatory binding arbitration, and claims against Kaiser have decreased 20% as a result. Just the legal filings, [...]
Medicare & Kaiser Senior Advantage Changing plans is a guaranteed nightmare Internet
REBUTTAL BOX™ | Respond to this Report!
In October '07, I contacted a Medical Insurer to get Supplemental Coverage for my 94yr old mother's medical insurance coverage. I told the salesman that my mother was currently with Kaiser's Senior Advantage and I wanted to get her out of Kaiser.
He had me/her apply to his company and to find a prescription drug company. I did both and she was approved by his company.
Mid December '07, Kaiser sent me a letter date 12/12/07, stating that my mother's health coverage would terminate as of 12/31/07. Come January '08, Kaiser withdrew from our checking account the monthly premium, so I called and they said that she was cancelled and then reinstated. They said that they would reimburse us. I wrote a letter to Kaiser stating that she was no longer with Kaiser so please terminate the deduction from our account. Kaiser followed the letter and the reimbursement came two months later.
Meanwhile during the first three months of 2008, mom had gone to three doctor appts. Medicare denied coverage stating that mom had another primary...Kaiser.
So I started calling Medicare and Kaiser. Each would blame the other and neither would take the control or walk it through. Medicare would not take your phone number and said that they cannot call you back, per policy.
Medicare for the most part had agents that listened, but you were to know to go up a step and ask for a supervisor, again they could not work with you beyond the phone call. And other agents and supervisor would say that the other supervisor did something wrong or didn't do enough.
Where at Kaiser they acted like it wasn't their fault or their concern. One Kaiser supervisor said that she would check something and get back to me. She left a message the next day and stated that they would issue a letter too. The letter arrived stating that Kaiser had terminated my mother as of 00/00/00.....what the hell???
So I called the Kaiser supervisor back and left her a message about the end date on the letter. She had someone else call me to say that the date was 12/31/07, but no replacement letter was sent out.
While this bs is going on, I get a letter from the Drug Insurance Company saying that Medicare denied them becasue I had coverage through Kaiser Senior Advantage and they sent all the premiums that I had paid for the year so far back. Strangely I remember that about 3-4 wks previously Medicare sent me a form letter saying that I didn't have Drug Insurance Coverage....how was that possible if they say I have Kaiser and denied the Drug Ins Company I signed up with.
FINALLY a Medicare supervisor says that this may take 4-6 weeks to be corrected...but I'm losing trust. I am due to have surgery within the next two mos and I want this rectified before I go in so that the bills don't end up in collections.
Five days later the Drug Insurance Companies and says that Medicare accepted them and they would rebill us. But a day later I get a benefit summary showing the two medical bills and showing that coverage was denied because my mother was covered by another company Kaiser Senior Advantage.
So I called Medicare and after dealing with one condesending agent who hung up on me, I got a supervisor that could not tell me exactly what she saw on her computer, but that one bill had been paid.
So now I wait........to see if that was the final chapter, or if just volume 1 of a zillion more.
I'm 53, I can't imagine what a 90 yr old with dementia would do with this.
One does not have to be a rocket scientist to know what health care AS CUSTOMER SERVICE -----trying to get service from global call centers-----trying to seek justice through global tribunal courts-----we obviously will not get justice. We will have monthly payments deducted for mandatory health insurance with absolutely no way to assure we get that service. The article above spoke about the inability to get Federal Medicare to respond and that is because our Federal Medicare and Medicaid is OUTSOURCED----they have no power of enforcement. Before CLINTON/BUSH/OBAMA our Medicare system was the envy of the world----it worked fine---it was responsive to Federal laws----US Constitutional rights----so this is not INEFFECTIVE GOVERNMENT----it is INEFFECTIVE GLOBAL CORPORATE CONTROL OF GOVERNMENT.
