Background - Practices (Details)
Health Care / Medicare Fraud & FCA Investigations

Crowell & Moring’s health care investigations team has deep experience advising clients in internal investigations and in inquiries conducted by regulatory and law enforcement officials. We regularly represent leading health care entities grappling with fraud and abuse issues, and we assist clients dealing with the complex and potentially devastating risks associated with fraud and abuse investigations and prosecutions. We regularly appear before key federal enforcement agencies, such as the U.S. Department of Health and Human Services' Office of the Inspector General, the Department of Justice, the Centers for Medicare & Medicaid Service, the Drug Enforcement Agency, and related federal and state agencies.

Whether a client launches an internal investigation as a result of suspected noncompliance or employee wrongdoing, or is responding to a government subpoena, we understand the various pathways through which issues are disclosed, corrected, and resolved. In fact, members of our team were responsible for the development and oversight of the Stark Law self-disclosure protocol while serving at CMS. We have successfully defended clients in a broad range of health care fraud and abuse litigation, regularly negotiating favorable settlements and working with officials to terminate investigations without pursuing formal charges.

Services

We emphasize a proactive approach to helping clients avoid and resolve potential fraud and abuse issues. We develop and review compliance programs and conduct internal compliance audits of high-risk areas. When government inquiries result in OIG or grand-jury subpoenas or search warrants, we help clients take immediate action to minimize exposure to financial penalties, administrative sanctions, and reputational harm. We conduct thorough investigations discreetly and efficiently, and work with agencies to achieve timely resolutions. When settlement is not in a client’s best interests, our fraud and abuse litigators do not hesitate to proceed to trial, mounting a strong, aggressive defense.

Experience

Our clients come from all areas of the health care marketplace, including:

  • Hospitals and hospital systems
  • Physicians and physician group practices
  • Academic medical centers
  • Managed care plans and insurers
  • Medical device manufacturers and distributors
  • Group purchasing organizations
  • Payors
  • Government contractors

Our health care practice has been ranked by Chambers USA, The Legal 500, and U.S. News-Best Lawyers’ The Best Lawyers in America. It includes several current fellows and leaders within the American Health Lawyers Association, as well as former in-house counsel for health care corporations, former state and federal prosecutors, and former top officials in federal agencies and legislative committees, including:

  • The Department of Health and Human Services, including the Office of General Counsel and Office of the National Coordinator for Health Information Technology
  • The Food and Drug Administration
  • The Centers for Medicare & Medicaid Services
  • The Department of Justice
  • The Federal Trade Commission
  • The U.S. Senate Judiciary Committee

Representative Engagements

  • Worked with 19 hospital regional health care system on legal and operational compliance and defense against government investigations concerning federal health care program anti-kickback statute and regulations, the federal prohibition on physician self-referrals (the "Stark Law"), related civil monetary penalty laws, and Medicare billing rules and regulations, e.g., provider-based billing requirements and hospital outpatient supervision requirements.
  • Represented an attorney and law firm that was under investigation by the Department of Justice for his/their role in issuing a legal opinion to a hospital client concerning the legality of a hospital-physician group relationship. The government asserted separately that the hospital-party to the hospital-physician group arrangement violated the Stark Law and the False Claims Act, and that the attorney and law firm who represented the hospital in this matter were also potentially liable for these violations.
  • Represented a hospital responding to a federal investigation into whether the hospital paid kickbacks to cardiologists in exchange for patient referrals through free rent, higher than appropriate medical director compensation or other measures.
  • Represented Academic Medical Center government investigation of billing practices related to supervision of anesthesia residents. After a thorough internal investigation and presentation to the government, the whistleblowers voluntarily dismissed their action and the government closed its investigation without seeking any penalty or other sanction against the Academic Medical Center.
  • Represented a large hospital system in conducting a wide spread internal investigation into its billing practices. Specifically, the billing issue involved submitting improper claims that may have led to higher levels of reimbursement. After completing an internal investigation, worked closely with the client to report a multi-million dollar self-disclosure to the HHS Office of the Inspector General.
  • Represented an MA plan against allegations in a qui tam case that it mispresented the adequacy of its provider network to CMS. Our internal investigation determined that the plan’s network adequacy had satisfied a review conducted by a national accrediting organization and thus deemed compliant under CMS regulations. The qui tam relator’s lawyers withdrew and the relator has not pursued his claim.
  • Conducted an internal investigation into whether an MA plan was at risk because of the marketing activities of a medical practice that the plan had acquired. Determined that the allegations of inappropriate marketing and possible violations of the Anti-Kickback Statute were unsubstantiated.
  • Represented a large national for profit hospital chain in DOJ investigation following series of qui tam complaints alleging systemic coding fraud.