Nelson Mullins is proud to announce a significant jury trial victory on behalf of American Choice Healthcare, LLC (ACH), a value-based care organization serving Medicare patients, in a Medicare deficit indemnity dispute. The firm’s litigation team secured a $1.5 million verdict following a multi-day trial before the U.S. District Court for the Southern District of Florida.

In American Choice Healthcare, LLC v. Coverys Specialty Insurance Company, the dispute centered on aggregate stop loss coverage purchased by ACH from Coverys Specialty. During the 2021 contract year with the Centers for Medicare & Medicaid Services (CMS), ACH delivered $94.3 million in patient care—exceeding its CMS benchmark by approximately $7 million. To recover that deficit, ACH submitted a claim under its aggregate stop loss policy.

Despite multiple assurances during policy negotiations that recoveries under a separate specific stop loss policy would not reduce aggregate benefits, Coverys Specialty offset the claim by $1.5 million—citing “other insurance” provisions. The jury found in favor of ACH on claims for breach of contract and promissory estoppel, awarding the full amount sought, filed on May 29.

The litigation team was led by partners Nina Welch and Peter Goldman, and associate Danna Khawam, with support from paralegal Robert House and administrative assistants Stacy Brown and Traci Lewis.