Mediation Approach.  To resolve disputes in mediation, Mr. Roth helps parties to understand that settlement would be more beneficial than continued litigation or arbitration by: (i) carefully reviewing the parties’ briefs and usually communicating with their counsel in advance of the mediation session; (ii) actively listening to the parties and their counsel in order to best use his subject matter expertise to help them evaluate their cases and respective positions; and (iii) assisting the parties and their counsel to craft solutions and settlements which address the parties’ monetary and other underlying interests and concerns.

Representative Issues at Roth’s Mediations: 

• Whether payor breached agreement with an ambulatory surgery center (ASC) when it sought to recoup prior payments based upon a new reimbursement rate to be retroactively applied in accordance with a contract term stating that the ASC would be paid no more than permissible under Federal law; and whether payor equitably estopped from recouping these prior payments to ASC.

• Whether hospital was entitled to payment as an in-network provider or out-of-network provider, which hinged on whether hospital was a participating facility in a network ("Network") with whom the payor had contracted to obtain discount rates from the Network's facilities or patient was enrolled in a payor-designated PPO that did not have a contract with the hospital.

• Determining the reasonable and customary value of emergency room services to be paid by a capitated physician group to the ER for services furnished to one of the group’s enrollees; and setting a contract rate for future services to be provided by the ER to the group’s enrollees.

• Whether billing agency breached its contract with physician and violated its good faith duty by failing to properly/timely bill claims, follow-up on and appeal denials/underpayments, and double billing for same services.

• A skilled nursing facility’s liability to a physical therapy provider for services furnished by the physical therapists to the SNF’s patients relating to whether contracts claims were waived, whether therapy provider failed to mitigate damages, and which contracts applied to the provided services.

• Whether insurance broker negligently advised insured to purchase costly and unnecessary insurance coverage for the insured and her son; and whether son’s preexisting condition precluded purchase of alternative coverage.  

• Whether seller of hospice misrepresented to buyer the geographic service area and number of its staff members and/or whether buyer failed to properly conduct due diligence.

• Whether a management services organization failed to maintain and provide the data, files, and other information needed by IPA to continue successful operations.

• Whether specialty hospital breached its ground lease from hospital system by subleasing ground-leased premises to private medical group.

• Real estate dispute between a hospital and its hospital-based medical group respecting who owned a wing added to hospital facility and liability for related utilities and costs.

• Fair market value for healthcare goods and services.

• Whether claims related to covered health plan members and whether services constituted "emergency" care. 

• Whether patient care services were medically necessary and provided at the appropriate level of care.

• Whether contract forged and, also, whether signature(s) forged. 

• Whether current licensee of health facility was successor corporation to former licensee.

• Whether partner fraudulently covered up business losses and used partnership's properties and assets to secure personal loan.

• Whether business was excused from paying fee due to placement service's breach of agreement by failing to provide professional reference checks and other authentication documentation respecting referred individual. 

• Who was at fault in an automobile accident and related calculation of damages.

• Whether seller of business fraudulently misrepresented the amount of inventory which would be on-hand at the close of escrow; whether merchandise had been converted by seller for his personal use; and seller's counter claim that no specific amount of inventory had been included in purchase price.

• Whether a surgeon’s performing an aortal bifemoral bypass without the assistance of, or consultation with, a vascular surgeon was consistent with the standard of care and based thereon whether a hospital’s medical executive committee’s summary suspension of the surgeon’s practice privileges was warranted or, instead, should be terminated or modified.