Overview
For physicians, hospitals, managed care organizations, and other health care providers, every aspect of service delivery is closely scrutinized for fraud and abuse.
In a space where simple mistakes can trigger onerous enforcement actions, our Fraud and Abuse Compliance Counseling and Defense lawyers work with providers to mitigate legal risk and defend them in government investigations.
Staying in Front of Compliance Issues
The best way to handle government inquiries is to avoid triggering them in the first place. Our clients count on us to structure compliance strategies that comport with their operational needs and risk tolerance. We scrutinize their processes and procedures to stay in front of any issues concerning the statutes—the Stark Law, the federal Anti-Kickback Statute, the Eliminating Kickbacks in Recovery Act, the False Claims Act (FCA), etc.—that are most likely to see enforcement. Often, our clients will sense a possible problem in advance of any government inquiry and will ask us to investigate and—depending on our findings—recommend corrective action.
Defending in Enforcement Actions
Government investigations can be lengthy, expensive, and disruptive to business operations. Our attorneys are the first ones called when a subpoena arrives, and our clients rely on us to respond to any investigation with an eye toward narrowing its scope or making it go away. Our deep knowledge of provider relationships in all health care categories—as well as their billing and reimbursement practices—informs our response and gives us strong arguments to offer in defense.
Understanding the Agencies
Whether we’re preventing government investigations or defending them, most of the issues that come up are ones we’ve seen many times before. Our attorneys have a deep understanding of federal, state, and local agencies and how best to meet their expectations. This invariably works to our clients’ advantage when responding to investigations and negotiating compliance agreements.
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Experience
- Protected a nonprofit health care provider from fraud and abuse liability after it entered into a joint venture with another hospital and local physicians. Due to a consulting error, distributions were made before the required assets were transferred to the joint venture. We re-characterized certain distributions in a manner that was permissible and eliminated the need for a voluntary disclosure to the government or dissolution of the joint venture.
- Negotiated a favorable result for a private investment manager in a matter before the Office of Inspector General (OIG) in which OIG concluded that a corporate integrity agreement (CIA) was not necessary with respect to a qui tam relator’s allegations that a health care company in the client’s portfolio violated the FCA by engaging in “swapping” arrangements.
- Conducted an internal investigation of an overpayment caused by a regional health care entity client’s overreliance on an artificial intelligence software program. Our findings led to a disclosure to a government agency and corrective action.
- Successfully defended a health care provider against an FCA lawsuit asserting that our client was part of a scheme to allegedly submit false claims for health care costs reimbursed by the federal Medicare, Medicaid, and TRICARE programs. We convinced the court that the qui tam relator failed to allege sufficient details proving that the claimed scheme led to our client submitting false claims to the federal government.
- Conducted an internal investigation into a whistleblower complaint against a Florida health system client. The complaint alleged possible legal violations by the company’s interim system CEO that were also potential violations of the client’s obligations under a CIA. After investigating the allegations, including reviewing documents and conducting interviews, we prepared a notification of the reportable event to OIG concerning the interim system CEO’s probable violations of the Anti-Kickback Statute. Our investigative findings led to the interim system CEO’s termination.
- Obtained a complete dismissal of a Medicare Advantage risk adjustment case against our health care client without any finding or admission of liability in exchange for a contribution of just 5 percent of the settlement amount. The cost to settle this case was a fraction of the costs the client would have incurred in litigating the case to a conclusion.
- Secured the dismissal of a federal criminal indictment in a federal court in the South charging our client—the former CEO of a durable medical equipment supplier—and several co-defendants with violating the Anti-Kickback Statute. The dismissal of a federal criminal case is unusual, even more so in this case, because the government sought dismissal in response to our defense motion arguing improper venue.
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- March 2025
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Insights
Insights
- Media CoverageSarah M. Hall Quoted in “Criminal Health Care Fraud Enforcement Expected to Remain Robust”2 minute read
- PublicationsWhat Does the Phrase “Resulting From” Mean? Circuit Courts Split on Standard for Determining When an AKS Violation Is a ...16 minute read
- BlogsFirst Circuit Joins Sixth and Eighth Circuits in Adopting “But-For” Causation Standard Under the Federal ...3 minute read
- Media CoverageTim Murphy Quoted in “Fraudsters Hit Exchanges Amid Medicare Advantage Crackdown”2 minute read
- Media CoverageMelissa Jampol Quoted in “Hospital in Virginia Is Charged with Crimes Stemming from Doctor’s Unnecessary Surgeries” ...10 minute read
- Media CoverageGeorge Breen Quoted in “DOJ Secured $1.7B from Healthcare False Claims Settlements, Judgments in 2024”5 minute read
- Media CoverageThomas Jaworski Featured in “Acting U.S. Attorney Joins Epstein Becker Green”1 minute read
- Media CoverageThomas Jaworski Featured in “On the Move”2 minute read
- Firm AnnouncementsEpstein Becker Green Adds Acting U.S. Attorney for the Middle District of Tennessee Thomas Jaworski3 minute read
- Publications
Chapter 6, “Fundamentals of Health Law Fraud and Abuse,” in Fundamentals of Health Law (Eighth Edition), AHLA ...