This article shows ONE Federal policy aimed at ONE abuse by a mandatory arbitration structure built during CLINTON/BUSH. Why do we think Congress only addressed this one issue----nursing home rule? Well, let's look at which global corporations own almost all our senior nursing homes----I spoke of MANORCARE ----here in Baltimore and Maryland owned by a global hedge fund-----CARLYLE GROUP. Now, Trans Pacific Trade Pact under Foreign Economic Zone policy will not allow these kinds of Federal protective laws----TPP creates that ONE WORLD written policy that takes all claims against global corporations to this global tribunal court for MANDATORY ARBITRATION. So, Obama and Congress both working hard to FAST TRACK TPP-----know TPP will overrule this NURSING HOME LAW. It is because Obama and Congress allowed global corporations and hedge funds to own all our public health facilities that these Federal laws will be ignored.
THE NEW YORK TIMES KNOWS THIS! NO JOURNALISM---SIMPLY REPEATING WHAT POWER SAYS.
'The nursing home rule, which was first proposed in July 2015, was aimed at improving disclosure. The agency began to re-examine the rule after a chorus of patient groups raised concerns about the widespread use of arbitration'.
U.S. Just Made It a Lot Less Difficult to Sue Nursing Homes
By JESSICA SILVER-GREENBERG and MICHAEL CORKERYSEPT. 28, 2016
A case involving Elizabeth Barrow, a 100-year-old woman who was found murdered in a nursing home in 2009, was initially blocked from court. Credit Ian Thomas Jansen-Lonnquist for The New York Times
The federal agency that controls more than $1 trillion in Medicare and Medicaid funding has moved to prevent nursing homes from forcing claims of elder abuse, sexual harassment and even wrongful death into the private system of justice known as arbitration.
An agency within the Health and Human Services Department on Wednesday issued a rule that bars any nursing home that receives federal funding from requiring that its residents resolve any disputes in arbitration, instead of court.
The rule, which would affect nursing homes with 1.5 million residents, promises to deliver major new protections.
Clauses embedded in the fine print of nursing home admissions contracts have pushed disputes about safety and the quality of care out of public view.
The system has helped the nursing home industry reduce its legal costs, but it has stymied the families of nursing home residents from getting justice, even in the case of murder.
A case involving a 100-year-old woman who was found murdered in a nursing home, strangled by her roommate, was initially blocked from court. So was a case brought by the family of a 94-year-old woman who died at a nursing home in Murrysville, Pa., from a head wound. The cases were the subject of a front-page article in The New York Times last November.
“The sad reality is that today too many Americans must choose between forfeiting their legal rights and getting adequate medical care,” Senator Patrick Leahy, a Democrat of Vermont, said in a statement on Wednesday.
The nursing home industry reacted strongly against the change. Mark Parkinson, the president and chief executive of the American Health Care Association, a trade group, said in a statement on Wednesday that the change on arbitration “clearly exceeds” the agency’s statutory authority and was “wholly unnecessary to protect residents’ health and safety.”
The new rule on arbitration came after officials in 16 states and the District of Columbia urged the government to cut off funding to nursing homes that use the clauses, arguing that arbitration kept patterns of wrongdoing hidden from prospective residents and their families.
With its decision, the Centers for Medicare and Medicaid Services, an agency under Health and Human Services, has restored a fundamental right of millions of elderly Americans across the country: their day in court.
It is the most significant overhaul of the agency’s rules governing federal funding of long-term care facilities in more than two decades.
And the new rule is the latest effort by the Obama administration to rein in arbitration’s parallel system of justice that was quietly built over more than a decade.
In May, the Consumer Financial Protection Bureau, the nation’s consumer watchdog, unveiled the draft of a rule that would prevent credit card companies and other financial firms from using arbitration clauses that bar consumers from banding together in a class-action lawsuit.
While Democrats, including Mr. Leahy, have tried to get rid of arbitration through legislation, their efforts have met resistance from various industry groups. The efforts by the consumer agency and now Health and Human Services do not require congressional approval.
Like other rules put forth by the administration, the rule on nursing homes that receive federal funding could be challenged in court. But absent those challenges, the rule is scheduled to go into effect by November. Only future admissions would fall under the new rule.
