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Health Care

The attorneys of Pietragallo's Health Care practice, many of whom are former federal or state prosecutors, are experienced in handling the numerous, diverse and ever-changing litigation needs of our health care clients, including:

  • Civil and administrative litigation brought by federal and state agencies, or private insurance carriers (including health insurance carriers), involving allegations of fraud or other misconduct
  • Civil litigation brought by private insurance carriers, including health insurance carriers and automobile insurance carriers, involving allegations of fraud or other misconduct
  • Counseling and negotiations in connection with federal and state agency inquiries/investigations
  • Disciplinary investigations and hearings by hospitals and health systems, including “disruptive physician” allegations, credentialing and privilege issues and medical staff disputes
  • Medicare, Medicaid or private health care insurance carrier exclusion litigation
  • Investigations and disciplinary proceedings by all manner of professional licensing boards
  • National Practitioner Data Bank issues
  • Litigation involving the separation of a provider from a practice group or the dissolution of a practice
  • Litigation concerning leases, contracts, employment agreements, restrictive covenants, non-competes, business disputes or arising from business acquisitions
  • Litigation involving antitrust issues
  • Litigation concerning intellectual property in the healthcare industry, including medical equipment patents, copyright and trademark
  • Investigations by federal and state regulatory agencies, including the Food and Drug Administration, Drug Enforcement Agency, Health and Human Services, Medicare and state Medicaid agencies
  • Overpayment demands by private health insurance carriers, Medicare and state Medicaid agencies
  • Medical malpractice defense

Our clients come from all areas of the health care industry. We have represented hospitals, clinics, physicians and surgeons, nurses, nurse practitioners, physician's assistants, health care practice groups of all sizes, dentists, anesthesiologists, chiropractors, health care entrepreneurs, pharmaceutical executives, medical device manufacturers, medical billing companies, health care insurers, diagnostic laboratories, medical schools and all types of sales and marketing representatives.

Our attorneys regularly guide clients through the complex, and often conflicting, web of laws, regulations, policies, billing codes and compliance issues that often serve as the basis of health care litigation. As a result, we regularly provide compliance advice to clients in all areas of the health care industry, and help clients formulate compliance plans, establish compliance hotlines and provide compliance training.

Our attorneys work in close association with members of our other practice areas to provide our health care industry clients with a full range of services in related areas of the law, including: employment litigation, compliance and contractual issues; business transactions; intellectual property rights and litigation; and insurance coverage and risk management.

Health Care Fraud Litigation

Federal and State authorities increasingly are using civil and administrative statutes and regulations, in conjunction with parallel criminal investigations, to investigate and pursue suspected health care fraud. Federal authorities do so through the federal False Claims Act, the Anti-Kickback Statute, and the Stark statute and its accompanying regulations. State authorities use civil remedies embodied in state False Claims statutes and state insurance fraud statutes.

In addition, private insurance carriers are aggressively using state insurance fraud statutes, many of which allow successful carriers to recover treble damages and attorney fees, to pursue health care providers they suspect of fraudulent billing practices. Civil judgments and/or administrative sanctions in these cases may result in severe collateral consequences, including debarment, exclusion and suspension from government health care programs and revocation of medical, health care or professional licenses.

Our attorneys, many of whom are former federal or state prosecutors and members of our White Collar Criminal Defense practice group, have defended countless health care providers, executives and businesses. They are nationally recognized as leaders in the defense of civil and criminal health care fraud cases. This experience is paramount in aggressively litigating the complex issues involved in defending civil fraud and misconduct claims, while still protecting the clients' rights in any existing or potential parallel criminal proceedings.

 

CONTACT

Kevin E. Raphael
KER@Pietragallo.com