Health Care Fraud & Abuse

Crowell & Moring's health law practice includes nationally recognized health care fraud counselors, and civil and criminal litigators. Our team is made up of members of our Health Care, White Collar & Regulatory Enforcement, and Government Contracts practice groups, who together establish the firm as a formidable advocate for health care clients grappling with fraud and abuse issues. We provide effective and experienced services to clients dealing with the complex and potentially devastating risks associated with fraud and abuse investigations and prosecutions. Our firm's presence in Washington, D.C., provides us ready and regular access to key federal enforcement agencies such as the U.S. Department of Health and Human Services' Office of the Inspector General (HHS-OIG) and the Department of Justice (DOJ), while our intimate understanding and experience in dealing with the federal False Claims Act, the Anti-Kickback Statute, and the Physician Self-Referral Law (or Stark law) permits us to advise and counsel clients on these substantive areas, regardless of location, through lawyers based in our Los Angeles, San Francisco, Orange County and New York offices.

Our lawyers recognize the value clients receive by avoiding potential fraud and abuse issues in the first place. We frequently assist our clients in the negotiation and crafting of business transactions that eliminate or minimize fraud and abuse risks at the outset. For established clients, our compliance counselors are often called upon to assist with the development and review of compliance plans and programs. We are also experienced in undertaking internal compliance audits and investigations frequently focused on identified fraud "risk areas."

Despite best efforts, the broadening web of fraud and abuse risks can sometimes result in the need to defend our clients in high-stakes, adversarial proceedings. When a client is confronted with serious fraud and abuse challenges — perhaps first signaled by receipt of an OIG or grand jury subpoena or a search warrant — we are often retained initially to not only respond to the demand, but to undertake an internal investigation in order to more fully assess the scope and gravity of the potential problem. We are experienced in conducting these complex and delicate investigations thoroughly, discreetly, and efficiently. When government enforcement agencies are involved in the matter, we are prepared to deal with these agencies in a direct, professional manner. Based on our experience and numerous interactions with these prosecutorial bodies, we can often be successful in convincing the government that no enforcement action is necessary.

On other occasions, we may recommend that the client seek to resolve a matter through settlement prior to trial. When we do so, we focus on negotiating global settlements that impose the least impact to our clients' businesses. We keep in mind the burdens of not only the financial aspects of settlement, but of other important parallel considerations, including potential program exclusions and other administrative sanctions.

There are some situations in which negotiating a settlement is simply not in a client's best interests. In these cases, we do not hesitate to proceed to trial, and mount strong and aggressive defenses. Our fraud and abuse litigation team consists of a number of experienced civil and white collar criminal defense lawyers and former federal prosecutors with experience that includes service as the coordinator of the government's Medicare Fraud Strike Force. These lawyers are well versed in the unique subject matter that is often the focus of health care fraud litigation, including not only the federal False Claims Act and its unusually broad application to the health care field, but other statutes unique to the health care industry as well. Teaming with our experienced health care regulatory and government program practitioners, we bring to any litigation engagement the optimum combination of significant trial experience and substantive knowledge.

Our fraud and abuse clients are representative of all components of the health care marketplace, including hospitals and hospital systems, managed care plans, medical device manufacturers, group purchasing organizations, payors, government contractors, and individual defendants. We maintain a close watch over new legal developments as the government continues to refocus its enforcement efforts on new theories of liability and on new targets. Our fraud and abuse practitioners provide our clients with updates on these new initiatives and how they may affect our clients' businesses through frequent client alerts, client conferences, and other media.

We also are called upon frequently by professional associations such as the American Health Lawyers Association and the American Bar Association to speak and write on health care fraud and abuse issues in various national forums. These engagements provide us unique, informal opportunities to interact with government representatives and industry experts, thereby adding to our insight into the government's priorities and strategies in the complex area of fraud and abuse enforcement.