Health Care

Crowell & Moring is one of the nation's premier health care law firms, handling the full range of federal, civil, criminal, regulatory, and legislative issues confronting the industry. We represent Medicare fiscal intermediaries and carriers, Medicare+Choice HMOs, Medicaid HMOs, FEHBP and TRICARE contractors, pharmaceutical companies, and a wide variety of providers.

Over the last 20 years, our practice has focused on disputes with government agencies, auditors, and the Office of the Inspector General. As a result, our lawyers have unparalleled experience in government investigations, voluntary disclosures, and defense of health care entities in qui tam actions. It is fair to say that we wrote the book in this area: "Responding to Government Investigations," Health Care Fraud Litig. Rep. (Andrews Pubs), April 1997. It is also true that we have litigated some of the most important cases involving alleged fraud by members of the health care industry.

Our lawyers are uniquely skilled at advising clients on how to respond to and, more importantly, avoid trouble. This includes responding to investigations, defending False Claims Act and qui tam actions, developing compliance programs and training, as well as advising on a broad range of legislation and agency policies, including the following:

  • Medicare/Medicaid Anti-Kickback Act
  • Stark rules
  • Exclusion and suspension
  • Billing and claims processing requirements
  • Coordination of benefits
  • Federal Employees Health Benefits Program
  • Upcoding
  • Physician incentive payments
  • Medicare secondary payor
  • Emergency Medical Treatment and Active Labor Act (EMTALA, or anti-dumping act)
  • Medicaid Rebate Act and Veterans Health Care Act of 1992
  • Provider reimbursement under Medicare and Medicaid
  • Pharmacy benefit management contracts
  • ERISA preemption
  • Provider and beneficiary appeals and grievance processes
  • Privacy and HIPAA compliance
  • Health care mergers and acquisitions