Sandra L. Heller
Partner
Overview
Sandra Heller is a South Florida attorney who focuses her national practice on healthcare reimbursement disputes between providers and both private and governmental payers. Ms. Heller works closely with behavioral healthcare facilities, hospitals, health systems and other providers to resolve reimbursement disputes efficiently and without disrupting provider-payer relationships. Ms. Heller understands the importance of maintaining strong relationships with commercial payers while concurrently defending the interests of a wide range of healthcare clients. From internal audits and investigations to the resolution of denied or delayed reimbursement claims, healthcare providers value Ms. Heller's experience on both sides of reimbursement disputes.
A skilled litigator, Ms. Heller has extensively litigated claims governed by the Employee Retirement Income Security Act (ERISA) and other healthcare benefits disputes in both state and federal courts across the country and in arbitrations administered by the American Arbitration Association (AAA). Ms. Heller also advises clients in the identification and prevention of complex fraud schemes, as well as seeking civil recovery on their behalf. Ms. Heller analyzes, counsels, investigates and litigates civil recovery actions in multiclaim insurance fraud cases on behalf of national property and casualty insurers.
In addition, Ms. Heller has extensive experience with fraud, waste and abuse schemes involving Personal Injury Protection (PIP), Bodily Injury (BI) and Uninsured/Underinsured Motorist (UM/UIM) related coverages in state and federal courts. She also litigates bankruptcy actions involving providers who seek protections to avoid litigation of fraud, waste and abuse claims. In addition, Ms. Heller guides and supports insurance clients by implementing strategies resulting from key legislative changes and regulatory reporting responsibilities. She assists in fraud investigations throughout the United States, and her work has created impactful and transformative case law in this arena.
Ms. Heller is an active speaker, often sharing her knowledge of insurance fraud at conferences nationwide. She began her legal career as an assistant district attorney in Tarrant County in Fort Worth, Texas, where, among other things, she was a member of the elite Crimes Against Children Unit, in which she took more than 90 prosecutions to jury verdict.
Prior to joining Holland & Knight, Ms. Heller was a board member and co-chair of the fraud and recovery practice group for a national law firm.
Representative Experience
- Assisted physician practices and other providers negotiate in-network contracts with regional and national health insurers
- Assisted emergency ambulance transport clients address claim denials and navigate the Independent Dispute Resolution (IDR) process
- Assisted healthcare providers navigate and respond to health insurance audits and special investigation unit (SIU) matters
- Assisted home healthcare services provider with internal audit regarding Medicare reporting compliance issues; identified, corrected and resolved the issues favorably for the client
- Resolved large volumes of denied and pended health insurance claims without litigation on behalf of a number of single-specialty and multispecialty physician practices and healthcare providers
- Represented a national health insurer in federal court against substance use disorder facility and associated laboratory, detox facility and marketing arm involving claims of fraud, violations of Florida's Deceptive and Unfair Trade Practice Act (FDUTPA) and unjust enrichment pertaining to performance of unnecessary and unlawful urine drug testing, as well as the inappropriate use of marketing entities and the unlawful brokering of patients
- Represented a national health insurer in an action in which counterclaims were advanced against related substance use disorder providers in numerous states alleging schemes involving patient brokering, referrals for unnecessary and non-U.S. Food and Drug Administration (FDA)-approved ancillary services and violations of the federal Elimination of Kickbacks in Recovery Act (EKRA)
- Represented a national health insurer as a creditor in a bankruptcy action in which a substance use disorder facility that was the subject of district court litigation sought relief via a Chapter 7 action
- Represented a national health insurer in federal court involving claims against substance use disorder facilities and a related laboratory involving claims of violations of FDUTPA and the Patient Brokering Act pertaining to the inappropriate use of urine drug testing and unlawful patient referrals
- Represented a major auto insurance carrier in federal court involving claims of fraud, FDUTPA, unjust enrichment and declaratory relief against a medical provider, prevailing on all claims on summary judgment; created new and impactful case law regarding the submission of a fraudulent application for licensure from the Florida Agency for Healthcare Administration deeming the resulting licensure void ab initio
- Represented a major auto insurance carrier in a federal court action involving unjust enrichment and declaratory relief, prevailing on all summary judgment claims; created new and impactful law regarding the failure to collect copayments and deductibles insurance fraud as a matter of law, as well as confirming the statutory duties of medical directors under Florida's Health Care Clinic Licensing Act
- Represented a major auto insurance carrier in state court declaratory action pertaining to allegations of provider coding and billing practices in contravention of American Medical Association (AMA) guidelines and the Florida No-Fault Law, prevailing at trial and establishing that failure to utilize AMA Editorial Panel Current Procedural Terminology (CPT) coding fails to place insurer on notice of a covered loss
- Represented a client in a matter involving counterclaims for fraud and unjust enrichment, on behalf of a major auto insurance carrier in an action including defense of breach of contract claims pertaining to PIP benefits
- Represented clients in defense of claims against major auto insurance carriers and their insureds, wherein damages included certain spinal procedures performed on personal injury claimants
Credentials
- Texas Tech University School of Law, J.D.
- Texas A&M University, B.B.A., Management
- Florida
- Texas
- U.S. Court of Appeals for the Eleventh Circuit
- U.S. District Court for the Middle District of Florida
- U.S. District Court for the Southern District of Florida
- U.S. Supreme Court
- Association of Certified Fraud Examiners
- Florida Insurance Fraud Education Committee, Certified Trainer
- International Association of Special Investigation Units (IASIU), Certified Trainer
- Medical Claims Defense Network, Certified Trainer
- Broward County Bar Association
- Florida Association of Women Lawyers
- Florida Super Lawyers magazine, 2020-2022
- Holland & Knight Pro Bono All-Star, 2020
- The Legal 500 USA, ERISA Litigation, 2021
