Healthcare Fraud & Abuse

No industry faces more government scrutiny related to fraud and abuse than healthcare. From whistleblower lawsuits under the False Claims Act to industrywide investigations spearheaded by the U.S. Department of Justice to ever-changing Medicare compliance requirements, healthcare companies are exposed to a wide range of investigations and enforcement actions by both federal and state officials.

With our base in Nashville, the nation’s healthcare capital, and our office in Washington, D.C., our healthcare fraud and abuse attorneys understand both the business and the politics of healthcare. Our counsel goes beyond the legal issues to consider all of the operational and management issues a healthcare organization faces when a healthcare fraud and abuse matter arises.

Government Enforcement

We routinely represent healthcare providers faced with fraud and abuse enforcement actions by the government and litigation stemming from those enforcement efforts. Our practice is led by our

Healthcare Fraud Task Force, which includes former members of the U.S. Department of Justice and a number of former Assistant U.S. Attorneys with significant experience handling healthcare fraud matters across the country. Our attorneys bring the knowledge of having worked inside the government, providing great insight into how HHS-OIG, U.S. Department of Justice and the various State Attorneys’ General offices think about fraud and abuse in healthcare and the strategies they use to pursue these cases.

We provide healthcare clients with counsel and support for every sort of civil and criminal exposure, across all sectors of healthcare, including:

  • Alleged violations of various healthcare fraud and abuse laws such as the Stark Law and the Anti-Kickback Statute
  • Litigation arising under the False Claims Act
  • Alleged violations of the Food, Drug and Cosmetic Act
  • Medicare compliance, Medicaid compliance and audits (RAC audits, ZPIC audits)

These civil and criminal actions threaten enormous potential damages and exclusion from Medicare and Medicaid – a loss of revenue that could imperil the viability of a healthcare provider. The attorneys on our Healthcare Fraud Task Force understand the high stakes involved through years of experience and detailed knowledge of healthcare regulations and fraud and abuse laws and the agencies that enforce them.

  • Successfully represented a private equity backed portfolio provider and its management company in a voluntary disclosure to HHS-OIG involving improper billing

    We successfully represented a private equity backed portfolio provider and its management company in a voluntary disclosure to the Department...
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  • Lead counsel for a large long-term care company named as a defendant in a FCA qui tam action involving allegations of medically unnecessary services and improper billing

    Our team acted as lead counsel for a large long-term care company named as a defendant in a False Claims...
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    Client Type: Private Company
  • Represented a large hospital system and negotiated a favorable settlement with HHS-OIG utilizing the OIG’s Self-Disclosure Protocol.  More specifically, our team conducted an internal investigation into possible compliance issues, drafted the disclosure for provision to HHS-OIG, and negotiated the final settlement between the parties resulting in a favorable resolution for the hospital.

    We represented a large hospital system and negotiated a favorable settlement with HHS-OIG utilizing the OIG's Self-Disclosure Protocol.  More specifically,...
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    Client Type: Nonprofit
  • Represented a global healthcare company in relation to an investigation conducted by DOJ and HHS-OIG into alleged violations of the False Claims Act. The alleged false claims involved the manner in which certain negative pressure wound therapy devices were being marketed and distributed as durable medical equipment. Conducted an internal investigation and negotiated a favorable settlement with DOJ, HHS-OIG, and counsel for the relator. No post-settlement oversight was required.

    We represented a global healthcare company in relation to an investigation conducted by DOJ and HHS-OIG into alleged violations of...
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    Client Type: Public Company
  • Representation of hospice provider in intervened FCA action pending in Eastern District of Tennessee based on allegations that hospice services provided not medically necessary

    We served as lead counsel representing a multi-state hospice provider in an investigation of alleged False Claims Act (FCA) violations...
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  • Representing a multi-state owner and operator of skilled nursing facilities (SNFs) in connection with a Department of Justice (DOJ) investigation of alleged False Claims Act (FCA) violations

    We served as lead counsel representing a multi-state owner and operator of skilled nursing facilities (SNFs) in connection with a...
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  • Lead counsel representing cardiology practice in FCA retaliation lawsuit alleging that cardiologist was terminated after raising concerns that his recruiting agreement violated the Anti-Kickback Statute and Stark Law. The district court dismissed the lawsuit and the dismissal was affirmed by the Sixth Circuit. Fakorede v. Mid-South Heart Center, P.C., 2017 WL 4217230 (6th Cir. Sep 22, 2017)

    We served as lead counsel for a cardiology practice in a FCA retaliation lawsuit alleging that a cardiologist was terminated...
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    Client Type: Private Company
  • Representation of The Brattleboro Retreat, an in-patient addiction treatment facility located in Brattleboro, Vermont, in a False Claims Act (FCA) lawsuit, resulting in the district court granting the Retreat’s motion to dismiss

    We served as lead counsel representing a not-for-profit in-patient addiction treatment facility located in Brattleboro, Vermont, in a qui tam...
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  • Representing a consultant to skilled nursing facilities (SNFs) in connection with a Department of Justice (DOJ) investigation of alleged False Claims Act (FCA) violations concerning medical necessity of therapy services

    We served as lead counsel representing a consultant to skilled nursing facilities (SNFs) in connection with a Department of Justice...
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  • Represented the former owners of a multi-state retail pharmacy chain in connection with a Department of Justice (DOJ) investigation regarding alleged violations of the False Claims Act (FCA) resulting from inaccurate reporting of usual and customary pricing of generic drugs

    We served as lead counsel representing the former owners of a multi-state retail pharmacy chain in connection with a Department...
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Allison Wiseman Acker
Associate
Angela L. Bergman
Associate
Brian D. Bewley
Member
J. Taylor Chenery
Member
Christopher J. Climo
Associate
Robert E. Cooper, Jr.
Member
Matthew M. Curley
Member
Nicholas A. Deuschle
Associate
Wallace W. Dietz
Member
Margaret Dodson
Associate
Kaitlyn L. Dunn
Associate
John C. Eason
Associate
Lindsey Brown Fetzer
Member
Mary Beth Fortugno
Member
Lauren M. Gaffney
Associate
Scott D. Gallisdorfer
Associate
Jeff H. Gibson
Member
Meri B. Gordon
Senior Litigation Attorney
Anna M. Grizzle
Member
Kaitlin E. Hazard
Associate
Kate Hunter-Salas
Associate
Brian Irving
Associate
Ashleigh Karnell
Associate
John E. Kelly
Member
Britt K. Latham
Member
J. Brook Lathram
Member (retired)
Sara K. Morgan
Associate
Sheaniva H. Murray
Associate
Elaine C. Naughton
Associate
Dawn Perez-Slavinski
Associate
W. Brantley Phillips, Jr.
Member
Brianna R. Powell
Associate
Lisa S. Rivera
Member
Brian D. Roark
Member
Glenn B. Rose
Member
Molly K. Ruberg
Associate
Taylor M. Sample
Associate
Olivia Seraphim
Associate
Danielle M. Sloane
Member
Julia Tamulis
Associate
Hannah E. Webber
Associate
Abby Yi
Associate

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
  • Revenue cycle management
  • Senior housing and long-term care
  • Specialty pharmacy and pharmaceuticals
  • Telemedicine
  • Urgent and retail care clinics
  • Wellness and disease management