Background - Practices (Details)

Government Health Care Programs


Under complex federal health care programs, clients with contracts or grants must simultaneously navigate the highly technical requirements of government contract law and the equally challenging statutes and regulations governing federal health care programs. Crowell & Moring's government health care programs practice includes lawyers who understand both of these areas and can guide clients through the detailed and unique requirements of federal health care programs. Over the course of many years, Crowell & Moring has developed one of the nation's largest and most renowned government contract health care benefit practices.

Our lawyers specialize in Medicare Advantage, Medicare Part D, Medicare Accountable Care Organizations (ACOs), cost contracting, Medicare Administrative Contractor (MAC), Medicaid managed care, TRICARE, Federal Employee Health Benefits (FEHB) Program 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 the following:

  • 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 health care 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 FEHB Program for both community-rated and experience-rated contractors, including successful representation in scores of claims to recover underpayments and defense against audits recovery claims
  • Representation of Medicare Advantage, FEHBP, and TRICARE contractors, and of providers in Office of Inspector General (OIG) 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 non-renewal and termination, and government contract flow-down clause requirements
  • Issues regarding applicability of OFCCP requirements to provider and subcontractor relationships of Medicare Advantage, TRICARE, and FEHBP contractors
  • Litigation of disputes involving federal health benefit government program preemption of state law

Recent Engagements

  • Recovering hundreds of millions of dollars for a government health care contractor in actions against OPM for underpaying premiums for members of plans and defense against FEHBP plan audits and False Claims Act investigations.
  • Defeating a hospital class action seeking hundreds of millions of dollars from a TRICARE contractor, in which the Delaware suit alleged that our client underpaid for outpatient services to CHAMPUS/TRICARE beneficiaries; the U.S. Court of Appeals for the Third Circuit upheld the district court's dismissal on the basis that prudential exhaustion should be upheld
  • 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
  • Dismissal of fraud and false claims allegations against a Medicare HMO contractor