Overview
In recent years, health care and life sciences companies have borne the overwhelming risk of devastating large-scale payments under federal and state False Claims Act (FCA) laws, including those initiated by private qui tam relators.
The technical complexity of the health care reimbursement laws, coupled with the strong financial incentives that FCA treble damages provide, offers great encouragement to federal and state enforcement authorities and private parties litigating in their name. And no area of health care has proved immune to the extraordinary breadth and power of suits brought under FCAs. Even in cases that do not result in verdicts, settlements, or other payments, mere FCA investigations are costly, disruptive, and destructive of corporate goodwill and market value. In short, in today’s litigious environment, it is not much of an exaggeration to say that there are only two kinds of health care and life sciences companies: those that have been subject to FCA matters and those that will be unless the latter have benefitted from aggressive counsel at every stage of an investigation or lawsuit.
Our Federal and State False Claims Act (Including Qui Tam) group rigorously defends health care and life sciences clients in FCA investigations, enforcement actions, and lawsuits. Clients also turn to our FCA lawyers to help them create and implement compliance strategies to avoid FCA litigation in the first place.
Navigating Each Stage
Our FCA attorneys guide companies and individuals through the entire response to FCA claims, up to and including trial. From the first federal or state subpoena, Civil Investigative Demand (CID), or other inquiry, our experienced lawyers act with speed and discretion to anticipate and resolve the issues with our government counterparts. We bring uncommonly strong assets to our clients’ defense, most notably our deep bench of health care attorneys and regulatory consultants—people whose knowledge of governing statutes and regulations meets and often exceeds that of both governments' and relators’ counsel. We are known for our ability to spot weaknesses in the arguments of government enforcers and whistleblowers and for convincing federal and state regulators and litigators to decline to pursue cases at an early stage, before substantial resources are committed.
Seeking Optimal Outcomes
In a regulatory environment where the reputational damage to a company can be at least as severe as potential financial penalties, clients can look to us to approach their case discreetly, avoiding undue media attention or operational disruption. Many of our most successful outcomes are achieved with no press exposure at all. If a case is headed for settlement, we work strategically to narrow the scope of the matter and have been successful not only in negotiating favorable financial terms but also in limiting the scope of, and sometimes avoiding completely, the imposition of costly imposed compliance oversight embodied in Corporate Integrity Agreements (CIAs). In addition, we have successful experience in preventing or resolving suspension and debarment proceedings that could arise from an FCA case.
When a settlement or informal resolution is not possible, the government is well aware of our litigation skills and our excellent track record—both in achieving pre-trial dismissals and in the courtroom.
Read less
Focus Areas
Experience
- Prevailed in a federal jury trial on behalf of a large urban hospital system charged by a qui tam FCA relator with obtaining improper reimbursements by allegedly upcoding bills submitted by affiliated medical school faculty members.
- Obtained the dismissal of a hospital system from a federal FCA lawsuit asserting that our client was part of a scheme to submit false claims for health care services reimbursed by the Medicare, Medicaid, and TRICARE programs. Our qui tam defense team 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.
- Concluded through dismissal on a pre-trial motion a federal FCA whistleblower retaliation claim brought in federal court in Virginia against a major federal defense contractor.
- Obtained summary judgment in a federal FCA case alleging that our hospital client submitted claims to the Centers for Medicare & Medicaid Services (CMS) for hyperbaric oxygen therapy services in violation of CMS's physician supervision requirement. Accepting our argument that when these services are provided on hospital premises, physician presence is presumed, the court found that the relator had failed to show either that a false claim was submitted or that our client caused or contributed to the submission of any false claim.
- Secured summary judgment on behalf of a long-term care pharmacy provider accused of improperly maintaining a pharmaceutical recycling program in violation of the federal FCA.
- Resolved an FCA case pursued against a large integrated care provider alleging improper coding and billing of certain medical services over the course of multiple years. We handled the investigation pursued by the U.S. Department of Justice (DOJ), leading to the government’s decision to decline to intervene in the case, and then defended the subsequent qui tam litigation, which was settled prior to trial.
- Successfully concluded prior to trial a multidefendant litigation brought under federal and multiple state FCAs, alleging fraudulent submissions in connection with the Medicare Risk Adjustment Program, with our client being responsible for just 5 percent of the overall settlement.
- Represented the operator of a large network of skilled nursing facilities in an FCA case brought by the DOJ. Our client faced allegations of submitting false claims to its state Medicaid program, which required physicians to certify a placement evaluation for each patient entering a nursing home. We negotiated a settlement and a CIA with the U.S. Department of Health and Human Services’ Office of Inspector General (OIG).
- Negotiated a fractional settlement of an FCA billing and coding federal and state investigation for a hospitalist company that preserved investor value and company relationships. The case involved the preparation and marshaling of complex legal, regulatory, and accounting input to defeat the expansive arguments of government experts.
- Attained summary judgment for an outpatient clinic in a matter brought under federal and state FCAs, arguing that the services provided were not supervised in accordance with CMS regulations. The court found that the relator had failed to show that any false claim was submitted or that our client caused or contributed to the submission of a false claim. Judgment was also entered in our client’s favor on the relator’s retaliation claims.
- Secured a favorable result for a private equity client in a matter before the OIG in which OIG concluded that a 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 federal FCA by engaging in “swapping” arrangements.
