Dr. David SeubertOUR PRACTICE IS DEDICATED TO 3 MAJOR AREAS:
Representation of the licensed healthcare professionals and individuals in the process of becoming licensed healthcare professionals, with issues threatening their ability to practice their chosen profession.
Representing the licensed healthcare professional with their professional practice needs including contract issues, practice formation and dissolution and compliance processes.
Representation of insureds encountering difficulties with their health, life or disability insurers.
MY GOAL IS TO OPTIMIZE YOUR ABILITY TO BE A LICENSED HEALTHCARE PROFESSIONAL IN YOUR CHOSEN PROFESSION
As a practicing physician, I am well aware of the difficulties encountered on the pathway of becoming a licensed healthcare professional. Healthcare providers go through a grueling educational process requiring many years of study, examinations and ultimately licensure. Healthcare providers dedicate a significant portion of their lives apart from family, friends and activities in order to be able to practice their profession. Throughout this dense, demanding pathway, the healthcare provider may accrue significant expenses and debt.
Many obstacles may be encountered in the educational, training, licensure and credentialing process. Individuals may encounter situations that could potentially prevent them from ever becoming licensed. The licensed healthcare provider may encounter situations that threaten their ability to continue to practice, such as difficulties with peer review processes, the ability to gain or retain hospital privileges or become or remain credentialed with healthcare insurers. Difficulty gaining licensure, limitations placed on licensure, sanctioning and license suspension or revocation are serious matters.
I am here to help you. I will:
optimize your ability to complete your educational training
optimize your ability to gain licensure
fight hard to defend you to maintain your ability to practice your profession
protect your rights and guide you through the processes to resume your ability to practice your profession in the event of loss or suspension of licensure.
support you in disciplinary procedures
help you negotiate remedial processes that may be required
If you are involved in a criminal matter that threatens your licensure, I will provide you with defense strategies or work collectively with your criminal law attorney to protect your rights as a licensed healthcare provider.
I became an attorney while practicing medicine as a high-risk obstetrician. My legal education vastly expanded my knowledge of administrative and healthcare law that directly affects the licensed healthcare professional. My goal is to combine my legal expertise with my background to assist licensed healthcare providers:
as a practicing physician for over two decades
as a former chief of obstetrics at three major academic medical centers
as a medical director for a large healthcare insurer
as a medical director of a major healthcare insurer
as a member of the Special Investigations Unit (SIU) while serving as a medical director of a major healthcare insurer
as a member of peer review and disciplinary committees
with expertise in compliance, certified in Healthcare Compliance (CHC), Privacy (CHPC) and Ethics (CCEP)
Dr. David Seubert
BUSINESS OF MEDICINE
The licensed healthcare provider’s educational pathway provides little to no exposure to the business of medicine. Licensed healthcare providers, after many years of training, are faced with complex career decisions that may change over time. Providers must execute, navigate and potentially dispute contractual agreements with their employer or employees. Practice formation and dissolution can be a challenging, time consuming and expensive process.
As a practicing clinician, I am well aware of the obstacles that the licensed healthcare provider encounters trying to practice their profession. I completed an executive MBA program for physicians while practicing general obstetrics and gynecology. This experience gave me knowledge and expertise in the business of medicine as it applies to practitioners, institutions and healthcare consumers.
Call on me to help. I am uniquely qualified to assist you as a licensed healthcare professional. I have the necessary skills and tools to optimize and protect you. I will provide you with preemptive strategies for proper contract negotiations and assist you with contract disputes. I will guide you through practice formation or dissolution in a time and cost-efficient manner. I will fight hard to defend your professional needs so that you can pursue excellence in your chosen profession.
Practitioners may encounter random and targeted audits by commercial insurers and government agencies such as the CMS in Medicaid and Medicare billing. Allegations of billing infractions, such as up-coding and fraud, must be urgently addressed, corrected if necessary or vigorously defended if unwarranted. Practitioners and practices must be in compliance with state and federal rules and regulations in the delivery of healthcare. Failure to meet state and federal compliance rules and regulations may subject the practitioner and practice into forced corrective action plans, civil and criminal penalties and potentially revocation of enrollment as a CMS provider.
Call me to protect and defend you. I am uniquely qualified to guide you and your practice. My broad breath of expertise and knowledge of compliance law, certified in healthcare compliance (CHC), healthcare privacy (CHPC), and as a certified compliance and ethics professional (CCEP) will allow me to assist you and your practice in all aspects of compliance including self-disclosure reporting, remedial and corrective action plans and defense of unwarranted compliance charges. My professional experience as a medical director assigned to the Special Investigations Unit (SIU) of a major healthcare insurer as well as my billing and coding expertise as a Certified Professional Coder (CPC) will allow me to defend you if you encounter allegations of upcoding and billing fraud. I will use my broad knowledge, expertise and professional repertoire to vigorously protect and defend you.
PROTECTION OF THE INSURED Health Insurance
We depend on our insurers to provide healthcare coverage, life insurance payouts to beneficiaries in the event of an insured’s death, and disability insurance in the event of a temporary or permanent health impairment. If an insurer determines your provider’s recommended treatment plan lacks medical necessity, you may be denied coverage. As a healthcare consumer, you may find yourself in the complex dilemma of wanting to follow your healthcare providers recommendations but lacking the support you depend on from your insurer. You may be forced to forego your provider’s recommendations or pay out of pocket for services you presumed were covered by your healthcare insurer. If you are encountering difficulties with your insurer, call on me to help. My background as a medical director for a major healthcare insurer and advanced educational background in insurance law makes me abundantly qualified to guide and assist you. At times negotiations with your insurer along your healthcare practitioner can resolve disputes without the need for formal proceedings. If negotiations are unsuccessful, I will fight hard to protect your needs and attempt to compel your healthcare insurer to provide for your medical needs.
If you become afflicted with a serious healthcare issue or catastrophic injury, you depend on your disability insurer to maintain your income. If your disease or injury is recoverable and you can return to your licensed healthcare profession, temporary disability coverage may suffice. If your disability is permanent without the ability to return to your licensed healthcare profession, permanent disability coverage is needed. If your healthcare provider’s assessment of your condition is not congruent with your disability insurer, you may find yourself unable to practice your profession and without the coverage you depended upon. I will fight hard to compel your insurer to deliver the temporary or permanent coverage you depended upon in the event you become disabled and are unable to work as a licensed healthcare professional.
If you are a beneficiary of a life insurance policy, an insured relied on the insurer to provide for your needs after the insured’s death. If the insurer declines to pay the beneficiary, significant hardships may be encountered. A beneficiary may be denied coverage or forced to settle for much less than the full policy value. If you are anticipating or experiencing obstacles in the application process for life insurance coverage or are being denied a payment as a beneficiary, allow me to provide guidance and assistance. I will aggressively defend your rights as the beneficiary of a life insurance policy that you and the decedent depended upon.
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