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.
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:
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.
We successfully defended a national home healthcare provider in appealing an $18 million extrapolated overpayment resulting from a UPIC audit.
We represented a global for-profit health insurance company with more than 20 million members in False Claims Act (FCA) litigation in federal court in the Northern District of Illinois.
Representation of ED company and other defendants in qui tam lawsuit alleging that ED provider’s violation of licensure laws caused submission of false claims and that defendants fraudulently billed services as performed by physicians even though patients were seen only by nurse practitioners. We obtained dismissal of the licensure claims and received summary judgment as to the upcoding claims. U.S. ex rel. Taylor v. Boyko, 2020 WL 520933 (S.D. W. Va. Jan. 31, 2020); U.S. ex rel. Taylor v. Perni, 2020 WL 2499544 (S.D. W. Va. May 14, 2020).
Representation of Life Sciences Company Fagron Holding USA LLC
Representation of Envision Healthcare Corporation, Inc. in a DOJ/OIG investigation of allegations that allowing physician owners to share in anesthesia profits of Envision’s Folsom, California and Fresno, California ASCs violates the Anti-Kickback Statute.
Representation of hospitals in a qui tam lawsuit alleging that cardiologist performed medically unnecessary cardiac stent procedures. Following declination, we obtained dismissal on grounds that the lawsuit was barred under the public disclosure bar. Following the Relator’s appeal, the Court of Appeals upheld the dismissal. U.S. ex rel. Maur v. Korban, 981 F.3d 516 (6th Cir. 2020).
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: