Because the health care industry is highly susceptible to allegations of fraud and abuse, it faces intense government scrutiny from federal and state regulatory agencies. Our team, which includes a former U.S. Department of Justice (DOJ) criminal health care fraud prosecutor who served on the Medicare Fraud Strike Force, has extensive knowledge of health care regulations and fraud and abuse laws. We have significant experience representing health care entities, licensed health care professionals and health care executives in government fraud and abuse investigations and enforcement actions as well as related litigation.
Our experience encompasses defending health care providers against claims brought by whistleblowers under the federal False Claims Act and state false claims acts, negotiating corporate integrity agreements with the U.S. Department of Health and Human Services (HHS) Office of Inspector General and the DOJ, performing internal investigations on behalf of health care clients, and representing their interests in agreement and contract disputes. We also advise clients who are under government investigation for suspected fraud or abuse and help clients avoid civil and criminal penalties and potential exclusion from participation in Medicare and Medicaid.
Illustrative examples of our experience with complex health care cases in federal and state courts across the country include:
In private practice
- Negotiating corporate integrity agreements for health care industry clients with the HHS Office of Inspector General.
- Obtaining dismissal at the pleadings stage of a complaint under the federal False Claims Act alleging fraudulent business practices by a national health care company.
- Defending a national health care company in Florida, California and Illinois state courts in three separate actions alleging fraudulent business practices under the states’ false claims acts. Obtained summary judgment on most claims, and the remainder settled favorably shortly before trial.
- Obtaining a temporary restraining order in federal court on behalf of a national health care company to enjoin the premature termination by a retail pharmacy company of its participation in a network provider agreement.
- Representing a national health care company in the negotiation and resolution of a multi-state attorney general investigation that resulted in the execution of individual consent orders with 29 state attorneys general.
- Obtaining TROs and negotiating favorable settlements in federal court on behalf of a national health care company in multiple lawsuits involving former employees.
- Representing a national health care company in resolving an action under the federal False Claims Act in which the United States intervened. Conducted a complex and lengthy internal investigation, responded to an expansive government subpoena and negotiated with the DOJ and relators’ counsel to resolve the matter.
- Negotiating a favorable settlement with the DOJ and relators’ counsel on behalf of a national health care company in litigation involving a complex action filed under the federal False Claims Act in which the United States and the state of Texas intervened.
- Obtaining complete dismissal of a federal False Claims Act lawsuit on behalf of a national health care company on the grounds that the allegations had been publicly disclosed and the relator was not an original source.
- Obtaining dismissal of a complaint alleging tortious interference with a contract brought against a national health care company by a competitor in Illinois state court.
- Conducting numerous internal investigations for national health care companies in connection with allegations by whistleblowers relating to alleged violations of the federal Anti-Kickback Statute and other laws.
- Representing a company in connection with an HHS Office of Inspector General whistleblower complaint related to alleged violations of the federal Anti-Kickback Statute in the acquisition of a pharmacy. No claims or charges were brought against the client.
- Representing a pharmaceutical company that was a victim in a federal criminal fraud case in connection with seeking restitution.
- Representing a pharmacy in connection with a DOJ and HHS Office of Inspector General criminal investigation into patient kickbacks and billing fraud. Also represented the company with respect to review of corporate contracts and HIPAA compliance.
- Representing a medical services company with respect to a criminal investigation, a grand jury subpoena and HIPAA compliance matters. Convinced law enforcement agency to withdraw grand jury subpoena.
- Representing a medical doctor in a DOJ and HHS Office of Inspector General investigation into alleged kickbacks and violations of the Stark Law. No claims or charges were brought against the client.
- Representing a medical sales representative in a Maryland Attorney General investigation into kickbacks related to alleged over-prescribing of opioids. No claims or charges were brought against the client.
At the U.S. Department of Justice
- Investigating and prosecuting a broad range of complex federal white-collar offenses, including health care fraud, wire fraud, commodities and securities fraud, money laundering, spoofing, bank fraud, bankruptcy fraud, conspiracies, major fraud against the government, kickbacks, advance fee schemes, bribery and gratuities.
- Serving as the lead Fraud Section prosecutor in a $77 million health care fraud, kickback and money laundering prosecution; obtained 13 convictions and substantial criminal sentences of up to 15 years’ incarceration and approximately $50 million in restitution orders.
- Serving as first- and second-chair counsel in federal health care criminal jury trials in several different courts; all trials resulted in convictions and lasted three to seven weeks.
- Obtaining dozens of health care fraud convictions via trial and plea in multiple federal districts, including Brooklyn, New York; Miami, Florida; Houston, Texas; and Baton Rouge, Louisiana.