Government Health Care Programs
Government health care law is a specialty that has emerged to meet the needs of clients with contracts or grants under complex Federal health care programs. Crowell & Moring LLP's Government Health Care Programs practice area blends the highly technical and specialized government contract law with the equally technical and unique statutes and regulations governing Federal health care programs. Over the course of many years, Crowell & Moring has developed one of the nation's largest and renowned government contract healthcare benefit practices.
Our lawyers specialize in Medicare Advantage, Medicare Part D, Medicare Accountable Care Organizations, cost contracting, Medicare Administrative Contractor (MAC), Medicaid, TRICARE, FEHBP and Veterans Administration matters, affording our clients one of the most outstanding and skilled government health care benefit contract practices in the country. Our experience includes:
- Defense of False Claims Act and qui tam claims
- Application, bidding, and compliance matters for Medicare Advantage and Part D contractors and downstream entities
- Federal and State bid protests of MAC, Medicaid, and other healthcare procurements
- Counseling on Medicare Part A and B, as well as peer review, and Medicare and Medicaid managed care cost and risk contracting and demonstration projects
- Bidding, contracting, and litigation for TRICARE contractors, including defense against class action claims of underpayments by providers
- Counseling, audit defense and litigation on accounting and pricing matters under the Federal Employees Health Benefits Program for both community rated and experience rated contractors, including successful representation in scores of claims to recover underpayments and defense against audits
- Representation of Medicare Advantage, FEHBP and TRICARE contractors and of providers in Inspector General investigations and Department of Justice False Claims Act investigations and anti-kickback law matters.
- Counseling and litigation on Medicare Secondary Payer, Medicaid third party liability and other coordination of benefits requirements
- Advice on application and interpretation of the Federal Acquisition Regulation, and on diverse issues such as Cost Allowability and Accounting, Conflict of Interest, Subcontracting, Fraud and Abuse, Anti-Kickback provisions, and Contract Nonrenewal and Termination, and government contract flow-down clause requirements
- Issues regarding applicability of OFCCP requirements to provider and subcontractor releationships of Medicare Advantage, TRICARE and FEHBP contractors.
- Litigation of disputes involving federal health benefit government program preemption of state law
Recent successful engagements include recovering hundreds of millions of dollars for a government health care contractor, defeating a hospital class action seeking hundreds of millions of dollars from a TRICARE contractor, securing recovery of underpayment claims for clients participating in the FEHBP program, successful defense of a Medicare administrative contract award, litigation of complex cost accounting disputes before the Board of Contract Appeals on behalf of experience rated FEHBP carriers, and dismissal of fraud and false claims allegations against a Medicare HMO contractor.