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Health Care / Medicare Fraud and FCA

Overview

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.

Representative Matters

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 USAThe 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