Damaris L. Medina

Medina, a Buchalter shareholder, is co-chair of the firm’s life sciences practice and a member of its litigation and health care practice groups. She represents providers in high stakes litigation including reimbursement issues, shareholder and breach of contract disputes, managed care contracting revenue cycle management and risk and compliance matters.

“I was assigned as an associate to a large complex business case with a health care component, and I got interested,” she said. Also, her family background didn’t hurt: her husband is a dentist and her father and brother are physicians.

“As a teen I worked in my dad’s clinic, and I was a pre-med in college before I switched to law. Now, there’s a lot of shop talk around the family table,” she said.

A major client is Ontario-based Prime Healthcare Services, a 42,000-employee hospital network in California and 13 other states.

When Prime sued insurer Humana Inc. in 2016 over alleged Medicare Advantage underpayments, the case originally remained in-house. But after Chief U.S. District Judge Virginia A. Phillips of Los Angeles granted Humana several motions to dismiss followed by amended complaints by Prime, the client called Medina. “The case seemed pretty much dead when it came to us,” she said. “So we thought outside the box.”

Examining the record, she found that Humana used an argument that shouldn’t have worked. “Humana was arguing that Prime had not exhausted Medicare’s administrative process. That was wrong,” she said.

The case hinged on Medina’s close familiarity with the intricate regulations governing health care. “We showed the court that as an in-network provider, Prime could not avail itself of the Medicare administrative appeals process, and we showed also that Humana and its attorneys should have known that.” Prime Healthcare Services Inc. v. Humana Insurance Co., 5:16-cv-01097 (C.D. Cal., filed May 26, 2016). As a result, Phillips last year allowed the case to proceed and dinged Humana for pursuing a frivolous argument by imposing sanctions limiting its defenses. In August 2019, following further litigation and with trial approaching, the parties reached a settlement. “I believe that Prime was pleased by the result,” Medina said.

“We found a way to prevail that had not been obvious to the client,” Medina said. “We resuscitated a case that looked to have no value.” She added that it was Buchalter’s expertise that allowed her client to take the matter forward.

“Part of what makes our group good at this is that we understand the industry—and we look at things creatively, even when they seem like they’re going nowhere. The outcome was satisfying because we were on the right side.”

— John Roemer