Albert M. Appel serves as an arbitrator and mediator following a career in general commercial and complex litigation and health law.
Appel M. Albert Of Counsel
Mr. Appel has substantial experience in commercial and health care disputes. Arbitrations have ranged from sole arbitrator of a one-day hearing to chairs of several three-member panels conducting preliminary injunction hearing and multi-week hearings on the merits; requests for relief have ranged from $100,000 to $50 million and also equitable relief. Matters have included breach of contract; 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; shareholder and partnership disputes; provider terminations from health insurer networks; managed care relationships; provider/payer relationships and contractual reimbursement disputes, including coverage, medical necessity, coding, billing, sequestration and other provider agreement compliance issues; 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; 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.
Mr. Appel also has counseled and litigated in courts and arbitrations throughout the country in a wide variety of matters, including health care; contracts; fraud and misrepresentation; interference with contractual and business relations, and other business torts; general business and commercial disputes; fiduciary obligations; government investigations; director and officer liability; employment disputes and discrimination law; wage and hour investigation; products liability; environmental law; partnership and shareholder disputes; corporate governance; health care payerprovider relationships, including contracting, liability, denial of claims, adequacy of reimbursement payments, and termination of network providers; hospitality law; antitrust; securities law; accountant’s liability; bankruptcy and workout negotiations; insurance coverage; mergers, acquisitions and joint ventures; trademark and trade dress; unfair competition; misappropriation of trade secrets; and non-compete litigation.
As counsel to a prominent New York City medical center, large HMO and other providers and managed care organizations, Mr. Appel has provided advice regarding compliance with health care laws and regulations; fraud and abuse and self-referral issues; government agency investigations regarding billing, performance of fiduciary obligations, patient care issues and other matters; physician and management employment agreements and related employment matters; managed care and other contractual arrangements, including development of provider delivery system and management services organizations; confidentiality of protected health information; corporate and commercial matters, including business arrangements among insurers, other third-party payers and providers and dissolution of entities; institutional affiliation agreements; physician and medical staff credentialing (granting and denying of privileges, including economic credentialing issues), and disciplinary proceedings (corrective action, suspension, curtailment and revocation/termination of privileges); institutional accreditation issues; corporate and medical staff governance; patient care advice and litigation and general litigation and dispute resolution.
Representative Matters
Some of Mr. Appel’s notable representations include:
• 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;
• 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;
• 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 ofnationally recognized sports figure;
• Mediation of product liability and product recall dispute;
• Mediation of numerous employment and discrimination disputes;
• Mediation of fraud and misrepresentation claims against broker-dealer;
• Represented a prominent medical center in providing the equivalent of in-house counsel services regarding all areas of operation;
• Represented a leading HMO in restructuring its relationships with large provider organizations, including bankruptcy litigation regarding same;
• Served as national coordinating counsel for manufacturer of dietary supplements and over-thecounter products in multidistrict proceedings consisting of more than one hundred federal and state product liability actions;
• Appointment as Liaison Counsel by numerous defendants and the court in parallel criminal and civil class action antitrust actions;
• Represented client in multiple lawsuits arising out of physician practice management relationships;
• Represented client in successfully defeating U.S. Department of Justice lawsuit to prevent hospital merger; and
• Represented client in successful resolution of New York Attorney General investigation of major notfor-profit institution.
Honors and Awards
Mr. Appel has been recognized by a number of industry publications, including Best Lawyers in America and Super Lawyers. He has also been featured in various editions of Who’s Who, including “Who’s Who in American Law,” “Who’s Who in Medicine and Health Care” and “Who’s Who in Finance and Industry.”
Selected Activities
• Member, American Bar Association
• Member, New York State Bar Association
• Member, Association of the Bar of the City of New York
• Member, American Health Lawyers Association
• Member of Commercial and Health Care Roster of Neutrals of the American Arbitration Association
• Member of Dispute Resolvers Panel of the American
Health Lawyers Association
• Member of Commercial Panel of Neutrals of the International Institute for Conflict Prevention & Resolution (“CPR”)
• Member of CPR’s National Health Care Panel of Neutrals
• Accredited as MCIArb by the Chartered Institute of Arbitrators
• Court-appointed member of Mediation Panel of the U.S. District Court for the Southern District of New York
• Frequent lecturer on the Health Insurance Portability and Accountability Act (“HIPAA”)
• Speaker, “Arbitration of Health Care Payor-Provider Disputes: What’s Different? What’s New?” Boston Bar Association, April 2017
• Author, “The Benefits of Mediation and Arbitration for Dispute Resolution in Health Law,” New York State Bar Association, Dispute Resolution Section, January 2011
• Author, book review of “Legal and Ethical Aspects of Organ Transplantation,” New York Law Journal, Vol. 225, No. 96, May 18, 2001
Admitted to Practice
New York; U.S. District Court, Southern District of New York; U.S. District Court, Eastern District of New York; U.S. Court of Appeals, Second Circuit; U.S. Court of Appeals, Fourth Circuit; U.S. Court of Appeals, Eleventh Circuit