David A. King

David King is a shareholder in the Health Care Litigation and Disputes practice in Nashville. Leveraging over 30 years of health care litigation experience, David’s well-seasoned approach is pragmatic and highly detailed, enabling clients to advance their business and legal interests in managed care disputes, managed care strategy and contracting and national and state legislative matters. He works with a wide range of health care entities, including profit and not-for-profit hospital systems, ambulatory surgery centers, air ambulance services, specialty providers, physician groups and ancillary service providers, as well as medical device companies.

David’s representative work includes: 

Managed Care Disputes

David counsels clients on a variety of managed care matters including disputes related to underpayments, medical necessity denials, attempted recoupments and offsets, contract interpretation, refusal to contract, discrimination and retaliation against out-of-network providers and related reimbursement disputes, and related legal issues involving the Affordable Care Act, ERISA preemption, UCR laws, prompt pay laws, any willing provider laws and laws regarding payor audits, recoupments and offsets. David has years of experience and success implementing all forms of resolution for these disputes, including negotiation, mediation, arbitration and litigation.

Managed Care Strategy and Contracting

David consults with healthcare providers on in-network and out-of-network strategies and other issues involving the relationships among providers, insurers, self-funded plans, benefit administrators and vendors. He counsels providers on challenges such as payor coverage and reimbursement policies, reference-based pricing initiatives, surprise medical billing, ERISA and ACA laws, hospital lien laws and persuading payors to cover medical devices and procedures. He also assists providers with various managed care contracting issues, including drafting and negotiating contracts, and advising on navigating tiered and narrow networks, silent PPOs, lease/rental networks, operational challenges and revenue cycle management.

National and State Legislation 

David consults with various providers on proposed national and state legislation impacting their strategies and reimbursement, such as proposed laws seeking to address “surprise” billing by hospital-based out-of-network providers and proposed laws seeking to establish rates and or dispute resolution procedures for all out-of-network emergency providers. David also strategizes about draft legislation to address improper payor practices.

David thrives on enabling clients to navigate the ever-changing and regulated health care industry. To this end, he is a frequent lecturer on payor relationships and has been nationally recognized for many years by Best Lawyers in America®, Super Lawyers and a multitude of other publications.

• Representing national air ambulance company in seven putative class actions filed in federal district courts around the country in which patients are challenging the reasonableness of the company’s charges for emergency air ambulance services

• Representing medical device company on a national basis in challenging medical coverage policies labeling FDA-approved device as “experimental or investigational”

• Represented eleven hospitals in Tennessee against a commercial insurer for underpaying thousands of out-of-network claims for emergency services

• Represented a group of hospitals in arbitration against major commercial payor to establish rates for out-of-network claims for emergency services

• Represented a Pennsylvania surgery center in state court suit against a major commercial insurer for seeking to impose a new non-negotiated payment methodology with a “facility bulletin” and then seeking to impose unauthorized recoupments and offsets

• Represented several hospitals against a self-funded employee benefit plan for underpaying hundreds of claims contrary to the agreed fee schedule, with a focus on ERISA preemption issues
• Representing intraoperative neuromonitoring company on a national basis in challenging medical coverage policies

• Guided one of the largest nonprofit hospital systems in the country in developing an out-of-network reimbursement strategy

• Representing hospitals part of national system in a series of arbitrations around the country in disputes against a large commercial insurer for underpaying hundreds of claims related to medical necessity

• Represented several hospitals in a dispute against a large commercial insurer due to changes to coding policy in the provider manual contrary to underlying contracts

• Represented a behavioral health and laboratory company in challenging recoupment demands by a large commercial insurer

• Represented a subsidiary of the largest air ambulance provider in the country in the favorable resolution of a dispute with a private insurer in which it was awarded all amounts accrued in connection with multi-state services

• Assisted a laboratory company in obtaining a network contract following years of medical necessity claim denials

• Represented a laboratory company against a large commercial insurer for several million dollars of claims denied for allegedly being investigational in nature

• Represented a laboratory company in pursuing several million dollars of unpaid claims because the insurer questioned the medical necessity based on allegedly ambiguous orders written by the treating physicians

• Represented a group of 21 Tennessee physicians in federal litigation in Nashville challenging a regulation from Centers for Medicare & Medicaid Services

• Assisted in the early and successful resolution of 47 arbitration claims under the Texas Prompt Pay laws brought by pharmacies against a pharmacy benefit manager

• Represented a national healthcare corporation in consolidated litigation involving a highly publicized nursing home fire involving 16 deaths, which resulted in the successful resolution of 30 out of the 32 cases within one year from the date of the fire

• Represented anesthesia teams in back surgery cases involving death of 38-year-old patient and the paralysis of another patient