To address the latest legal challenges in the health care industry, our managed care team develops creative solutions for the largest payors. Leveraging our extensive understanding of the complex and constantly changing legal environment impacting health care companies, we provide responsive, day-to-day legal advice to efficiently minimize and prevent obstacles so our clients can remain innovative and achieve their business goals.
Our services cover complex health care industry issues involving the Employee Retirement Income Security Act (ERISA), network contract disputes, utilization review, reimbursement, bad faith, behavioral health claim disputes (including claims alleging violations of federal and state mental health parity and addiction equity laws), Medicare, Medicaid, and compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in critical class actions, multidistrict litigation, arbitration, mediations, administrative proceedings, trials, and appeals. Our managed care team has tried cases and presented at evidentiary hearings across the United States in the following areas:
- Employee Retirement Income Security Act (ERISA)
- Network contract disputes
- Utilization review
- Reimbursement
- Bad faith insurance denial litigation
- Behavioral health claim disputes, including federal and state mental health parity and addiction equity laws
- Medicare and Medicaid
- Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance
- Qui tam matters, sealed and unsealed
- State and federal false claims (FCA) allegations
- Fraud and abuse and Stark Law allegations
- Antitrust
- Medical malpractice and products liability matters
- Pharmaceutical industry matters, such as product recalls and product liability claims
- Reinsurance premium disputes
Enforcement and Investigations
We have extensive experience in enforcement and investigation matters, including:
- State AG consumer fraud probes
- Medicare and Medicaid fraud and abuse matters
- Civil monetary penalty matters
- HHS, CMS, state health agencies, and state department of insurance compliance investigations, examinations, and audits
- False Claim Act matters
- Whistleblower and qui tam litigation
- Internal investigations and voluntary disclosures
- OIG, DOJ, DEA, FDA, FTC, and other federal enforcement investigations
- Grand jury and parallel civil investigations
- Defense of fraud and abuse investigations and enforcement proceedings
- Anti-kickback and Stark Law matters
- Pricing and consumer fraud issues
- Medical device and drug marketing and pricing issues
- Price fixing, market allocation, conspiracy, and other antitrust claims
- Market Conduct Exams.
