Healthcare Fraud and Abuse

As federal and state authorities increasingly focus on health care providers, key stakeholders — individuals and large practices, hospital networks, nursing home systems, laboratory and diagnostic testing companies, and private equity and other investors — are turning to Arnold & Porter. We have a proven record of defending clients against aggressive criminal prosecution and civil enforcement, handling hundreds of health care cases in federal and state courts around the country — from government and internal investigations, to criminal and civil pretrial litigation, to trials and appeals up to the U.S. Supreme Court. We also help clients develop proactive compliance reviews and corrective action plans. With recognized regulatory and defense attorneys working together, our team has the experience that clients trust to gather the facts, evaluate the options, and obtain results.

Trial & Investigations Expertise: Experienced lawyers, many of whom are former federal prosecutors, backed up by one of the most sophisticated civil litigation and regulatory practices in the country with former attorneys and advisors from agencies including DOJ, CMS, and FDA, among others.
False Claims Act & Criminal Fraud: Unparalleled experience in defending health care providers in False Claims Act and criminal fraud investigations, litigation, and prosecutions, with an impressive record of dismissals, declinations, and negotiated no-fault resolutions.
Experienced Regulatory Advocates: Well-respected advice for health care providers of all sizes facing complex allegations of medically unnecessary services, improper financial relationships, fraudulent billing and coding practices, and other issues arising under federal and state fraud and abuse laws, including the FCA, AKS, Stark Law, FDCA, and others.

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Experience Highlights

National hospital system, with in-patient facilities across 25 states, in connection with DOJ criminal healthcare fraud and False Claims Act investigations, 14 associated qui tam complaints filed across 10 different judicial districts, and proceedings before the Judicial Panel on Multidistrict Litigation, concerning alleged violations of Anti-Kickback Statute and Stark Law, medically unnecessary services, upcoding, and improper cost reporting.
One of the largest ophthalmic cataract practices in the country in ongoing DOJ investigation regarding alleged kickbacks.
National managed care organization’s home healthcare subsidiary in successfully defending against a civil False Claims Act investigation by the US Attorney’s Office for the Eastern District of Michigan, securing a no-fault Medicare overpayment settlement concerning laboratory and diagnostic testing services, and securing the complete dismissal of five qui tam complaints.
Major New York-area hospital in political corruption and healthcare fraud investigation being conducted by USAO for Eastern District of New York; successfully led hospital's cooperation, leading to declination from DOJ.
Newark Beth Israel Medical Center and its parent RWJBarnabas Health in conducting an independent investigation, responding to multiple enforcement investigations and regulatory reviews, and overseeing the response to extensive media scrutiny and congressional and legislative inquiries following allegations in the national press that patient care in the hospital’s heart transplant program was compromised to improve survival statistics.
Wanaque Center for Nursing and Rehabilitation, a New Jersey-based acute pediatric nursing facility, in regulatory, legislative and civil investigations relating to viral outbreak.
DC-area dermatologic surgeon in both winning complete acquittal after five-week federal criminal jury trial on charges of healthcare fraud and aggravated identity theft and securing full dismissal of related FCA allegations.
Anesthesiologist at Forest Park Medical Center in multiyear investigation and anti-kickback inquiry by the USAO for the Western District of Texas.
Dr. Salomon Melgen, a Democratic Party donor, as lead trial counsel in 10-week federal criminal trial in District of New Jersey involving charges of bribery and honest services fraud involving Medicare and other regulatory issues. On our Rule 29 motion, the court acquitted Dr. Melgen and his co-defendant, US Senator Robert Menendez, on all political contribution counts, following mistrial where jurors hung 10-2 in favor of acquittal. DOJ subsequently dismissed all remaining charges with prejudice.
Leading provider of in-home video EEG testing services in multidistrict investigation that involved seven separate qui tams and a criminal investigation conducted by Department of Justice, Criminal Fraud Section, and US Attorney’s Offices in Southern District of Texas, Middle District of Florida and Northern District of Texas. Case settled.