Gregory A. Brodek
Partner
Duane Morris LLP
100 High Street, Suite 2400
Boston, MA 02110-1724
USA
Phone: +1 207 262 5440
Fax: +1 207 433 1164
Email: GABrodek@duanemorris.com

Bangor Address:
88 Hammond Street, Suite 500
Bangor, ME 04401-4915

Gregory A. Brodek concentrates his practice exclusively in the area of healthcare law and represents hospitals, physicians, physician groups and integrated delivery systems on a wide variety of regulatory, compliance, and reimbursement issues nationwide. He draws on his years of experience and deep understanding of the healthcare industry to counsel his clients on the business impact of the legal issues at stake.

His extensive healthcare experience includes representing providers in resolving disputes with public and private payors, negotiating settlements with federal and state agencies, structuring integrated delivery systems and physician networks, negotiating managed care arrangements, developing reimbursement strategies both on a state and federal level, and advising on self referral laws, tax-exempt concerns and day-to-day operational questions.

Mr. Brodek is an active member of the Healthcare Financial Management Association, the American Health Lawyers Association and the Healthcare Law sections of the Maine State and American bar associations. He has lectured widely and has written on many healthcare matters, including "Managed Care Contracting Issues for Providers," Health Law and Compliance Update, to be published by Aspen in 2009. He is a 1988 graduate of Drake University Law School and a graduate of Boston University.

Representative Matters

• Assisted clients with recoupment of payments in excess of $90 - $100 million.

Pathology

• Represented physician group practices with respect to a payor aggressively seeking to recoup payments made to the groups.
• Represented physician group practices in a dispute with a payor regarding the payor's failure to compensate the group practices for the professional component of clinical pathology services at the contracted rate.
• Represented three physician groups in Tennessee regarding a payor's refusal to pay for clinical pathology services when billed by pathologists as is required under the contracts these pathologists have entered into with the payor.
• Represented four physician groups in Illinois regarding a payor's refusal to pay for clinical pathology services when billed by pathologists as is required under the contracts these pathologists have entered into with the payor.
• Representing physician groups on claims of breach of contract and deceptive trade practices against a payor for failure to pay for covered services (i.e., the professional component of clinical pathology services).

Emergency Room

• Represented a physician group practice in recovering underpayments made by a payor by paying the non-participating group practice physicians at participating provider rates.
• Resolved a class action brought by non-participating emergency medicine providers against a payor to address a unilateral reduction of fees paid to these non-participating providers.
• Represented physician group practices in recovering underpayments made by a payor.
• Resolved a class action brought by non-participating emergency room doctors against a Medicaid managed care plan for unilaterally electing to reimburse these doctors at Medicaid rates.
• Representing a California physician group against a payor for downcoding and failing to pay for emergency medical services rendered to the payor's members.

Other Matters

• Represented client in an investigation by the Office of Inspector General for purported billing improprieties, resulting in the investigation being closed.
• Represented physician group practices with respect to a payor aggressively seeking repayments.
• Class action against a payor on behalf of independent physical therapists in Maine regarding breach of contract, antitrust and quantum meruit claims.

Professional Activities

• American Bar Association
  - Health Law Section
• Maine State Bar Association
  - Health Law Section
  - Business Law Section
• Penobscot County Bar Association
• Healthcare Financial Management Association
• American Health Lawyers Association
  - Health System Transactions Special Interest and Substantive Law Committee Regulations, Accreditation-Payment Special Interest and Substantive Law Committee

Admissions

• Maine

Education

• Drake University Law School, J.D., 1988

Selected Publications

• Co-author, "State Medicaid Fraud Control Units' Data Mining Likely to Increase Through Federal Funding," Duane Morris Alert, June 11, 2013
• "Increased Spotlight on Emergency Department Facility Coding by CMS, HHS and DOJ," Duane Morris Alert, May 16, 2013
• Co-author, "Reform Means Hospitals Must Consider Primary Care Strategies," Modern Healthcare, July 2011
• Contributing Author, "Managed Care Contracting Issues for Providers," Health Law and Compliance Update 2005 and 2009
• "Medicaid Program Provider Self-Audits," Monitoring & Auditing Practices for Effective Compliance, published by Health Care Compliance Association, 2002
• "Rural and Sole Hospital," Hospital Affiliated Integrated Delivery Systems Handbook, published by the American Academy of Hospital Attorneys, 1995

Selected Speaking Engagements

• Co-Speaker, "Payer Accountability Forum Teleconference," Teleconference, February 15, 2012
• Speaker, "Contracting Strategies with Eye Toward Enforcement," Private Practice Section of the American Physical Therapy Association, Washington, D.C., November 4, 2010
• Speaker, "Pathology Business and Billing Structure," Illinois Society of Pathology Spring Conference, Oak Brook, Illinois, May 9, 2009
• Speaker, Physician Entrepreneurs' Roundtable, Boston, February 26, 2009
• Speaker, "Payer Disputes: A Legal Perspective," Massachusetts College of Emergency Physicians (MACEP) Annual Emergency Medicine Coding and Reimbursement Fall Conference, Waltham, Massachusetts, November 21, 2008
• Speaker, "Ask the Experts: The Legal, Financial, and Risk Management Responsibilities for Boards," Maine Primary Care Association Health Center Board Development Workshop, Lucerne, Maine, May 30, 2007
• Co-Speaker, "Reconsidering Long Held Behaviors - Why Now/What Now?," College of American Pathologists, Pathology-Economic Issues, Orlando, Florida, October 14, 2006
• Speaker, "Monitoring of Reimbursement: What Effective Strategies Can Be Instituted to Avoid Being Short Changed," Maine Chapter of the American College of Surgeons, Northeast Harbor, Maine, May 30, 2003
• Speaker, "Contracting with Commercial Payors," Maine Medical Association 12th Annual Physician Practice Seminar, Bangor, Maine, May 28, 2003
• Speaker, "Beating the Devil You Know: Managing Managed Care Organizations," Medical Group Management Association (MGMA) Annual Conference, Las Vegas, Nevada, October 29, 2002
• Speaker, "Monitoring and Enforcing Commercial Payor Agreements," American Society of Medical Association Counsel (ASMAC) CLE, Kennebunkport, Maine, September 29, 2002
• Speaker, "Managed Care Contracts," Gastroenterology Practice and Endoscopic ASC's Creating Success 2002 Course, Knoxville, Tennessee, April 13, 2002