Kelsey J. Hope

Kelsey Hope is a business litigator who works closely with clients faced with complex commercial disputes, with an emphasis in the managed care industry. Ms. Hope represents clients as plaintiffs and defendants in federal and state lawsuits, as well as arbitrations, involving contractual and extra-contractual disputes, as well as overpayment and fraudulent billing issues. She advises group insurers, plan administrators, third-party claim administrators, employers, and pharmacies in lawsuits involving medical benefits, including ERISA and state law claims. Ms. Hope has experience in all stages of litigation, including drafting pleadings and discovery requests, briefing jurisdictional and procedural issues, managing complicated discovery dockets, responding to evidentiary challenges, working with experts, interviewing witnesses, and handling bench and jury trials. Ms. Hope has represented clients in Texas, Oklahoma, Delaware, and Florida. While the range of business disputes on which Ms. Hope works crosses many industries, she has extensive experience in managed care litigation. Ms. Hope handles cases involving disputes over medical benefits, claim billing and payment, reimbursement disputes, fraud, and other healthcare issues. Ms. Hope's pro bono practice includes working as a volunteer prosecutor for the City of Houston Municipal Court where she tried numerous jury trials to verdict and handled all aspects of pretrial motions, voir dire, direct and cross-examination, and closing arguments.

Representative Cases

Ms. Hope handles contested proceedings brought by or against managed care clients; she has extensive experience defending and/or prosecuting many types of claims and causes of action, including:

• Disputes involving facility-based providers, free-standing emergency centers, hospitalbased providers, and facilities.
• Disputes involving anesthesia services, pharmaceutical services, emergency services, medical billing and coding issues, and bariatric surgeries and related procedures.
• Disputes involving prompt payment laws, payment and claim processing policies, pharmaceutical reimbursement, balance billing, surprise billing, and out-of-network payment methodologies
• Represented pharmacy in lawsuit relating to usual and customary billing; following jury trial, obtained complete verdict in client’s favor.
• Represented managed care company in litigation involving surprise emergency medical billing; obtained favorable result for client.
• Represented managed care company and prosecuted fraud claim against out-of-network hospital and affiliated emergency clinics; obtained summary judgment award based on misrepresentations regarding the nature and location of service provided.