What We Do

Eisenbrey Law advises and represents healthcare providers, with a particular focus on substance use disorder and mental health treatment providers. We help clients pursue reimbursement, respond to investigations, manage regulatory risks, and address the legal issues affecting their operations.

Counsel for provider disputes, compliance, and business operations.

  • Counsel addressing the distinctive clinical, reimbursement, and operational challenges facing substance use disorder and mental health providers.

    • Residential, inpatient, and outpatient treatment

    • Partial hospitalization and intensive outpatient programs

    • Medical necessity, length-of-stay, and level-of-care disputes

    • Mental health parity and coverage issues

    • Local ordinances affecting treatment facilities and sober living homes

  • Representation in payment disputes under health plans, provider agreements, and applicable law.

    • Network and out-of-network reimbursement

    • ERISA and non-ERISA claims

    • Denied and underpaid claims

    • Administrative appeals and pre-litigation strategy

    • Assignments of benefits, plan exclusions, and claim limitations

  • Guidance from the first records request through response, negotiation, administrative review, and litigation when appropriate.

    • Special Investigation Unit (SIU) inquiries

    • Prepayment and post-payment audits

    • Payment holds, recoupments, and overpayment demands

    • Billing, coding, and documentation reviews

    • Document preservation and investigation response

  • Analysis of the responsibilities and financial relationships among health plans, insurers, third-party administrators (TPAs), and pricing vendors.

    • Plan documents and administrative services agreements

    • Claims authority and delegated responsibilities

    • Repricing and payment-integrity practices

    • Network leasing and vendor arrangements

    • Financial incentives affecting reimbursement

  • Practical advice on billing policies, payer requirements, and patient financial obligations.

    • Copay, coinsurance, and deductible policies

    • Financial hardship assistance and waiver practices

    • Invoicing, collections, and payment arrangements

    • Balance billing issues

    • Billing-company relationships and revenue-cycle documentation

  • Advice on provider operations, marketing, and referral practices, with attention to regulatory and payer scrutiny.

    • Marketing and advertising review

    • Referral arrangements and anti-kickback issues

    • Fraud, waste, and abuse allegations

    • Compliance policies, training, and internal reviews

    • Vendor and marketer agreements

  • Legal support for the organizations and relationships that allow providers to operate, grow, and collaborate.

    • Entity formation and governance

    • Provider affiliations and joint ventures

    • Management and services agreements

    • Employment and independent contractor agreements

    • Ownership, workforce, and business disputes

  • Representation grounded in the evidence and the provider’s business objectives.

    • Payer and reimbursement litigation

    • ERISA benefits and contract disputes

    • Recoupment challenges and litigation defense

    • Emergency and injunctive relief

    • Trial, arbitration, mediation, and settlement