The nursing home industry has said that arbitration offers a less costly alternative to court. Allowing more lawsuits, the industry has said, could drive up costs and force some homes to close.
But some government officials and elder care lawyers see a different rationale. For corporations, they say, arbitration also potentially keeps embarrassing practices under wraps.
The nursing home rule, which was first proposed in July 2015, was aimed at improving disclosure. The agency began to re-examine the rule after a chorus of patient groups raised concerns about the widespread use of arbitration.
The final version of the rule went a step further than the draft, cutting off funding to facilities that require arbitration clauses as a condition of admission.
Lawyers who work with the elderly say that people are being admitted to nursing homes at one of the most stressful moments of their lives. Distraught and often desperate for a room, prospective residents do not fully grasp what they are signing, the lawyers say.
Sometimes, that does not matter. Judges are bound by a pair of Supreme Court decisions, in 2011 and 2013, that blessed the widespread use of arbitration clauses. Those decisions have made it virtually impossible to overturn clauses, even those signed by the most vulnerable nursing home residents.
An appeals court refused to throw out an arbitration clause signed by a man who could not read or sign his name, reasoning that “illiteracy alone is not a sufficient basis for the invalidation of an arbitration agreement.”
In the last decade, arbitration clauses have affected things like cellphone contracts, employment agreements and student loans.
But even as the use of arbitration clauses spread, little was known about what happened to those who took their chances there. Companies argued that arbitration offered a simpler, swifter and less expensive alternative to court, without the headaches and delays.
Those claims, though, were largely anecdotal because arbitrations are confidential and there is no federal database that records their outcomes.
In a yearlong investigation, The Times tried to pierce the veil, getting inside the secretive proceedings. To do that, The Times examined records from more than 25,000 arbitrations between 2010 and 2014 and interviewed hundreds of lawyers, arbitrators, plaintiffs and judges in 35 states.
The proceedings bear little resemblance to court. They have been conducted in the offices of lawyers who represent the companies accused of wrongdoing.
In the case of nursing homes, The Times found many troubling examples where issues of abuse and potential neglect never made it into the public light because they were blocked from court.
In May 2014, for example, a woman with Alzheimer’s was sexually assaulted two times in two days by residents at a nursing home in Lemon Grove, Calif. A subsequent investigation by the state’s department of public health found the nursing home “failed to protect” the woman.
But when her family tried to hold the nursing home accountable in court, their case was scuttled because of an arbitration clause. Ultimately, they gave up and settled with the nursing home.
These mandatory arbitration laws fill our national Rule of Law with the goal of dismantling citizen ability to seek justice against any corporate malfeasance-----these have been in place through Clinton/Bush and continue through Obama. I would suggest that citizens in US cities victim of police homicide think about how our US cities deemed Foreign Economic Zones would not see public justice but MANDATORY ARBITRATION in which the global military police corporation simply pays a settlement-----
THAT IS WHY WE SHOUT THAT ALL THESE INJUSTICES----FROM LOOTED PENSIONS AND RETIREMENTS----TO MEDICAL MALPRACTICE----TO CONSUMER AGREEMENTS TAKING OUR ABILITY TO SUE FOR FALSE BILLING----AND TO THESE MEDICAL ISSUES----ALL ONE WORLD ONE GOVERNANCE DISMANTLING OF OUR US CONSTITUTION AND US RULE OF LAW----
What we have seen from Clinton's use of Executive Order to deregulate our public health system ---deregulating consumer protections and processes-----creating widespread distrust by US citizens with their health system----are all tied to taking the US to colonial status----citizens in third world nations lose their lives in alarming numbers due to negligence, predatory health care, and refusal to access---
NO HIPPOCRATIC OATH/NO PATIENT'S BILL OF RIGHTS IN THIRD WORLD!
