Healthcare Disputes

Disputes in the healthcare industry are on the rise. They stem from aggressive government and commercial payor initiatives and positions on reimbursement issues, strict rules on data privacy, and fast-moving technological advances where there may be inconsistent expectations among the parties involved. All of these issues can be very complex and they often involve sensitive business relationships. The fair and prompt resolution of these disputes can be critical to operational success.

Our Healthcare Disputes Group focuses on these disputes and they have a proven record of success. We also provide operational support on more “routine” investigations and other matters creating potential liability and we regularly provide in-service training to help clients stay ahead of these issues. Our clients include hospitals and health systems, nonprofit academic medical centers, ambulatory surgery centers, air ambulance companies, specialty pharmacy, dialysis centers, clinical laboratories, senior living communities, home healthcare companies, physician practice management companies, and physicians’ practices.

We use an interdisciplinary approach, engaging lawyers from our healthcare regulatory and operations group to create the right legal team for every investigation or dispute.

Our healthcare dispute services include:

  • Healthcare fraud and abuse
  • Compliance and audits
  • Managed care disputes
  • IT software vendor disputes
  • Privacy and data security
  • Antitrust and trade practices
  • Professional liability and risk management
  • Medical staff disputes
  • We successfully defended a regional home health agency in a responding to an audit conducted by the Office of Audit Services of the Health and Human Services’ Office of Inspector General (OIG-OAS) and appealing the results recommended in the OIG-OAS final report. Our representation resulted in a reduction of the multi-million dollar overpayment in the OIG-OAS final report by 30 percent and recoupment to less than $10,000.

    We successfully defended a regional home health agency in a responding to an audit conducted by the Office of Audit...
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    Client Type: Private Company
  • We have successfully represented a multi-hospital non-profit health system in negotiating practice leases with several physician groups in specialties including orthopedics, gastroenterology and urology.

    We successfully represented a multi-hospital non-profit health system in negotiating practice leases with several physician groups in specialties including orthopedics,...
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    Client Type: Nonprofit
  • Successful defense of a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that the provider failed to meet Hospice Quality Reporting Program (HQRP) requirements for Calendar Year 2021. This alleged non-compliance would have resulted in a 2% reduction in the provider’s annual payment update for Fiscal Year (FY) 2023. Through the HQRP reconsideration process, Bass Berry & Sims successfully demonstrated that CMS’ determination of non-compliance was erroneous because CMS’ inadvertent termination of the provider caused a systemic problem with the provider’s submission of requisite HQRP, Hospice Item Set data. At reconsideration, CMS reversed its initial determination of non-compliance and granted the provider the full FY 2023 annual payment update.

    We successfully defended a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that the provider failed...
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  • Successful defense of two agencies of a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that the provider failed to meet Hospice Quality Reporting Program (HQRP) requirements for Calendar Year 2021. This alleged non-compliance by both agencies would have resulted in a 2% reduction in the provider’s annual payment update for Fiscal Year (FY) 2023. Through the HQRP reconsideration process, Bass Berry & Sims successfully demonstrated that, despite guidance to the contrary, CMS’ non-compliance determination erroneously included timeframes in which each provider was not responsible for submitting HQRP, Hospice Item Set data. When such inappropriate time periods were excluded from consideration, both providers clearly satisfied HQRP requirements. Therefore, CMS reversed its initial determination of non-compliance and granted the provider the full FY 2023 annual payment update.

    We successfully defended two agencies of a national hospice provider against Centers for Medicare & Medicaid Services’ (CMS) determination that...
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  • Representation of Tennessee Oncology, PLLC, in an investigation of False Claims Act allegations arising from a qui tam case filed in the Middle District of Tennessee by a former hospital employee who alleged Tennessee Oncology provided radiation oncology treatment without appropriate supervision and prostate cancer treatment without complying with applicable documentation requirements. Following its investigation, the Department of Justice declined to intervene in the action, and the relator dismissed the case. Ferren v. HCA Health Services of Tennessee, et al. (M.D. Tenn.)

    Lead counsel representing Tennessee Oncology, PLLC, in an investigation of False Claims Act allegations arising from a qui tam case...
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  • We successfully defended a national home healthcare provider in appealing an $18 million extrapolated overpayment resulting from a UPIC audit.

