A highly accomplished litigator with tremendous depth and breadth of expertise in the health care industry, Andrew Selesnick is the Chair of M&R's Health Care Department.
Mr. Selesnick has successfully litigated a number of California’s most high-profile, large exposure health care cases, including those involving all the major health plans, as well as many independent practice associations. He has secured hundreds of millions of dollars for his clients, with these results setting several legal precedents. In one groundbreaking case, Mr. Selesnick successfully argued that health plans are responsible for reimbursing a reasonable portion of out-of-network emergency service providers’ costs.
Mr. Selesnick represents physicians, physician groups, hospitals, skilled nursing facilities and ambulatory surgery centers in reimbursement matters, provider-payer disputes and fraud and abuse defense. His clients include a wide array of national and regional providers, whom he has provided counsel through litigation, contracting, acquisitions, business formation and dissolution and risk management. Mr. Selesnick regularly advises skilled nursing facilities in shareholder derivative litigation and management and ownership disputes. He frequently provides counsel regarding the intricacies of the Affordable Care Act to his clients.
Mr. Selesnick has often been invited by both the California State Senate and the State Assembly to comment on legislation and regulations affecting health care providers.
He is a member of M&R's Executive and Strategic Planning Committees, as well as the Affordable Care Act Advisory Group.
Chair, Health Care Group — Mr. Selesnick is Chair of M&R's Health Care Industry Group
Managed Care Liability — In Centinela-Freeman Emergency Medical Associates v. Health Net of California, our clients, a large medical group, staffed the emergency room at multiple hospitals. An Independent Physician Association (IPA), La Vida, sent many patients to the ER, but the IPA was struggling financially and failed to reimburse the ER doctors before going out of business. Mr. Selesnick and his team sued every major HMO in California, alleging that they knew that La Vida could not pay its bills. The trial court sustained the HMOs’ demurrer to the ER doctors’ complaint without leave to amend, finding that the HMOs could delegate their responsibility to IPAs with immunity. In a unanimous published decision, the Court of Appeal reversed the trial court and held in favor of the ER doctors. Finding the HMOs’ conduct demonstrated negligence and showed a degree of “callousness,” the Court ruled that negligent delegation is a viable cause of action in California. This case is currently pending before the California Supreme Court.
Provider Reimbursement — In Centinela-Freeman Emergency Medical Associates, et al. v. Hispanic Physicians IPA Medical Corporation, Mr. Selesnick represented an emergency physician group against a managed care organization. The IPA systematically underpaid or completely denied payment for emergency services provided by our client to its members. On the eve of trial, the judge ordered the parties to participate in a mandatory settlement conference. The parties were able to settle a portion of the claims. However, in order to provide our clients with a business solution going forward, settlement of a portion of the claims became contingent on arbitrating a case rate for all services going forward. In arbitration, each party was to propose a rate to be paid for each patient visit by any member of the IPA to any of the ten hospitals in which our clients provide emergency services. The arbitrator found in favor of the emergency providers.
Provider Reimbursement — In this seminal case (one of the healthcare industry’s most significant decisions), Bell v. Blue Cross of California(2005) 131 Cal.App.4th 211, we successfully argued that health plans are responsible for reimbursing a reasonable portion of out-of-network emergency service providers’ costs