Health Care Services Cleared of False Claims Allegations
We represented a health care services business that provided billing services to physicians groups and emergency rooms after a false claims act (FCA) suit was filed alleging the company had improperly coded and overcharged government health care services, including Medicare and Medicaid, by millions of dollars. We did our own analysis of the company’s records while working closely with the U.S. attorney’s office as well as the U.S. Department of Health and Human Services and found an explanation for the company’s coding and charges. As a result of our investigation no criminal charges were filed and the civil suit was not pursued.
Defense of a Supplier Through a Health Care Fraud Investigation
Defended a DME supplier in an extensive federal criminal/civil health care fraud investigation involving the alleged submission of false claims (FCA) to the federal and state health care programs by upcoding, improperly using billing modifiers, and other allegedly fraudulent billing practices. The matter was resolved with civil payback and client avoided criminal penalties.
Defense of Academic Medical Center in False Claims Act (FCA) Lawsuit
Representation of an academic medical center in a False Claims Act qui tam lawsuit alleging improper billing practices. The client was operating under a CIA at the time of the representation. The matter was resolved favorably for our client after extensive discovery, with no extension of the length of the CIA and no press release issued by the federal government.
False Claims Allegations Against Client Dismissed
Representation of an academic medical center in a False Claims Act (FCA) lawsuit involving allegations that the hospital lacked documentation to support its cost reports for GME expenses. The government declined intervention and the FCA claims were ultimately dismissed with prejudice without any payment.
Defended a Large Academic Medical Center Physician Practice in False Claims Act (FCA) Lawsuit
Representation of a large academic medical center physician practice in a False Claims Act lawsuit alleging improper referral arrangements among area hospitals and our physician practice client. The matter resolved for nuisance value with no CIA or other penalty imposed on our client.
Defense of National Physician Practice in False Claims Act (FCA) Lawsuit
Representation of a national physician practice in a False Claims Act lawsuit involving emergency department billing practices. The government declined intervention and the relator quickly abandoned prosecution of the case.
Represented Home Health Agency During Health Care Fraud Investigation
Representation of a Kentucky home health agency in a dual investigation by the Eastern District of Kentucky U.S. Attorney’s Office and Kentucky Medicaid into alleged improper mail order supply business, operating without a Certificate of Need and other claims. The investigation was closed without either agency taking any adverse action against the client.
Conducts Internal Investigations Relating to Potential Health Care Fraud and Business Conduct for Clients
Conducts internal investigations relating to potential health care fraud and other business conduct for clients across the health care spectrum, including a large health insurer, national long-term care and other providers, hospitals, physician practices, ambulance providers, therapy services providers, community mental health providers, DME suppliers, pharmaceutical and medical device manufacturers, laboratories, and others.
National Health Care Litigation Counsel for Large Multi-State Provider
Serve as national litigation counsel to a large, multi-state provider, overseeing litigation and serving as lead counsel nationwide. By taking consistent positions on discovery and other issues in every case, clients are better positioned to avoid litigation potholes and arrive at more favorable outcomes.
Represents Clients with Security Breaches
Representation of clients over 100 security breaches, including clients in the health care, financial and other industries, including state data breach laws.
Dispute Over Physician Compensation
Representation of Health Care Clients in Alleged HIPAA Violation Investigations
Representation of numerous health care clients in OCR investigations relating to alleged HIPAA violations. The vast majority of these investigations have resulted in OCR deciding either: 1) no breach or violation occurred or 2) to close its investigation after the client’s response and documentation were provided.
Representation of Client in State Medicaid Fraud Investigation
Representation of an ambulance supplier in state Medicaid audit/investigation into allegedly medically unnecessary transports and other claims. Client ultimately received a minimal payback request.
Representation of Large National Health Insurer in ERISA Litigation
Handled all aspects of health plan denial of benefits issues in numerous lawsuits and administrative claims, in particular analyzing whether plans were ERISA or non-ERISA plans, whether claims were governed by federal or state law, whether administrative process was followed, and defended against claims brought by participants for denial of benefits, breach of fiduciary duty, and other ERISA-related and/or state law claims.
Successfully Defended Client's Insurance Plan
Successfully defended a church plan by obtaining a voluntary dismissal of the church plan from litigation claiming breach of fiduciary duty under ERISA, state breach of contract, fraud and bad faith failure to pay accidental death benefits.
Representation of National Insurer/Third-Party Administrator in ERISA Litigation
Successful handling and resolution of short-term and long-term disability denial of benefits claims under ERISA. Representative cases:
- Storer v. Prudential Insurance Co. of America, et al.
- Early resolution of case after successful mediation.
- Wheeler v. Prudential Insurance Co. of America, et al.
- Obtained decision in favor of long-term disability benefits plan leading to resolution on appeal.
Representation of Large Multi-National Company in ERISA Litigation
Successful handling of multiple ERISA denial of benefits and breach of fiduciary duty lawsuits involving all aspects of ERISA litigation, plan drafting, standard of review, coverage and jurisdictional analyses for large employer-sponsored plans in defense of claims for denial of retirement, health, disability and other employee benefits under the plans. Representative cases:
- Bybee v. Procter & Gamble Co., et al
- Obtained court ruling in favor of employer-sponsored health plan after evidentiary hearing on the merits in ERISA denial of benefits case.
- Mechley v. Procter & Gamble Co. Disability Benefit Plan, et al.
- Decision in favor of disability benefit plan affirmed by Sixth Circuit on appeal of ERISA denial of disability benefits claim.
- Halcomb v. The Procter & Gamble Disability Benefits Plan, et al.
- Reached successful early resolution of ERISA denial of disability benefits claim.