Contacts
- Board of Directors / Member of the Firm
- Member of the Firm
- Member of the Firm
Media
Events
Upcoming Events
Past Events
Insights
Insights
- BlogsUnited States’ Complaint-in-Intervention Highlights Continuing Effort to Use the False Claims Act to Pursue Alleged ...5 minute read
- Media CoverageMelissa Jampol Quoted in “Surgery Hospital Settles FCA Case for $14M Over Contributions to Medical Group Foundation” ...4 minute read
- BlogsAffordable Care Act Overpayments in the CY 2025 Medicare Physician Fee Schedule Proposed Rule: Implications for False ...10 minute read
- Firm AnnouncementsEpstein Becker Green’s Lisa Gora Named One of New Jersey’s “Forty Under 40”2 minute read
- PublicationsNew Wine into Old Wineskins: Artificial Intelligence Fraud and Abuse Enforcement3 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 CoverageMelissa Jampol Quoted in “Spine Device Maker Settles FCA Case for $12M; Self-Disclosures ‘Are a Calculated Risk’” ...6 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
- Media CoverageGeorge Breen Quoted in “Supreme Court Ruling Changes View of Wrongful Intent”5 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
- PublicationsSponsored Genetic Testing Programs: Compliance Considerations Following DOJ False Claims Act Settlement13 minute read
- Media CoverageElizabeth Harris, ’11, Featured in California Western School of Law Alumni News2 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
- Firm AnnouncementsEpstein Becker Green’s Edward J. Loya, Jr., Elected as Texas Bar Foundation Fellow3 minute read
- PublicationsRecent Developments in Federal and State Fraud and Abuse Investigations2 minute read
- Publications
Checking In on How SuperValu Has Altered FCA Litigation
4 minute read - Media CoverageGeorge Breen Quoted in “Conservative Justices Cast Constitutional Cloud Over False Claims Act Decision”7 minute read
- Media CoverageGeorge Breen Quoted in “Supreme Court Reopens Fraud Suits Against SuperValu, Safeway”3 minute read
- PublicationsFalse Claims Act: Businesses Should Consider How to Document Their Interpretations3 minute read
- PublicationsPatient Monitoring Services Need Increased Scrutiny to Prevent False Claims Act Enforcement Action3 minute read
- Media CoverageGeorge Breen Quoted in “Landmark FCA Showdown Looking Like Defense Bar Letdown"2 minute read
- Media CoverageGeorge Breen Quoted in “Justices Appear Open to Whistleblowers’ Drug Fraud Arguments”2 minute read
- PublicationsFCA Enforcement and Litigation Trends to Watch3 minute read
- BlogsDOJ’s FY 2022 False Claims Act Recoveries: A Mixed Bag5 minute read
- Firm AnnouncementsEpstein Becker Green’s Edward J. Loya, Jr., Elected President of Dallas Hispanic Bar Association, and Appointed to ...3 minute read
- PublicationsBiden Administration Prioritizes Health Equity in Proposed Reforms to Medicare Managed Care33 minute read
- Media CoverageGeorge Breen Quoted in “Justices Ignite FCA Debate: Fairness vs. 'Invitation to Fraud'”3 minute read
- Media Coverage
George Breen Offers a Prediction as SCOTUS Considers DOJ's Ability to Dismiss FCA Qui Tam Suits
2 minute read - PublicationsCurrent Trends in Federal and State Fraud and Abuse Investigations1 minute read
- Firm AnnouncementsEpstein Becker Green Announces 2023 PromotionsOctober 28, 20225 minute read
- PublicationsHealth Care Fraud Law: A 50 State Survey2 minute read
- Firm AnnouncementsLynn Shapiro Snyder Serves on the Nashville Health Care Council’s Board of Directors2 minute read
- Media CoverageLynn Shapiro Snyder Continues Service on Nashville Health Care Council’s Board of Directors2 minute read
- Firm AnnouncementsEpstein Becker Green’s Lasting Support of AHLA Recognized in 2022 Top Honors and New Leadership Positions2 minute read
- Media CoverageJason Christ Quoted in “Legal Experts Expect 'More Scrutiny' of Medicare Prior Authorization from Feds”2 minute read
- Media CoverageLisa Gora Featured in “Epstein Becker Taps Cannabis, Health Care Pro”2 minute read
- Media CoverageLisa Gora Featured in “Wake Up Call: Laterals, Moves, In-House”1 minute read
- Firm AnnouncementsHealth Care Attorney Lisa Gora Joins Epstein Becker Green in Newark5 minute read
- Media Coverage
Epstein Becker Green Attorneys Elected to Law360’s 2022 Editorial Advisory Boards
4 minute read - PublicationsFCA Trends to Watch for Health, Life Sciences Cos.3 minute read
- BlogsDOJ Releases FY 2021 False Claims Act Recoveries: A Record-Shattering Year for Health Care and Life Sciences Enforcement ...4 minute read
- PublicationsDOJ’s Civil Cyber-Fraud Initiative: What Contractors Need to Know About Novel Use of False Claims Act3 minute read
- Firm Announcements
Richard W. Westling Named to the 2021 Mid-South Super Lawyers List
8 minute read - PublicationsFDA's Ingredient Advisory List Raises Due Process Concerns2 minute read