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Health Care and FDA: Health Care Fraud and Abuse (U.S.)

As one of the most heavily scrutinized industries in the United States, health care has been and will remain a primary target for allegations of fraud and abuse, which can expose those operating in the health care industry to government enforcement actions, qui tam lawsuits initiated by whistleblowers, significant civil and criminal liability, and potential exclusion from participation in federal programs.

When health care fraud and abuse matters arise, health care professionals need a legal team that possesses sophisticated defense skills on both the civil and criminal fronts, as well as a deep understanding of health care laws and regulations.

Our health care fraud and abuse group is uniquely positioned to defend health care clients when the stakes are at their highest and when results are critical. It is composed of a powerful combination of lawyers from our investigations, enforcement, and white collar and health care practice groups, and supported as necessary by the firm’s e-discovery analysis and technology (e-DAT) group. This collaboration offers a unique perspective that informs and drives the defense strategies and teams deployed for our clients.

Consisting of former U.S. Attorneys and Assistant U.S. Attorneys, as well as lawyers with significant experience handling the most sophisticated health care regulatory matters, the health care fraud and abuse group is equipped to help clients navigate the inherent complexities and challenges of health care fraud and abuse investigations, including those associated with electronically stored information and electronic medical records. With team members located in our offices across the country and in virtually every region, the health care fraud and abuse group is able to meet our health care clients’ needs wherever, whenever, and however they arise. 

We routinely represent health care systems, hospitals, providers, and companies across the health care industry. These matters include investigations and litigation related to the False Claims Act, including actions initiated by the government and through qui tam or whistleblower lawsuits; the Stark Law and the Anti-Kickback Statute; the federal Food, Drug, and Cosmetic Act; and Medicare and Medicaid audits, including recovery audit contractor, zone program integrity contractor, and unified program integrity contractor audits. 

In addition to responding to federal investigations and litigation, our health care fraud and abuse group routinely represents health care systems, academic medical centers, hospitals, health care corporations, and executives in proactively undertaking internal investigations triggered by external inquiries and internal compliance functions, and associated representation surrounding government proffers, disclosures, repayments, and revisions to internal policies and procedures. In conjunction with these internal investigations, the group also has significant experience handling Office of Inspector General Self-Disclosures and Centers for Medicare and Medicaid Services Voluntary Self-Referral Disclosure Protocol filings.  

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