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.

  • 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
  • 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
  • Successfully represented cardiologist in FCA lawsuit, which alleged that defendants submitted false claims in connection with medically unnecessary cardiac procedures

    We successfully represented a cardiologist in a False Claims Act (FCA) lawsuit, which alleged that the defendants submitted false claims...
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  • Successfully represented hospital in connection with self-disclosure to U.S. Department of Justice and settlement of potential FCA claims regarding medical necessity of in-patient psychiatric services

    We successfully represented a hospital in connection with a self-disclosure to the U.S. Department of Justice and settlement of potential...
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  • 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 are representing a hospice provider in an intervened False Claims Act (FCA) action pending in the Eastern District of...
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  • Lead counsel representing pain management practice in allegations that practice engaged in fraudulent billing practices. Following declination of the relator’s claims, negotiated a settlement relating to urinalysis billing practices. U.S. ex rel. Cleland v. Pain Management Group, P.C., No. 3:15-cv-1209 (M.D. Tenn.)

    We served as lead counsel representing pain management practice in allegations that practice engaged in fraudulent billing practices. Following declination...
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    Client Type: Private Company
  • Lead counsel representing North Dakota health system in qui tam lawsuit alleging that health system’s compensation of certain employed physicians violated the Anti-Kickback Statute and the Stark Law. U.S. ex rel. Benaissa v. Trinity Health, No. 4:15-cv-159 (D.N.D.)

    Bass, Berry & Sims served as lead counsel representing health system in qui tam lawsuit alleging that health system's compensation...
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    Client Type: Nonprofit
  • Lead counsel representing Medicare Advantage service provider in qui tam that alleged that defendants caused the inflation of risk adjustment scores. U.S. ex rel. Ramsey v. Censeo Health, L.L.C., No. 3:14-cv-118 (N.D. Tex.)

    We served as lead counsel representing Medicare Advantage service provider in qui tam alleging that defendants caused the inflation of...
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    Client Type: Private Company
  • Represented owner of ambulance company indicted for Medicare and Medicaid fraud for its transportation of dialysis patients. Following conviction at trial, we persuaded the Sixth Circuit Court of Appeals to overturn the defendant’s aggravated identity theft conviction on the grounds that the defendant did not “use” the identifying information of Medicare beneficiaries within the meaning of the statute merely by misrepresenting how the beneficiaries had been transported. United States v. Medlock, 786 F.3d 431 (6th Cir. 2015)

    Bass, Berry & Sims represented Woody Medlock, co-owner of family-owned Murfreesboro Ambulance Service, who was indicted on charges of Medicare...
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    Client Type: Individual
Angela L. Bergman
Associate
Brian D. Bewley
Member
Kevin J. Butler
Associate
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
Kaitlyn L. Dunn
Associate
John C. Eason
Associate
Lindsey Brown Fetzer
Associate
Mary Beth Fortugno
Member
Lauren M. Gaffney
Associate
Scott D. Gallisdorfer
Associate
Jeff H. Gibson
Counsel
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)
Katherine S. Linsey
Associate
Sara K. Morgan
Associate
Elaine C. Naughton
Associate
Daniela J. O'Mara
Associate
W. Brantley Phillips, Jr.
Member
Robert K. Platt
Associate
Brianna R. Powell
Associate
Lisa S. Rivera
Member
Brian D. Roark
Member
Glenn B. Rose
Member
Molly K. Ruberg
Associate
Taylor M. Sample
Associate
Danielle M. Sloane
Member
Julia Tamulis
Associate
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