Mandatory Arbitration Clauses:
Undermining the Rights of Consumers, Employees, and Small Businesses
Today most Americans are bound by at least one mandatory, pre-dispute arbitration clause. Buried in the fine print of a billing insert, employee handbook, health insurance plan, or dealership or franchise agreement, these clauses waive one’s right to access the courts, diverting cases to a costly private legal system that favors defendants. Arbitration clauses are achieving their intended purpose—undermining consumer protection, civil rights, and other laws that level the playing field between big businesses and individuals. The individual is left with no choice but to waive these rights, because arbitration clauses are presented on a take-it-or-leave-it basis.
How Individuals Are Disadvantaged by Arbitration:
Arbitration was conceived as an informal, expedited process for resolving routine disputes between businesses. But when it is imposed on a weaker party, such as a consumer, arbitration can be used to defeat valid claims.
Arbitration has several unique characteristics that make it harder for individuals to prevail in a dispute with a business:
High costs: A claimant must pay steep filing fees just to initiate a case—seldom less than $750. These fees do not cover the arbitrator’s hourly charges, which are generally in the range of $200 to $300 per hour, split between the parties. All these fees must be deposited in advance, and almost always amount to thousands of dollars. Because the claimant has usually sustained a serious loss in the dispute with the business—foreclosure on a home, firing from a job, termination of a franchise or dealership—most individuals covered by an arbitration clause cannot afford these costs and are forced to drop their cases.
Bias: Arbitration providers are organized to serve businesses, not consumers. Their marketing is targeted entirely at businesses, and their panels of arbitrators consist primarily of corporate executives and their lawyers. Since only businesses will be repeat users of an arbitrator, there is a disincentive for an arbitrator to rule in favor of a consumer or employee if he expects further retentions. There is also a long-standing custom among arbitrators to “split the difference” between two sides’ positions. The result is that arbitration awards to consumers and employees are substantially lower than court awards. Comparisons of average awards by arbitrators and courts in employment cases and medical malpractice cases show that arbitration claimants receive only about 20 percent of the damages that they would have received in court.
Limited discovery: Discovery is the process by which litigants obtain information and evidence in the possession of their opponent or third parties. In arbitration, discovery is a privilege, not a right, and many businesses draft arbitration clauses to severely restrict the claimant’s ability to obtain necessary evidence. Moreover, since arbitrators do not have the power to enforce subpoenas, claimants must sometimes file lawsuits to get compliance—defeating the purpose of arbitration.
Prohibition of class actions. Nearly every arbitration clause prohibits participation in class action lawsuits. Class actions are the only effective remedy for wide-scale scams that rip off individual consumers or farmers in small amounts. Individuals do not have the time or resources to recognize, investigate, or prove the existence of such fraudulent practices.
Inconvenient venue. Arbitration clauses often require that hearings be held in a location inconvenient to the claimant. Individuals may have to bear the cost of long-distance travel to have their case heard. For example, the Internet auction site e-Bay requires its customers to travel to its home turf of San Jose, California, to arbitrate any dispute.
One-way requirements. Most arbitration clauses require only the weaker party (the consumer, employee, or franchisee) to arbitrate its claims, while allowing the dominant party (the corporation) to sue in court on its claims. Thus, a sexual harassment victim can be forced to arbitrate a discrimination claim against a former employer while litigating identical issues in court if the employer sues to stop her from joining a competitor.
No public record. While proceedings and records of the courts are open to the public, most arbitration clauses and provider organizations require that proceedings be kept confidential. As a result, only the businesses that impose arbitration can track past decisions and know which arbitrators have ruled for them. Public discussion of the fairness of an arbitration ruling is discouraged, even if the case raises policy issues of wide concern. Moreover, arbitration sets no legal precedents to guide a company’s future conduct.
Limited judicial review. Parties are allowed only limited judicial review of an arbitration award. A decision may only be overturned when there is fraud or “manifest disregard of the law.” This is a high hurdle, because arbitrators need not issue written findings of fact or legal conclusions. Oddly enough, courts will refuse to hear appeals of arbitration decisions even when both sides have agreed to let a court do so!
