ADR Services

The vast majority of Mr. Appel’s arbitration services have been as the sole arbitrator of disputes and chair of three-member panels.  His arbitrations have spanned from one day to several weeks, have included preliminary injunction hearings, and encompassed requests for relief ranging from $100,000 to $90 million and equitable relief. 

Substantive Areas of Law

The subjects of Mr. Appel’s arbitrations and mediations have included breach of contract, including the implied covenant of good faith and fair dealing; corporate buy-sell and purchase price dispute; business torts, including breach of duty of loyalty and other fiduciary obligations, tortious interference, deceptive business practices, fraud, conversion and embezzlement; physician relationships and medical practice management, including professional and practice obligations of physicians and arrangements with billing companies for revenue cycle management: shareholder and partnership disputes, including governance, deadlock, dissolution, determination of ownership interests and implementation of contractual buy-out provisions and private equity arrangements; provider terminations from health insurer networks; managed care relationships; acquisition of physician practice; medical provider/payer relationships and contractual reimbursement disputes, including interpretation of contractual payment obligations, coverage of claims, medical necessity, coding, out-of-network emergency care reimbursement, appropriate levels of care, prior authorization and internal appeal process; indemnification, representation and warranty claims regarding plant and equipment and billing issues arising out of hospital acquisition; post-merger purchase price adjustments; corporate shareholder, employment, severance, compensation, profit sharing and pension disputes; independent hearing officer in hospital-staff disciplinary proceeding; interpretation of supply and pricing contract provisions; national residency program accreditation dispute with academic medical center; copyright infringement; request for an accounting; employment and discrimination claims; product liability and medical device recall; securities fraud; and defamation.

Representative Matters

• • Chair of three-arbitrator panel determining $90 million claim by hospital system against health insurance company for improper adjudication of claims for services rendered on alleged grounds such as lack of medical necessity, lack of authorization, inappropriate level of care, untimely filing, and failure to exhaust administrative remedies. Proceedings included establishing sampling and extrapolation protocols for selection of claims to be presented at evidentiary hearing.

  • Sole arbitrator of $7 million claim by hospital system against health insurance company determining proper methodology for payment of emergency care services rendered as out-of-network provider.

  • Sole arbitrator of $6 million claim by large anesthesiology practice against billing company for breach of contract in failing to properly perform revenue cycle management.

  • Sole arbitrator of dispute between hospital system and health insurance company determining whether terms of settlement agreement were void as against public policy.

  • Chair of three-arbitrator panel, and member of three-arbitrator panel, in two arbitrations among large medical practices, pharmacy benefit managers and health insurance companies regarding $20 million assessments in fees arising out of alleged improper measurement of practices’ performance in violation of contract and federal law.

  • Sole arbitrator in thirteen arbitrations against international credit card company alleging antitrust claims in connection with provisions in merchants’ agreements.

  • Sole arbitrator of dispute between owner of large medical practice and private equity organization alleging fraud, statutory violations, conversion, breach of contract and unjust enrichment.

  • Member of three arbitrator panel determining $40 million claim by hosital system against health insurance company for breach of contract arising out of denials of claims for lack of medical necessity;
  • Chair of three-arbitrator panel determining $45 million claim by large medical provider against health insurance company for breach of contractual obligations, fraud and misrepresentation, antitrust violations, procuring breach of contracts and bad-faith non-performance;
  • Chair of three-arbitrator panel determining hospital’s $18 million reimbursement claims against insurance company involving multiple reasons for underpayment and denial of claims and statistical sampling, including numerous coding, coverage, medical necessity, timeliness and other contract compliance issues;
  • Sole arbitrator of $12 million claim by multi-hospital health system against insurance company for breach of contract and statutory violation;
  • Chair of three-arbitrator panel determining corporate ownership, governance, operations, partnership dissolution, shareholder buy-out and interim and permanent injunctive issues;
  • Sole arbitrator of claims for $10 million regarding plant and equipment and billing issues arising out of hospital acquisition;
  • Sole arbitrator of dispute involving claims and counterclaims for employment compensation, severance pay, pension and deferred compensation and breach of contract and fiduciary obligations;
  • Member of three-arbitrator panel determining claims and counterclaims for damages and interim and permanent injunctive relief relating to corporate deadlock, conversion and embezzlement of $5 million, breach of fiduciary duty and removal of corporate officers;
  • Sole arbitrator of dispute between regional pharmacy and owner/operator of skilled nursing facilities involving issues of contract interpretation, fraud and misrepresentation and enforcement.
  • Chair of three-arbitrator panel determining appropriateness of insurance company’s recoupment from hospital based on statistical sampling and extrapolation;
  • Sole arbitrator of physician claim for wrongful termination from health insurer network;
  • Sole arbitrator of $4 million reimbursement and breach of contract claims and counterclaims between hospital and health insurer;
  • Sole arbitrator of closely-held corporation shareholder dispute regarding profit-sharing, compensation and dissolution;
  • Member of three-arbitrator panel determining $9 million claims of withdrawing member of excess insurance consortium;
  • Sole arbitrator of dispute regarding insurance company’s reduction of claims payments based on federal government sequestration as impacted by provider agreement provisions;
  • Chair of three-arbitrator panel determining coverage claim for insurance recovery;
  • Member of three-arbitrator panel addressing claims for breach of contract, defamation, tortious interference and deceptive business practices;
  • Sole arbitrator of physician practice dissolution and compensation dispute;
  • Independent hearing officer for hospital Fair Hearing;
  • Sole arbitrator of dispute regarding termination of shareholder interest and request for corporate dissolution based on shareholder deadlock;
  • Sole arbitrator of dispute involving accreditation of national residency training program;
  • Mediation of $50 million contract and reimbursement dispute between health insurer and national laboratory provider;
  • Mediation of billing and reimbursement dispute between hospital system and insurer;
  • Mediation of dispute involving marketing of nationally recognized sports figure;
  • Mediation of contract dispute between hospital system and exclusive outsider provider of medical services;
  • Mediation of product liability and product recall dispute;
  • Mediation of numerous employment and discrimination disputes; and
  • Mediation of fraud and misrepresentation claims against broker-dealer.