Michael Kolosky is a member of the firm's Litigation Section, where he focuses his practice on managed care, ERISA, and health care issues. He has significant experience defending managed care clients in class action cases and representing life, ADD, and disability carriers in coverage disputes. In addition to his litigation experience, Mr. Kolosky regularly counsels clients on regulatory issues and compliance matters involving employer-sponsored and government health benefits programs, capitated and no-risk medical service arrangements, and other aspects of the health care payor-provider relationship. Mr. Kolosky also represents individual and institutional clients in government investigations ranging from medical reimbursement audits conducted by state and local regulators to criminal and grand jury proceedings initiated by federal regulatory and enforcement agencies. While earning his undergraduate degree, Mr. Kolosky spent a year at Oxford University researching for his honors thesis. He has also won awards for both his legal writing and advocacy. Professional Associations Connecticut Bar Association, Administrative Law Section, Chair - Connecticut Bar Association, Health Law Section, Executive Committee Member - Defense Research Institute - American Health Lawyers Association Community Involvement - VNA HealthCare, Inc., Member of Board of Directors and Governance Committee Honors and Awards - Listed as a Rising Star in Connecticut Super Lawyers® in the area of Health Care Law since 2010 (Super Lawyers is a registered trademark of Key Professional Media, Inc.) Experience Health Law - Represented one of Connecticut's largest providers of home health services in connection with a multi-agency federal and state investigation into the company's billing practices. Worked closely with the client to conduct an internal investigation of the agency's billing processes to identify potential areas of exposure and to develop a comprehensive corporate compliance program. Successfully persuaded the United States Attorney's Office not to pursue charges and to issue a formal declination letter. - Represented a hospital network and behavioral health center in an investigation of billing practices brought by the Federal Bureau of Investigation and the Office of the Inspector General. - Regularly represent institutional health care providers in connection with financial audits and quality of care investigations relating to the Medicaid and Medicare programs conducted by the Connecticut Department of Social Services and the Department of Public Health. - Ongoing representation of major pharmaceutical manufacturer in average wholesale price ("AWP") litigation. - Regularly advise and represent clients in administrative licensure investigations and proceedings before the Department of Public Health. Experience includes negotiation of consent agreements, compliance audit counseling and adverse event investigations. - Regularly advise and represent clients in proceedings before the Department of Social Services regarding financial audits, administrative sanctions and Title XIX appeals. Life, ADD, & Disability Insurance and ERISA Litigation - Regularly defend insurers in benefit litigation involving coverage of ADD and life claims. - Defended a plan sponsor in a case brought by retired employees who claimed that the termination of their benefits violated ERISA. Obtained summary judgment on all of plaintiffs' claims and eliminated potential liability to hundreds of other retirees. - Represented life insurer in rescission action based on alleged misrepresentations in application. Negotiated favorable settlement following the assertion of cross-claims against broker. Managed Care and Health Insurance - Representation of a publicly traded workers' compensation insurer as a plaintiff in an arbitration involving claims that a repricing error by a managed care network preferred provider organization (PPO) caused our client to overpay Texas medical providers by more than $3 million. Robinson & Cole negotiated a settlement prior to arbitration through which the client received 100 percent of its compensatory damages. - Defended managed care organization against member class action (100,000+ class members) challenging prompt provision of services and notification of denied and terminated benefits. Successfully negotiated settlement involving no monetary payment to class members or to class counsel. - Advise new and established managed care organizations regarding the federal requirements for administering Medicare Advantage, Medicare Part D, and Medicaid Managed Care plans. Facilitate implementation of plans by working collaboratively with state regulators. - Represented a managed care organization in a successful appeal before the Connecticut Supreme Court involving the reasonableness of utilization review criteria used to make medical necessity decisions in the early prevention, screening, diagnosis, and treatment ("EPSDT") program. - Defended member class action alleging that client MCO improperly sought subrogation recoveries for medical costs paid in personal injury actions. Plaintiffs sought to certify a class of thousands of individual members. Succeeded in limiting size of class certified to under 200 members and settled all claims through private mediation on a favorable basis. - Prosecuted a fraud recovery action against targets engaged in extensive fraudulent billing practices. Obtained significant recovery for the client while simultaneously settling two counter-claim lawsuits for no payment. - Regularly assist SIUs in managing ongoing investigations, pursuing recovery actions, and coordinating with law enforcement and other regulatory agencies. - Regularly handle benefit coverage and ERISA claims made against managed care entities. - Regularly negotiate and draft provider network agreements, group plan documents, government benefit service agreements, vendor contracts, ASO arrangements, and stop-loss/excess loss contracts. - Representation of Health Net in negotiating favorable monetary settlement against unfair and deceptive trade practices brought by eight-person physician group arising from health plan's administration