Limited remedies. Courts can provide a range of remedies that are not available to a claimant in arbitration. Injunctive relief—a court order compelling the offending party to do something, or prohibiting that party from taking some action—cannot be obtained through arbitration. Punitive damages, which may be awarded by a judge or jury to “punish” particularly egregious behavior, are also not available in arbitration.
As we said---both Congress, Obama, and the New York Times reporter writing the article above acting as though that ONE nursing home law will actually do something for WE THE PEOPLE know TPP is set to negate any of these Federal, state, and local laws-----
Maryland is hyper-corporate because our governance is completely outsourced to appointed corporate commissions or run by corporations so citizens come to these issues wanting to PROTECT corporations against lawsuits. Suspending all citizens' rights simply because a state governance is captured and operating outside Rule of Law should spark MORE CITIZEN protest. As we said, once they take our public health to for-profit global market maximization----they are ending any ability for WE THE PEOPLE to have any rights or say to what our health system looks like.
THIS IS HUGE FOLKS. EVEN IF WE SET ASIDE FOLKS NOT LIKING MEDICARE OR MEDICAID---THE US HAS ALWAYS OPERATED UNDER WESTERN STANDARDS OF MEDICINE---DO NO HARM.
Any candidate who shouts HEALTH CARE FOR ALL------which of course is what voters want to hear----we know they are 1% Wall Street global corporate players with no intent of doing what they say. We have this in Baltimore with Baltimore having absolutely no public health oversight and accountability----so there is no national data to show our institutional abuses------the data is all skewed----and this will soar as US cities deemed Foreign Economic Zones bring all kinds of foreign corporations as partners in these global corporate campuses-----BIOTECH/GLOBAL HEALTH SYSTEMS-----
For those not understanding why no Wall Street bankers or people tied to last decades massive subprime mortgage fraud were brought to justice and fines on banks so low-----it is this GLOBAL TRIBUNAL COURT structure where our US Justice Department simply took these banks to a global court for arbitration -----and VOILA----Wall Street banks get pennies on the dollar in fines----as a settlement with no charge----THIS IS THE GLOBAL TRIBUNAL COURT ---and WE THE PEOPLE received NOTHING from all that fraud.
Below is very, very boring public policy but it is critical to being that informed voter----please glance through and google as this is only a partial post.
ARBITRATION AND MEDIATION IN THE
NEW HEALTH CARE UNIVERSE
Katherine Benesch, Esquire
Geoff Drucker, Esquire
Benesch & Associates, LLC
AHLA Dispute Resolution Service
Princeton, New Jersey 08540
Washington, D.C. 20006
Arbitration and mediation (“ADR”) have become the forums of choice for major healthcare business disputes. These disputes are domestic and worldwide, and may involve millions of dollars. Disputes over health care issues extend far beyond traditional lawsuits between patients and physicians. Most of the claims are contractual and are not covered by insurance. Chief executive officers and general counsel of large and small companies and medical practices dictate the strategy of the case. While some cases are filed in state or federal court, and diverted
to ADR, most health care providers and payers do not enter the courtroom. Many of the contracts
contain mandatory binding arbitration clauses.
Some contain two-step mediation/arbitration processes. Parties involved in health care ADR include health systems, hospitals, physicians and
their medical groups, insurance carriers, practice management and billing companies, managed care plans, laboratories, large and small pharmaceutical companies, durable medical equipment
companies, contract research organizations, nursing homes, assisted-living and residential care
Major “bet the company” commercial disputes in health care frequently are decided outside of courts and administrative agencies. Arbitrators in Illinois rejected a health plan’s claims in a contentious antitrust dispute, in which the plan had argued that providers violated state and federal antitrust laws in their negotiation of contracts.
Tenet Healthcare Corporation was awarded $46 million by an arbitration panel in a dispute with one of
its insurance carriers over payment of damages in a settlement involving two physicians alleged to have performed unnecessary heart procedures.
A number of statutes mandate ADR in specific types of disputes between health care providers and payers. Medicare and other federal statutes establish their own arbitration and/or mediation processes. Where an agreement to arbitrate is contained in a contract signed by both parties, and one party seeks adjudication by the court, most federal and state courts return disputes to arbitration for resolution.
