88 Hammond Street, Suite 500
Bangor, ME 04401-4915
Gregory A. Brodek is chair of the firm's Health Law Practice Group. Mr. Brodek concentrates his practice exclusively in the area of healthcare law and represents hospital systems, hospitals, physicians, physician groups and integrated delivery systems on a wide variety of transactional, 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 clients are throughout the United States.
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 also represents hospitals in joint venture transactions, including formation of integrated delivery systems, PHOs, HOs, and hospital-owned MCOs.
Mr. Brodek has lectured widely and has written on many healthcare matters, including "Payment Issues Update," Health Law and Compliance Update, which was published by Aspen in 2020. He is a 1988 graduate of Drake University Law School, where he was elected to the Order of the Coif, and a graduate of Boston University.
- Assisted hospitals and other providers with recoupment of payments in excess of $500 million.
- Represented numerous hospitals in connection with the formation of healthcare systems.
- Represented hospitals in the acquisition of a variety of medical practices.
- Advised hospitals in the formation of Medicaid strategies.
- Represented hospitals in the development of medical office complexes.
- Assisted hospitals and healthcare systems in maintaining their tax-exempt status and fighting state and local efforts to eliminate their tax exemptions.
- Has served as general counsel and special counsel to numerous hospitals and hospital systems.
- Represented a Missouri pathology group in a dispute with a payor over the billing of the professional component of clinical pathology services, resulting in the payor agreeing to sign the previously negotiated and abandoned participation agreement.
- Represented a Missouri pathology group in litigation with payor in dispute over the billing of the professional component of clinical pathology services, which resulted in the client obtaining a $3 million settlement.
- Represented a Florida physician group practice with respect to a payor aggressively seeking to recoup purported overpayments for the professional component of clinical pathology services made to the group, resulting in the payor recovering considerably less than the amount it initially sought.
- Represented a Wisconsin pathologist physician group practice with respect to a payor aggressively seeking to recoup purported overpayments made to the group, resulting in the payor not recovering the overpayments.
- Counsel to statewide classes of pathologists in Illinois, Texas and Tennessee asserting class action claims in three separate class action arbitrations against health insurance companies arising out of improper reimbursement for the professional component of clinical pathology services provided to beneficiaries enrolled in the insurer’s health care plans.
- Represented 22 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.
- Represented an Illinois physician group in an arbitration on a claim of breach of contract against a payor for failure to pay for the professional component of anatomic pathology services. The action resulted in a going-forward resolution, including prospective contractual relief.
- Represented a statewide class of Illinois pathologists against a payor seeking payment of professional component fees. Secured a certified class and resolved the arbitration with payments to all class members and other prospective contractual relief.
- Represented an Illinois physician group in an arbitration on a claim of breach of contract against a payor for failure to pay for the professional component of anatomic pathology services. The action resulted in a lump-sum payment resolution.
- Class action arbitration in Tennessee on behalf of all pathologists against a payor on a claim of breach of contract where the payor unilaterally stopped paying for the professional component of clinical pathology based on its claim that it can make such a change as a “policy amendment,” which was successfully settled.
- Assisted numerous pathology groups in several states over point of service issues and appropriate coding concerns.
- Represented physician group practices with respect to a payor aggressively seeking to recoup payments made to the groups.
- 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).
- Representation of the emergency department (ED) physicians in a putative class action against the Commonwealth of Massachusetts with respect to MassHealth’s failure to reimburse physicians for all services rendered in the ED, by bundling the procedure with the evaluation and management (E/M) service. Upon dismissal without prejudice of the class action, individual ED groups were instructed to go through the administrative appeals process. Our firm is assisting ED groups with each step of the administrative appeal process, including the resubmission of claims, and possible further litigation once the claims are denied.
- 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.
- 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.
Hospitals and Health Systems
Physicians and Physician Specialties
- Drake University Law School, J.D., 1988
- Order of the Coif
- American Bar Association
- Health Law Section
- Maine State Bar Association
- Health Law Section
- Business Law Section
- Penobscot County Bar Association
- American Health Lawyers Association
- Health System Transactions Special Interest and Substantive Law Committee Regulations, Accreditation-Payment Special Interest and Substantive Law Committee
- Co-author, "Affidavit: Healthcare and the Law - An Examination of Federal Legislative Approaches on Payment of Surprise Bills," The Wharton Healthcare Quarterly, Spring 2020
- Author, “Payment Issues Update,” Health Law and Compliance Update 2020
- Author, “Reimbursement Update: Payment Issues,” Health Law and Compliance Update 2019 Mid-Year
Author, "Departments Reaffirm "Greatest of Three" Rule and Clarify Outstanding Questions," Duane Morris Alert, May 2, 2018
- Contributing Author, “Navigating the Labyrinth of Payor Audits,” Health Care Law Enforcement and Compliance, 2013 ed.
- Author, "Considerations for Providers Facing Audits From Payors," The Legal Intelligencer, July 10, 2013
- 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
- Panelist, "Assessing the Impact of Surprise Billing Legislation on Providers and MCOs," 11th Annual Advanced Forum on Managed Care Disputes and Litigation, Virtual Conference, July 22, 2020
Presenter, 2018 UCAOA Urgent Care Convention & Expo, Paris Hotel, Las Vegas, Nevada, May 8, 2018
- Speaker, "Texas Unencumbered #bizPT Conference," PTB Alliance, May 29-30, 2015
- Speaker, "Managing Payer Audits: Recommendations for Children's Hospitals Based on National Experience," Children's Hospital Association 2013 Forum Series, Chicago, October, 23, 2013
- 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