Healthcare Government Investigations & Litigation

We represent and defend healthcare clients against a wide spectrum of healthcare litigation matters, including

• Fraud and Abuse Matters
• State and Federal Government Investigations
• Billing Company Disputes
• Exclusion from Medicare, Medicaid and other Federally-Funded Programs
• Medicare, Medicaid, and Third Party Payor Audit Appeals/Overpayment Demands
• Third Party Payor Departicipations
• Violations of Covenants Not To Compete
• Physician-to-Physician Disputes
• Physician Recruitment Matters
• Physician Residency Terminations
• Other Physician-Hospital Disputes
• Hospital Staff privileging Matters
• Certificate of Need
• Licensing Matters

Defending and resolving healthcare litigation and investigations is what we do- our team is able to hit the ground running

• Firm attorneys have represented clients in courtrooms across the United States
• Healthcare litigators include former Department of Justice, Attorney General and federal litigators with extensive experience before DOJ, CMS, FDA and state healthcare regulatory agencies
• National trial counsel for hospitals in False Claims Act cases
• National counsel for a number of clients providing services across the healthcare spectrum, including:  durable medical equipment providers, laboratories, physician practices
• Deep understanding of regulations and billing issues brings efficiencies (time and cost)
• Nelson Mullins’ dedicated e-discovery practice, Encompass, brings understanding of healthcare data and technology systems and approach embraced by Fortune 200 clients

Clients our attorneys have served span the healthcare spectrum  

• Hospitals and hospital systems
• Pharmaceutical companies
• Durable medical equipment providers
• Laboratories
• Physician groups
• Nurses
• Surgery Centers
• Skilled Nursing Facilities (SNF)
• Academic Medical Centers
• Accountable Care organizations
• Healthcare Insurance Companies
• Healthcare Consulting Groups

Helping clients avoid litigation and defending cases in courts when necessary

We have experience resolving matters out of court.  We also have deep experience in the courtroom

• Administrative law hearings (e.g., state certificate of need licensing actions)
• Alternative dispute resolution (ADR) (e.g., mediation and non-binding arbitration)
• Judicial proceedings (e.g., state and federal court litigation)
• Quasi-judicial proceedings (e.g., hospital fair hearings, third party payor appellate hearings, and binding arbitrations)

Our attorneys assist you in making careful, timely, and informed decisions

• Crisis management – when they occur and with a view towards issues to consider regarding potential related litigation
• Internal investigation processes and procedures – to identify and memorialize documents and testimony of employees, witnesses and management
• Expert witnesses and opinions – guiding on identifying and hiring experts who give valuable advice and can serve as litigation witnesses
• Government agency interactions – facilitate meetings and strategies with state and federal government agencies regarding certificates of need and facility licensure matters
• Internal and external communications plans – including with your board of directors and law enforcement
• Joint defense strategies – providing strategic guidance to clients and co-counsel in joint defense
• Litigation defense – through discovery, settlement negotiations, alternative dispute resolution, and  – when necessary – trial and appeal
• Opposing expert strategies – including investigating and examining opposing experts
• Prepare defense strategy – with regard to internal investigations
• Preventive measures – to help prevent litigation before it arises
• Public relations strategy – including timing, media approach, and content
• Response to search warrant, subpoena or civil investigative demands – by DOJ or state regulatory authorities
• Time-sensitive investigations – including for internal investigations and matters involving criminal allegations
• Witness depositions – preparing witnesses for and defending depositions of corporate, executive and managerial witnesses and conducting depositions of adverse and non-party witnesses

Following is a selected sampling of matters and is provided for informational purposes only. Past success does not indicate the likelihood of success in any future matter.

Healthcare Litigation

• Acted as lead trial counsel in one of the largest Medicare and Medicaid healthcare carrier case verdicts in the U.S. 
• Recovered damages of $144 million for the Federal Insurance Fund.
• Defended a major healthcare system in a substantial case involving allegations of billing fraud. Case involved numerous qui tam matters filed in various district courts and involved the review of millions of documents, hundreds of depositions, numerous court hearings, pretrial motions, etc.
• Defended Department of Justice investigations for billing irregularity issues with regard to durable medical equipment groups, medical device manufacturers, and pharmaceutical companies. Prevailed in favorable settlements in numerous matters.
• Defended hospitals and healthcare providers in government investigations.
• Assisted in the investigation and plea negotiation in one of the largest medical device fraud cases in the state of Virginia.
• Criminal and civil matter involving the interpretation of California law with regard to physical therapy, Med-X treatment, and therapy.
• Represented client in civil litigation matter involving the defense of the treatment of Lyme disease by IV infusion for longer terms and dealing with the challenges to this treatment.
• Attorney experience as lead trial counsel in some of the largest hospital fraud and abuse cases in the country.
• Experience defending clients as lead trial counsel in matters involving:  durable medical equipment, laboratories, hospitals involved in antitrust litigation, physician practices facing exclusion under Medicare/Medicaid programs, radiology and oncology practices facing sanctions by OIG for supervision violations.
• Negotiated settlement on behalf of hospital CEO against former employer alleging non-compete violations.
• Won summary judgment on unfair trade practices claims against medical equipment manufacturer and vendor.
• Obtained sanctions and default judgment on behalf of ambulance service provider against shareholder, affirmed on appeal.
• Won summary judgment in qui tam suit brought by consultant alleging contractor client had overbilled the U.S. Department of Defense.
• Negotiated settlements for a variety of healthcare clients, including hospitals, healthcare systems, academic medical centers, and ambulance service providers in qui tam suits.

Medicare and Medicaid Audits and Appeals

• Obtained judgment from State Administrative Law Court on behalf of over 60 nursing homes challenging fines imposed by the State for allegedly exceeding the allowable number of Medicaid patient days.
• Represented academic medical center’s faculty practice plan in voluntary disclosure of Medicare overpayment and related internal investigation.
• Obtained favorable ruling from Federal Administrative Law Judge for nursing home client appealing ZPIC overpayment extrapolation, involving issues of medical necessity.
• Managed academic medical center’s response to ZPIC’s educational outreach request.
• Coordinated hospice client’s response to ZPIC request for medical records.
• Designed internal Medicaid RAC appeal procedures and templates for hospital system.
• Managed hundreds of Medicare and Medicaid RAC audits on behalf of several hospital clients.
• Represented hospice in responding to Medicaid Integrity Contractor (MIC) audit.
• Negotiated settlements for several nursing homes following appeals of Medicaid cost report audits.
• Designed exclusion screening processes for hospital and vendor clients and managed client response after excluded individuals were identified.

Certificate of Need

• Awarded judgment by South Carolina Supreme Court in suit brought on behalf of South Carolina Health Care Association against state agency for unlawfully suspending CON program
• Represented coalition of home health agencies in related efforts to revise State Health Plan CON standards and appeal multiple agency decisions to deny licensing renewal applications
• Negotiated successful bid on behalf of client to purchase existing home health agencies from State
• Numerous agency approvals and court orders awarding CONs to clients in contested cases, including CONs for a new acute care hospital, a radiation therapy center, an elective PCI program, and an open heart surgery program