Health Care Disputes

by Barbara A. Reeves and R. Wayne Thorpe

Abstract:

There is a wide variety of health care industry disputes. The complexity of many health care disputes, the parties’ desire for confidentiality, the ongoing business relationships between and among the parties and the importance of privacy of health care information make arbitration more advantageous than litigation for health care disputes. This article will discuss the nature of the disputes that are commonly brought to arbitration, the issues that characterize these disputes and how they can best be resolved, and sample language for drafting an arbitration clause for provider/payor disputes, which account for the largest volume of health care industry disputes that utilize arbitration.

The complexity of many health care disputes, the parties desire for confidentiality, the ongoing business relationships between and among the parties and the importance of privacy of health care information make arbitration more advantageous than litigation for health care disputes.

Many different kinds of health care industry disputes benefit from resolution in binding arbitration rather than by traditional litigation in the courts. Factors that can make arbitration more advantageous for such disputes than litigation include the complexity of many health care disputes, parties’ desire for business confidentiality and protection of personal health information,  preservation of ongoing business relationships between and among the parties, decision making by a professional with healthcare expertise, and potential savings in time, energy and cost.

In arbitration, parties can select arbitrators knowledgeable about health care and insurance regulation and compliance issues, reimbursement and billing issues, coding practices, quality of care issues and privacy regulations such as HIPAA and HITECH.

This article will discuss the nature of the disputes that are commonly brought to arbitration, the issues that characterize these disputes and how they can best be resolved, and sample language for drafting an arbitration clause; this clause is particularly focused on provider/payor disputes, which account for the largest volume of health care industry disputes that utilize arbitration.

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