2 minute read - Media CoverageGeorge Breen Featured in “Medtech 2025: Deregulation, Tariffs Anticipated from New US Administration”3 minute read
- Media CoverageGeorge Breen Featured in “Medtech 2025: ‘Moving Forward, No Matter What’”3 minute read
- Firm AnnouncementsEpstein Becker Green Awards 2024 Annual Core Values Champions5 minute read
- Media Coverage
Featured in Law360: Epstein Becker Green Adds Research Compliance Pro Elizabeth McEvoy
2 minute read - Firm AnnouncementsEpstein Becker Green Welcomes High-Stakes Research Misconduct Attorney and Litigator Elizabeth J. McEvoy, Improves Bench ...3 minute read
- Firm AnnouncementsEpstein Becker Green Announces 2025 Promotions4 minute read
- BlogsDOJ’s First Civil Cyber-Fraud Initiative Litigation Serves as Warning to Government Contractors Who Fail to Abide by ...3 minute read
- Firm Announcements
Four Epstein Becker Green Attorneys Named to the 2024 Massachusetts Super Lawyers and Rising Stars Lists
8 minute read - Media CoverageMelissa Jampol Quoted in “Surgery Hospital Settles FCA Case for $14M Over Contributions to Medical Group Foundation” ...4 minute read
- Media CoverageChristine Worthen Featured in “Beltway Moves”1 minute read
- Media CoverageEpstein Becker Green Adds Healthcare Attorney Christine Burke Worthen in Washington, DC2 minute read
- Firm AnnouncementsEpstein Becker Green Adds Health Care Regulatory Firepower with Attorney Christine Burke Worthen in Washington, DC ...2 minute read
- Firm AnnouncementsEpstein Becker Green’s Lisa Gora Named One of New Jersey’s “Forty Under 40”2 minute read
- BlogsDOJ Criminal Fraud Section’s Annual Health Care Fraud Enforcement Action: “We Are a Target-Rich Environment” ...20 minute read
- Firm Announcements
Elizabeth Scarola Named to the 2024 Florida Rising Stars List
7 minute read - Media CoverageGeorge Breen Quoted in “High Court Petition Asks Justices: What's a 'Willful' Kickback?”3 minute read
- Media CoverageJeremy Avila Featured in “People on the Move”1 minute read
- Media CoverageGeorge Breen Quoted in “Custom Drug Makers Stay on DOJ Radar in Fla. Fraud Case”2 minute read
- Media CoverageLaw360’s Hottest Firms and Stories Features Epstein Becker Green Insight on False Claims Act Enforcement Trends ...1 minute read
- PublicationsMid-2024 FCA Enforcement and Litigation Trends to Watch3 minute read
- Media CoverageMelissa Jampol Quoted in “SNF Provider Settles FCA Case Involving Waivers; 'Incorrect Reasoning' Raises Questions” ...7 minute read
- Firm AnnouncementsEpstein Becker Green Fuels West Coast Momentum with Six-Attorney Health Care Team6 minute read
- BlogsPRF Update: HRSA Sends Out “Audit Reporting Requirement Attestation” Notice Mandating Quick Action3 minute read
- BlogsDOJ’s FY 2023 Statistics: Highest Number of Settlements, Judgments, and Civil Investigative Demands in History and a ...7 minute read
- PublicationsSponsored Genetic Testing Programs: Compliance Considerations Following DOJ False Claims Act Settlement13 minute read
- Media CoverageAmy Lerman Quoted in “Patient Care, Policy & More: A Look at This Year’s Virtual Care Trends”5 minute read
- Publications9th Circ. Scienter Ruling May Strengthen FDA's Leverage1 minute read
- Blogs
What to Do If the Government Knocks on Your Company’s Door … or Breaks It Down – Speaking of Litigation Podcast
28 minute read - Firm AnnouncementsEpstein Becker Green Announces 2024 Promotions6 minute read
- PublicationsRecent Developments in Federal and State Fraud and Abuse Investigations2 minute read
- Firm Announcements
Elizabeth Scarola Named to the 2023 Florida Rising Stars List
6 minute read - Media CoverageGeorge Breen Quoted in “Conservative Justices Cast Constitutional Cloud Over False Claims Act Decision”7 minute read
- Publications
3 Abortion Enforcement Takeaways 1 Year After Dobbs
2 minute read - Firm Announcements
Jessika Tuazon Named to the 2023 Southern California Rising Stars List
6 minute read - Firm Announcements
Epstein Becker Green Recognized Among Top 10 Largest Health Care Law Firms by Modern Healthcare
2 minute read - PublicationsFCA Enforcement and Litigation Trends to Watch3 minute read
- Media CoverageLisa Pierce Reisz Featured in “People on the Move”1 minute read
- Media CoverageLisa Pierce Reisz Featured in “Wake Up Call: Laterals, Moves, In-House”1 minute read
- Firm AnnouncementsHealth Care Attorney Lisa Pierce Reisz Joins Epstein Becker Green in Columbus4 minute read
- Media CoverageLisa Pierce Reisz Featured in “Epstein Becker Brings On Health Care Atty in Ohio”2 minute read