of bonus payment "pay for performance" program. Plaintiffs alleged that bonus program deceptively claimed to reward quality medical care but instead drove physicians to deliver cheaper care. - Representation of HIP Health Plan of New York in private realtor qui tam action brought by several hospitals alleging that managed care insurers violated New York's health care reform law by failing to pay the state the appropriate surcharge amount on payments made to hospitals for member services. Defendants moved to dismiss the complaint in its entirety based on plaintiff's failure to adequately plead a false claims act claim and a violation of the surcharge statute. Motion to dismiss was granted. - Representation as outside counsel for health insurer concerning its administration of the Connecticut Medicaid program, including matters relating to provider reimbursement and compliance with Connecticut's Freedom of Information Act requirements, an area in which Robinson & Cole litigated the leading cases involving Medicaid managed care organizations. - Appealed before Connecticut Supreme Court an issue of first impression regarding reasonableness of utilization review criteria used to make medical necessity decisions for Medicaid recipients in the early prevention, screening, diagnosis, and treatment (EPSDT) program. - Defended Health Net of Connecticut against a class action lawsuit filed by three participating podiatrists and a podiatric medical association in Connecticut Superior Court. Plaintiffs alleged that the client violated the state unfair trade practices and unfair insurance practices statutes by unfairly discriminating against podiatrists by paying them a lower reimbursement rate than medical doctors for performance of the same foot and ankle related services. Robinson & Cole argued that Connecticut's unfair trade practices and unfair insurance practices statutes did not prohibit insurers from treating different types of health care providers differently, that podiatrists and medical doctors were not similarly situated such that they were required to be paid the same, and that recognizing these differences was not discriminatory. After extensive discovery, court granted Robinson & Cole's motion for summary judgment, holding that the state unfair insurance practices act was not intended to be an equal pay or pay parity statute and that reimbursing podiatrists and medical doctors at different rates for the same services does not constitute unfair discrimination. - Representation as Health Net of the Northeast's lead litigation and regulatory counsel when Health Net administered the Connecticut Medicaid program. As regulatory counsel, advised Health Net regarding its legal obligations to the Medicaid state agency and represented the client in numerous administrative matters. - Provide regulatory and risk management counseling to administrators of special needs plans for dually eligible Medicare/Medicaid enrollees. - Representation of Medicare Advantage Organizations (MAO) in administrative litigation, arbitration, and regulatory matters. Provided legal advice to MAOs regarding legal issues, such as Medicare marketing guidelines, broker compensation arrangements, risk-based provider contracting, coordination of benefits, and compliance with anti-kickback safe harbors. - Representation of Health Net against a medical doctor who has filed dozens of cases against Health Net over the past decade. Won summary judgment on breach of contract and unjust enrichment claims asserted by the nonparticipating provider on the grounds that he failed to comply with requirements for timely submission of claims. Preserved victory on appeal by persuading appellate court to affirm. Publications & Presentations Articles - "Fraud, Abuse Laws Expanded under Reform Legislation: Health Care Providers Should Take Extra Steps to Ensure Compliance," coauthored with Brian D. Nichols (5/24/2010), published in Connecticut Law Tribune - "Aetna v. Davila: A New Look at ERISA Preemption of Medical Malpractice Claims" (5/24/2005), published in The Brief, American Bar Association, Tort Trial and Insurance Practice Section - Frequently present the program "HIPAA for Civil Litigants" to a variety of audiences. Past presentations have been made at the Boston Bar Association, the Central Connecticut Paralegal Association, and as a Lorman Seminar. Books - ERISA Survey of Federal Circuits (2005 edition), published by ABA Publishing, Tort & Insurance Practice Section, Health & Disability Insurance, contributing author Legal Update/Newsletters - ERISA Litigation Update, coauthored with Theodore J. Tucci (2/2003), Second Circuit Erodes ERISA Preemption Presentations - "ACO Liability and Risk Management Issues: The Managed Care Perspective," copresented with Theodore J. Tucci, Jean E. Tomasco (5/2011), webinar - "Legal and Strategic Considerations in Defending Medicaid Audits," copresented with Theodore J. Tucci (4/27/2011) at Connecticut Community Providers Association - "Navigating Department of Social Services Financial Audits," copresented with Theodore J. Tucci (11/19/2010) at Connecticut Hospital Association - "Legal and Strategic Considerations for Responding to Healthcare Audits" presented at the 2007 Symposium of the Connecticut Healthcare Financial Management Association/Connecticut Health Lawyers Association - Frequent guest lecturer at Masters of Public Health program offered by University of Connecticut. Past topics include "Medical Malpractice Claims In The Managed Care Context" and "The Insanity Defense: A Historical Perspective" News 7.21.11, Michael Kolosky Appointed Chair of CBA Administrative Law Section 6.08.11, Robinson & Cole Attorneys Present Webinar on Accountable Care Organizations (ACOs) 5.05.11, Robinson & Cole Attorneys Present Medicaid Audit Defense Seminar 12.06.10, Health Care Attorneys Talk Strategy with Hospitals 11.01.10, VNA Health Care Elects Attorney to Board of Directors 6.04.10, Robinson & Cole Attorneys Author CT Law Tribune Article on Expansion of Fraud and Abuse Laws Under Reform Legislation 5.14.10, Robinson & Cole Attorney Speaks at Healthcare Reform Program 11.12.08, Robinson & Cole Announces New Partners |