Healthcare Litigation

From reimbursement regulations to provider manuals, we know the issues affecting our healthcare clients’ businesses and we don’t scramble to get up to speed on the fly and on the client’s dime.

Overview

Today’s regulatory and reimbursement environment exposes healthcare providers to complex disputes with the government, intermediaries, vendors, other providers, and sometimes patients. Our Healthcare litigators distinguish themselves with an unusual combination of healthcare expertise and litigation prowess that’s highly effective in protecting our healthcare-provider clients’ interests in whatever dispute they may face. We bring our insiders’ knowledge of the healthcare industry to the matters we handle in the courtroom, in arbitrations, and in complex administrative appeals.

We handle all aspects of provider-side healthcare litigation, from moving for injunctions against government recoupments or licensure revocations, to defending national False Claims Act investigations. In addition to False Claims Act and whistleblower defense, we litigate all forms of reimbursement disputes, including RAC, ZPIC, and MIC appeals. We also represent providers seeking to obtain or challenge Certificate of Need (CON) approvals. For providers facing steep fines and civil monetary penalties (CMPs), we are there from the IDR level all the way up through the Departmental Appeals Board (DAB) and on to the courts if necessary. In addition, we have a team of attorneys specifically dedicated to the defense of owners and operators of long-term healthcare facilities.

Our in-depth industry knowledge is complemented with clinical and provider-side experience because our team includes physical therapists, former general counsel for healthcare companies and a full-time registered nurse who provides medical record analysis and insights. Our group also includes Fellows of the Litigation Counsel of America, an invitation-only trial honor society.

Additional Specialties

  • We represent clients in medical liability and professional licensure cases throughout the Southeast. We work collaboratively with our healthcare clients, not only to defend current cases, but also to prevent or minimize future cases. Two of the key aspects of our practice are our intense focus on implementing comprehensive arbitration programs for our clients and our assistance in structuring clients’ self-insurance trusts and captive insurance programs, which offer greater control and cost savings over litigation and budgets.

Experience

  • Obtained a precedent-setting ruling that low Medicaid payment rates to healthcare providers may constitute an unconstitutional taking of property.

  • Represented a coalition of national trade associations in securing the withdrawal of a proposed Medicare reimbursement rule.

  • Obtained a ruling from the Georgia Supreme Court establishing a provider-friendly standard of review in Medicaid reimbursement disputes. In lieu of an administrative law standard whereby deference is given to the agency’s interpretation, the Court held that such disputes are governed by contract principles, with ambiguities in reimbursement manuals being construed against the agency.

  • Represented the largest single-specialty allergy practice in the United States against a False Claims Act action brought by former employee. Managed substantial electronic discovery and assisted with settlement negotiations with the Department of Justice.

  • Conducted an internal investigation of a hospital-run daycare facility following suspension of license, which resulted in reversal of adverse determination.

  • Represented the Secretary of the North Carolina Department of Health and Human Services in a nine-week federal bench trial involving claims under the Americans with Disabilities Act and the CMS Medicaid Waivers. Secured favorable judgment on all claims at trial.

  • Represents multiple ER practices as plaintiffs in a civil RICO action in federal court in NY

  • Represents multiple emergency medicine physician practices as plaintiffs in a civil RICO action against a major payer and its cost containment vendor

  • Represents plaintiffs in numerous ERISA class actions in California federal court against Cigna, United and other payers for using Multiplan to systematically underpay outpatient claims

  • Lead counsel for plaintiffs in two ERISA class actions in California federal courts against major payers who systematically underpay claims for certain services

  • Represents providers in a RICO class action against a major payer accused of using illegal medical necessity guidelines to systematically deny behavioral health claims

  • Represents multiple facilities in a $40M suit in federal court against BCBS Michigan for illegally underpaying thousands of patient claims

  • Represents multiple behavioral health facilities in a $40M suit in federal court against BCBS Michigan for illegally underpaying thousands of patient claims;

  • Represents Florida physicians and facilities in a $50M state court suit against Florida Blue for systematically denying claims.

  • Obtained a multi-million dollar verdict for an Atlanta-area hospital against one of its service providers in a federal court jury trial.

  • Obtained favorable rulings from multiple state appellate courts enforcing nursing home arbitration agreements, including Georgia, North Carolina, South Carolina, and Florida.

  • Obtained a precedent-setting injunction restraining a national plaintiff law firm from using deceptive advertisements that mischaracterized nursing home survey results.

  • AGG obtained a temporary restraining order in federal court on behalf of a skilled nursing facility halting termination of the facility’s provider agreement. Through a bankruptcy filing made during the pendency of the temporary restraining order, the skilled nursing facility has successfully avoided termination of its provider agreement pending completion of the appeals process.

  • Obtained Order dismissing Heritage Healthcare of Ashburn from multi-party litigation based on the Plaintiff’s failure to arbitrate claims of negligence as required under a valid and enforceable arbitration agreement.

  • Successfully defended Health Management Associates at trial from claims that it breached the terms of an employment contract with a former employee.

  • Represented developer in claims against contractor that misappropriated construction proceeds; secured favorable settlement in excess of sums taken.

  • Defended UHS-Pruitt Corporation in a two week nursing home liability jury trial, obtaining a favorable result on behalf of the client.

  • Obtained order from the Court requiring arbitration of a Plaintiff’s claims in accordance with the provisions of a pre-dispute arbitration agreement governed by the Federal Arbitration Act.

  • Compelled arbitration for nursing home provider, then prevailed at arbitration and received an award of attorney’s fees and costs against the plaintiff.

  • Implemented a novel strategy of filing a federal lawsuit to successfully compel arbitration of a nursing home case, for Kindred Nursing Centers, resulting in a decision of first impression in Georgia. (Kindred Nursing Centers Limited Partnership v. Cynthia Jones, USDC Southern District of Georgia, Case No. CV409-105 (March 16, 2011))

  • Drafted Amicus Curiae brief on behalf of the Georgia Hospital Association and the Georgia Health Care Association regarding denials from trial courts of qualified protective orders allowing ex parte interviews with plaintiffs’ treating medical providers.

  • Successfully obtained default judgment for nursing home client in case alleging breach of contract.

  • Successfully obtained reversal of over $1.3 million in Medicare denials for nursing home therapy services by implementing strategy of attacking the statistical extrapolation methodologies used by the audit contractor.

  • Obtained a decision of first impression in Georgia, for Omni H.C Inc. by establishing a statute of limitations for a cause of action for the False Claims Act retaliation provisions (United States ex rel. Nichols v. Omni, H.C., Inc., No. 4:02-CV-66(HV), 2008 WL 906426 (M.D. Ga. March 31, 2008))

  • Acted as lead counsel for medical records company in defeating class certification. Cotton v. Med-Cor Health Information Solutions, Inc., 472 S.E.2d 92 (Ga. App.)

  • Gained CON approval for a new cancer center for Meadows Regional Cancer Center LLC over objections and administrative appeals by two competitors. The approvals were upheld after additional judicial appeals.

  • Negotiated the return of a civil money penalty of over $220,000 from CMS by a healthcare REIT.

  • Representing university and hospital system in defending lawsuit alleging tortious interference with business relations, defamation, and RICO violations.  After filing a motion to dismiss based on Georgia’s anti-SLAPP statute, plaintiff voluntarily dismissed the case. Other issues in the case are scheduled to be heard by the Georgia Court of Appeals.

  • Successfully litigated a case in which CMS had to refund more than $600,000 plus $53,000 in interest to a nursing home.

News & Insights