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Health CareControversies

Our team of attorneys has years of experience representing clients in government investigations and regulatory proceedings, including Medicare and Medicaid, and in the litigated or adversarial proceedings they can spawn.

Overview

Our health care controversies team provides clients with access to a team of experienced attorneys with the skills necessary to resolve complex disputes that arise in the health care industry.

Health care controversies represent the crossroads between adversarial proceedings, including litigation and administrative proceedings, and the highly regulated health care industry. A health care controversy can include major litigation involving health care providers, credentialing proceedings before licensing bodies, or disciplinary proceedings before the many state agencies with jurisdiction over providers. They include administrative and arbitration hearings and, if necessary, state or federal court appearances.

Regulators’ increasing focus on the use of recovery-driven adversarial proceedings to enforce developing standards of compliance and fraud waste and abuse detection makes this a growing area of concern for clients in the health care industry. Now more than ever, health providers are likely to find themselves affected by investigations or enforcement proceedings that carry the risk of substantial, and even exponential, civil or criminal liability.

Our team of attorneys has years of experience representing clients in government investigations and regulatory proceedings, including Medicare and Medicaid, and in the litigated or adversarial proceedings they can spawn. They have the required aggressive litigation skills and thorough knowledge of substantive health care laws.

Team Members
Representative Experience
  • Conducted a sexual harassment investigation involving claims against a CEO.

  • Successfully advocated for a physician's enrollment in Medicaid following a wrongful exclusion and successfully negotiated the physician's return into numerous health care provider networks. 

  • Served as counsel to a home health care agency and provided representation in multiple audits by the Office of Medicaid Inspector General (OMIG), resulting in significant reductions in overpayment amounts. Also negotiated settlement agreements with OMIG, resulting in agreements for even lower overpayment amounts.

  • Representing a physician in a landmark lawsuit against insurers for failing to protect the physician's confidential information from fraud and abuse by third parties. 

  • Successfully obtained a reversal of the termination of five pharmacy locations.

  • Successfully obtained an injunction to delay the termination of a pharmacy contract after the client was terminated from the network for fraud.

  • Successfully appealed a PBM's audit findings related to "advisory" prescriptions on behalf of a NY pharmacy.

  • Successfully secured a preliminary injunction barring the NYS Department of Health from implementing dramatic cuts in Medicaid reimbursement for incontinence supplies. Through an Article 78 proceeding, plaintiffs alleged the severity of the cuts would eliminate local home-delivery-service networks, leaving a de facto mail-order system in its place. The Kings County Supreme Court issued a preliminary injunction in the plaintiffs' favor, barring the NYS Department of Health (DOH) from implementing the reduced rates through the pendency of the litigation, representing a big win for the DME and pharmacy provider communities.

  • Brought an Article 78 proceeding against the Office of Mental Health to eliminate COPS payment recoupments and negotiated a settlement where the client paid less than what was demanded.

  • Represented a state employee in federal civil-rights actions involving constitutional due-process issues and allegations of the denial of the First Amendment, due process, and Equal Protection rights, including allegations of rights violations by individuals under the auspice of the NYS Office of People With Developmental Disabilities (OPWDD) following investigations by the NYS Justice Center and the Department of Health (DOH).

  • Represented multiple health care industry employers who were former members of health care group self-insurance workers’ compensation trusts, defending multi-million claims brought by the NYS Workers Compensation Board and helping to recover substantial proceeds in multi-party lawsuits against the third parties responsible for the $188 million trust deficit. 

  • Served as counsel in a trial in which the NYS Department of Health (DOH) and the NYS Office for People With Development Disabilities (OPWDD) were found responsible for funding the reasonable actual costs of administrative overhead in providing services under Medicaid.

  • Successfully defeated a $1.6 million liability arising from an Office of Medicaid Inspector General (OMIG) finding that an intellectual/developmental disability (I/DD) agency documentation was insufficient to support reimbursement it received for services provided.

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