At the same time, consumer filings contesting mandatory binding arbitration clauses in health care contracts continue to proliferate in state courts.
The United States Supreme Court has held that the Federal Arbitration Act (“FAA”) applies to all arbitrations that involve interstate commerce.
Where this issue arises, most courts determine that activities in healthcare constitute interstate commerce.
The FAA has been held to pre-empt contrary state law
unless a federal statute says otherwise, as is the case with state insurance laws. Thus, state insurance law, not the FAA, has been held to control where the health plan arbitration clause did not comply with state law in a dispute involving HMO’s.
In addition to broad-based state arbitration statutes patterned on the Uniform Arbitration Act, many states have statutes and regulations requiring some
type of ADR and/or hearing process for reimbursement or other issues between health care parties. New Je
rsey is a good example. There, the Health Care Carrier Accountability Act authorizes mediation and binding
and non-binding arbitration instead
of a hearing to determine the liability of an organized
delivery system or carrier resulting from negligence in the denial or delay of the approval of
medically necessary covered services
Other examples include hearings for provider
terminations from a health maintenance organization,
and the complaint and appeal system for members of HMOs established by state regulation.
The Health Claims Authorization, Processing and Payment Act, and amendments related thereto, require health insurers and providers in New Jersey to arbitrate health care payment disputes. Under amendments to the Health Care Quality Act, a health care appeals program is established, which mandates a two-step process for dispute resolution.
Other states have similarly mandated ADR programs for complaints and grievances related to care rende
red and to reimbursement in managed care and
other health insurance modalities.
ADR Processes Used for Health Care Matters
The ADR processes most commonly used in health care cases are binding arbitration, mediation, mediation/arbitration, early neutral evaluation and mini-trials. Non-binding arbitration, private judging, fact
-finding/special referee and voluntary settlement conferences are used less frequently. These processes may be mandated by statute, by the contract or by state or federal court, if the case was commenced in litigation.
Arbitration versus Mediation.
Arbitration is private adjudication.
A single arbitrator, or a panel of three, hears evidence and renders an award (binding decision) in accordance with a set of rules. Because the grounds for appealing an arbitration award are very narrow, an arbitrator
wields greater authority over an individual case than a trial court judge. Mediation is assisted settlement. The mediator has no power to impose a solution on the
parties, who must make the decisions themselves. Rather, the mediator facilitates communication between the parties and helps them overcome barriers to agreement, often by assisting them to analyze the strengths and weaknesses of their case objectively.
All too often, attorneys delay mediating until they are almost literally on the courthouse steps. The time and cost savings are far greater if mediation takes place early on in the pre-trial (or pre-hearing) process.
Moreover, in complex cases, mediation can be highly productive long before the parties are ready to discuss settlement. The mediator can help parties refine the issues and structure an efficient and effective discovery process. For example, instead of engaging in an expensive battle of experts, parties may agree to secure an opinion from a single trusted source. A neutral who has worked with the parties on managing discovery will be well prepared to assist in reaching a settlement when the time is ripe.
Health Care Matters Frequently Decided through ADR include:
Managed care disputes between payers and providers involving contract interpretation, risk sharing, insurance, reimbursement and/or administrative issues;
Employment contract disputes between physicians and medical groups or between physicians and hospitals (including covenants not to compete);
Medical staff, credentialing and peer review disputes;
Shareholder disputes with physician practices;
Contract and reimbursement disputes involving health care joint ventures;
Laboratory billing disputes;
Disputes between third party vendors, durable medical equipment providers and healthcare facilities;
Disputes over the dissolution of a medical practice or other health care entity;
Insurance carrier disputes with providers over coding, billing and claims payment;
Disputes involving management services companies, providers and third party vendors;
Class actions over coverage and claims payment;
Contested guardianship disputes;
Medical necessity disputes;
Long term quality of care and billing issues;
National and international contract disputes involving pharmaceutical companies, research and clinical trials of new drugs; and
Medical malpractice cases.