Healthcare Fraud & Abuse

Given the complexity of fraud and abuse laws and the level of scrutiny faced by the healthcare industry, it is critical to have experienced fraud and abuse counsel in your corner. Whether our clients are facing a government enforcement action or investigation, conducting an internal/compliance investigation, evaluating an existing arrangement or structuring a new arrangement, we have the understanding and experience to assist clients in navigating these complex issues.

With our foundation in Nashville, the nation’s healthcare capital, and our presence in Washington, D.C., our healthcare fraud and abuse attorneys understand both the business and the politics of healthcare. Our multi-disciplinary practice is led by our Healthcare Fraud Task Force, which is made up of more than 50 attorneys drawn from throughout the firm. Our counsel goes beyond the legal issues and considers the myriad of the operational and management issues a healthcare organization may face in dealing with healthcare fraud and abuse matters.

Government Enforcement

We routinely represent healthcare providers from across all sectors of the healthcare industry faced with fraud and abuse investigations initiated by the government and the related litigation stemming from those enforcement efforts. Our Healthcare Fraud Task Force includes former members of the U.S. Department of Justice (DOJ) who have held leadership positions within DOJ and who have gained significant experience handling healthcare fraud matters across the country on behalf of the United States. Our attorneys bring the knowledge of having worked inside the government, providing great insight into how Department of Health and Human Services- Office of Inspector General (HHS-OIG), Centers for Medicare & Medicaid Services (CMS), and the various State Attorneys’ General offices think about fraud and abuse issues in healthcare and the strategies used to pursue these cases.

We have litigated and/or resolved civil and criminal healthcare fraud-related allegations on behalf of clients in jurisdictions located in more than 25 states throughout the country. These actions often involve exposure under the False Claims Act (FCA) that could result in criminal exposure; the threat of enormous potential monetary damages or penalties; and exclusion from Medicare, Medicaid and other federal healthcare programs – 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. Our team has a proven and demonstrable track record of successful outcomes on behalf of healthcare clients throughout the country—whether litigating on behalf of clients or negotiating favorable resolutions—and we are poised to walk side by side with clients every step of the way in these most challenging matters.

Fraud and Abuse Counseling

Beyond our strength in dealing with the external pressures associated with government enforcement, we have one of the pre-eminent fraud and abuse counseling teams in the country. The fraud and abuse laws impact virtually every aspect of the healthcare industry. Our talented team of lawyers brings decades of government and industry experience together to devise practical solutions to you most complex fraud and abuse issues.

Over the years, our team has served as national fraud and abuse counsel to many of the leading companies in the healthcare industry. Our fraud and abuse counseling team works with clients to structure innovative arrangements that satisfy business objectives while managing risk under the fraud and abuse laws. From the shift toward value-based care to the seemingly endless promise of digital health, the healthcare industry is in a nearly constant state of flux. With our deep understanding of the regulatory and reimbursement environment, we can help formulate innovative, legal solutions. We also have the credibility with government regulators to gain insight into the fraud and abuse risks associated with innovative arrangements through both information guidance and, where appropriate, successful advisory opinion strategies. We also help clients navigate the fraud and abuse risks and regulatory complexities surrounding the growing use of value-based care arrangements.

In addition, we regularly analyze existing business arrangements for risk and potential violations of the fraud and abuse laws in the context of ongoing compliance efforts and due diligence. We develop practical strategies for managing the risk associated with past violations. We have extensive experience negotiating successful resolutions of past violation through the OIG and CMS self-disclosure protocols, payor and contractor reporting mechanisms, and, where appropriate, proffers to federal or state prosecutors.

No matter how complex your fraud and abuse issues are, our experienced fraud and abuse counseling team has the knowledge and experience to help. We are committed to providing timely, practical solutions that help meet business objectives while addressing the fraud and abuse risks that permeate the healthcare industry.

Allison Wiseman Acker
Associate
Michael K. Bassham
Senior Litigation Attorney
Angela L. Bergman
Counsel
Kristin M. Bohl
Member
Justin K. Brown
Counsel
Nathan F. Brown
Associate
Garrah Carter-Mason
Associate
J. Taylor Chenery
Member
Hannah Choate
Associate
Robert E. Cooper Jr.
Member
Matthew M. Curley
Member
Margaret Dodson
Associate
John C. Eason
Member
Charlotte G. Elam
Associate
Lindsey Brown Fetzer
Member
Mary Beth Fortugno
Member
Emily E.  Fountain
Associate
Lauren M. Gaffney
Member
Scott D. Gallisdorfer
Member
Marianne C. Garner
Counsel
Jeff H. Gibson
Member
Anna M. Grizzle
Member
Maleaka N. Guice
Associate
Jeremy  A. Gunn
Associate
Brian Irving
Associate
Clayton P. Jackson
Associate
Stewart W. Kameen
Counsel
Ashleigh Karnell
Associate
Britt K. Latham
Member
Travis G. Lloyd
Member
William T. Mathias
Member
Jennifer  E. Michael
Member
Sara K. Morgan
Associate
Christine M. Morse
Member
Sheaniva H. Murray
Associate
Mallie A. Myers
Associate
Elaine C. Naughton
Associate
Dawn Perez-Slavinski
Associate
Brianna R. Powell
Associate
Peter Rathmell
Associate
Neerja  Razdan
Associate
Lisa S. Rivera
Member
Brian D. Roark
Member
Glenn B. Rose
Member
Molly K. Ruberg
Member
Laurence B. Russell
Counsel
Taylor M. Sample
Associate
Scott B. Shanker
Member
Danielle M. Sloane
Member
Page Minton Smith
Associate
Briana Sprick Schuster
Associate
Julia Tamulis
Member
Nesrin Garan Tift
Member
Hannah E. Webber
Associate
Abby Yi
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.
  • Revenue cycle management.
  • Senior housing and long-term care.
  • Specialty pharmacy and pharmaceuticals.
  • Telemedicine.
  • Urgent and retail care clinics.
  • Wellness and disease management.