    We defended a national home healthcare provider in appealing an $18 million extrapolated overpayment resulting from a UPIC audit. Through...
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    Client Type: Public Company
  • Successfully represented AmSurg Holdings, Inc. in a dispute with a group of physicians seeking to invalidate a non-compete provision that was a material feature of a highly profitable surgery center partnership located in  Minnesota

    We represented AmSurg Holdings, Inc. in a dispute with a group of physicians seeking to invalidate a non-compete provision that...
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    Client Type: Public Company
  • We serve as lead counsel for the company and 23 individual defendants in a putative class action alleging violations of Sections 10(b), 10A and 20(a) of the Securities Exchange Act of 1934 and Sections 11, 12 and 15 of the Securities Act of 1933. The plaintiffs allege that defendants made materially false and misleading statements and omissions concerning the company’s contracts and its out-of-network billing. In re Envision Healthcare Corporation Securities Litigation, Civil Action No. 3:17-cv-01112 (M.D. Tenn.).

    We serve as lead counsel for the company and 23 individual defendants in a putative class action alleging violations of...
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    Client Type: Private Company
  • We served as lead counsel for Envision Healthcare Corporation and current and former board members in four derivative actions asserting claims for breach of fiduciary duty, wasted corporate assets, unjust enrichment and violations of the Securities and Exchange Act of 1934 arising out of allegations of over billing and improperly billing medical patients, failing to supervise corporate action and failure to maintain proper internal controls.  These cases were consolidated in 2018.  Following a company merger, the case was dismissed in its entirety on October 25, 2018. Purrone v. Sanger et al., Case No. 3:17-cv-01472 (M.D. Tenn.).

    We served as lead counsel for Envision Healthcare Corporation and current and former board members in four derivative actions asserting...
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    Client Type: Private Company
  • Represented Quest Diagnostics in its acquisition of the Outreach Laboratory Service Operations of Marin General Hospital

    We represented Quest Diagnostics (NYSE: DGX) in its acquisition of the outreach laboratory services operations of Marin General Hospital, a non-profit, full-service...
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    Client Type: Public Company
Angela L. Bergman
Counsel
Nathan F. Brown
Associate
Stefanie P. Carter
Healthcare Attorney
J. Taylor Chenery
Member
Hannah Choate
Associate
E. Steele Clayton, IV
Member
Michael Dagley
Member
John C. Eason
Member
Lindsey Brown Fetzer
Member
Mary Beth Fortugno
Member
Lauren M. Gaffney
Member
Leslie Demaree Goldsmith
Member
John S. Golwen
Member
R. Dale Grimes
Member
Anna M. Grizzle
Member
Brian Irving
Member
Travis G. Lloyd
Member
William T. Mathias
Member
Christine M. Morse
Member
W. Brantley Phillips, Jr.
Member
Brianna R. Powell
Associate
Lisa S. Rivera
Member
Glenn B. Rose
Member
Molly K. Ruberg
Member
Laurence B. Russell
Counsel
Taylor M. Sample
Associate
Matthew J. Sinback
Senior Litigation Attorney
Danielle M. Sloane
Member
Lucas Ross Smith
Member
Page Minton Smith
Associate
Julia Tamulis
Member
Shelley R. Thomas
Member
Meredith Mallard Thompson
Counsel
Nesrin Garan Tift
Member
Kathryn Hannen Walker
Member
Elizabeth S. Warren
Member
Virginia Maynard Yetter
Associate

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Our healthcare attorneys encompass the multitude of legal specialties necessary to service one of the largest, most highly regulated industries in the United States. We bring our multidisciplinary, team approach to our representation of the following sectors and facilities:

  • Academic medical centers.
  • Ambulatory surgery centers.
  • Behavioral health.
  • Cancer therapy.
  • Clinical laboratories.
  • Dermatology.
  • Diagnostic imaging.
  • Health plans, managed care companies and benefit management companies.
  • Healthcare information technology.
  • Home health.
  • Hospice.
  • Hospitals and health systems.
  • Life sciences.
  • Managed care.
  • Medical device.
  • Nonprofit providers.
  • Orthotics and prosthetics.
  • Pharmaceuticals and pharmacies.
  • Physician practices, outsourced physician services and management companies.
  • Private equity.
  • Real Estate Investment Trusts (REITs).
  • Revenue cycle management.
  • Senior housing and long-term care.
  • Specialty pharmacy and pharmaceuticals.
  • Telemedicine.
  • Urgent and retail care clinics.
  • Wellness and disease management.