Healthcare Qui Tam Investigations & Litigation

Our qui tam team defends clients against whistleblower allegations of fraud and abuse under the

• False Claims Act
• Fraud Enforcement and Recovery Act (FERA)
• Anti-Kickback Statute
• Stark Law
• State false claim and Medicare/Medicaid fraud statutes  

These matters, which include Medicare and Medicaid fraud claims, involve allegations of

• Billing for services not rendered
• Billing for services not covered
• Unbundling
• Upcoding                               
• Excessive or medically unnecessary services
• Duplicate claims
• Paying or receiving kickbacks
• Physician self-referral

Experienced qui tam litigators offer proven strategies and devise creative new ones designed to

• Guide the client’s internal investigation
• Identify problems and remedies
• Demonstrate investigation and remediation to the government
• Impel info-sharing between the government and defense
• Ascertain and interact with the whistleblower
• Avoid government intervention
• Avoid criminal charges
• Respond to retaliation claims
• Negotiate a settlement
• Try the case, whether in federal or state courts

With practical perspectives

• Decades of collective experience, including as national trial counsel in FCA cases
• Attorney team includes the former U.S. Attorney for the District of South Carolina, former Senior Trial Counsel for US DOJ (Criminal Division), and in-house counsel for healthcare businesses

• Hospitals/hospital systems
• Outpatient clinics
• Physician groups
• Labs
• Compounding pharmacies
• Hospices/hospice care systems
• Home health providers
• Behavioral health providers
• Staff nursing providers
• Academic medical centers
• Ambulance service providers
• DME suppliers

• Internal Investigations – the qui tam team supervises internal investigations through document review and interviews to help assess potential liability, preserve confidentiality, minimize disruption to business and morale, identify problems, prepare defenses, and recommend corrective actions
• Compliance program advice – we work with our clients’ compliance officers to recommend any necessary disciplinary actions, changes in practice, reorganizations, or refund of overpayments
• Consultant and expert witness retention – we guide clients on identifying and retaining clinical, billing, coding, IT, public relations, and other kinds of consultants and expert witnesses
• Ground rules with prosecutors – our team has good professional experience with government prosecutors.  We work with them on ground rules, curbs on disruption to the client, and resolution without litigation
• Government interview advice and preparation – we meet with employees to prepare them for interviews by government investigators
• Crisis and public relations communications and plan preparation and execution – we work with public relations staff and consultants to design and implement internal and external communication plans that protect confidentiality, maintain employee morale, manage crises, promote client messaging, and diffuse negative publicity
• Negotiations with relators and regulators to resolve disputes – our lawyers are negotiators of  reasonable compromises and settlements with qui tam relators (including current and former employees, customers, patients, and external auditors) and government regulators to avoid litigation
• Corporate Integrity Agreements – our team has experience negotiating CIAs and advising clients as they implement and conduct operations in compliance with the agreement's terms
• Litigation defense – when necessary, our litigation team provides an aggressive, comprehensive defense

Following is a selected sampling of matters and is provided for informational purposes only. Past success does not indicate the likelihood of success in any future matter.

• Represented academic medical center's faculty practice plan in voluntary disclosure of Medicare overpayment and related internal investigations
• Represented hospitals, DME providers, physician practices, dialysis and hospice care providers, nursing homes and healthcare professionals
• Represented CEOs, CFOs and Board Chairmen of national as well as small healthcare providers
• Negotiated settlement for academic medical center in qui tam suit involving allegations of inappropriate physician supervision
• Negotiated settlement for hospital in qui tam suit involving allegations of inappropriate physicians supervising and upcoding
• Negotiated settlement for healthcare system in qui tam suit involving allegations related to medical necessity for inpatient stays
• Negotiated settlement for ambulance service provider involving alleged swapping arrangement