Selected Representations
- We have successfully defended a major healthcare insurer against federal lawsuits challenging certain of its policies and procedures, including contract provisions requiring participating hospitals to afford the insurer rates no less favorable than those afforded to other private insurers, minimum participation requirements in healthcare contracts with groups, and policies regulating the manner in which groups could conduct audits of their healthcare payments.
- We have successfully represented the same major healthcare insurer in numerous federal lawsuits under the ERISA statute, challenging such matters as the manner in which coverage rates are calculated, and the adequacy of disclosures in group agreements and benefit booklets.
- We are representing a major pharmaceutical company in connection with federal civil and criminal Medicare fraud investigations involving pricing policies and alleged violations of the Anti-Kickback Act and the Physicians Drug Marketing Act.
- We represented the senior officers and managers of a major national clinical laboratory in connection with a federal criminal Medicare fraud investigation involving the alleged provision of unnecessary services and alleged violations of the Anti-Kickback Act.
- We have represented long-term-care facilities in connection with federal and state Medicare and Medicaid fraud investigations involving allegations of inadequate care.
- We represented the senior officers and managers of a biotechnology company in connection with a federal investigation involving alleged violations of the Food, Drug and Cosmetic Act in connection with a clinical trial program.
- We represented a medical device manufacturer accused of felony crimes involving scientific fraud in connection with an FDA filing. After a thorough investigation and presentations to the US Attorney’s Office, we were able to negotiate a misdemeanor plea and a modest fine on the company’s behalf.
- We conducted an internal investigation for a major pharmaceutical and diagnostic company to determine compliance with the provisions of supply contracts with the federal government.
- In response to a "whistleblower" who claimed illegal conduct in the performance of a government contract, we conducted an intense internal investigation of company practices. As a result, the company demonstrated conclusively that no wrongdoing had occurred, and thus avoided a time-consuming and expensive governmental investigation.
- We are representing an executive of a major regional healthcare provider in connection with a governmental investigation concerning the proper use of the so-called "incident to" rules related to billing for services provided by physician's assistants.
- We are representing a major regional healthcare system in connection with a governmental investigation concerning the propriety of billing for outpatient laboratory services under the so-called "72-hour rule."
- We are representing a hospital system in a qui tam action under the False Claims Act.
- We are representing a regional system of behavioral health centers in connection with a False Claims Act litigation instituted by the US Attorney’s Office.
