Health Care Litigation
Alston & Bird’s Health Care Litigation Team consists of experienced litigators who also understand the complex regulations governing the health care industry. Our litigation team works closely with our regulatory compliance, legislative and public policy and FDA colleagues. Our litigators have represented companies in the health care industry in jurisdictions throughout the United States and in every aspect of litigation and dispute resolution, from administrative proceedings to jury trials and bench proceedings to appellate arguments.
We regularly defend health care companies and executives in criminal and civil investigations before U.S. Attorneys’ offices across the country, as well as at the Department of Justice. In the course of those investigations, we interact with various federal and state enforcement agencies that often work health care fraud investigations together, such as the FBI, U.S. Department of Health & Human Services—Office of Inspector General (HHS-OIG), state Medicaid Fraud Control Units and the FDA.
We are also very experienced in internal and independent investigations, having conducted hundreds of internal investigations on behalf of our health care clients.
- Alston & Bird is serving as the Independent Review Organization and Outside Reviewer for a major pharmaceutical company, reviewing the company’s systems, policies and procedures; interviewing employees; and preparing a written assessment report pursuant to the terms of company’s Corporate Integrity Agreement.
- Defended a national hospital chain in federal False Claims Act (FCA) litigation and parallel state patients’ tort class action arising from a physician’s alleged performance of unauthorized medical procedures. Won motions to dismiss both actions on the pleadings, both of which were affirmed on appeal.
- Defended a nationally renowned research university and multiple administrators in an antitrust and Section 1983 lawsuit challenging the revocation of a physician's privileges by the university's hospital. Successfully sought dismissal of all claims.
- Counsel to a national health insurer in a bid protest and civil action contesting the award of third-party administrator and medical management portions of a state health benefit plan contract to a competitor.
- Obtained summary judgment in an FCA case involving allegations of swapping in qui tam for the country’s largest mobile medical imaging company.
Criminal and Civil Government Investigations
- Represented New Orleans hospitals in criminal investigations and congressional hearings related to their response to Hurricane Katrina, including allegations that patients were euthanized in the immediate aftermath of the storm.
- Defended a national health insurer in a state attorney general’s industry-wide investigation concerning insurers’ physician and hospital ranking systems.
- Represented a major dialysis provider in two nationwide federal investigations involving allegations of health care fraud.
- Defended the owner and operator of a third-party administrator against allegations of insurance fraud where the government’s cooperating witness pled guilty and then falsely accused our client of participating in the fraud. After we presented our facts to the federal prosecutor, he closed the investigation.
Governmental Litigation and Administrative Proceedings
- Defended a Louisiana Medicare Advantage plan against a claim by the Centers for Medicare & Medicaid Services (CMS) and the HHS-OIG that the plan’s criteria for benefit approvals was too restrictive and therefore deprived Medicare beneficiaries of the services for which CMS had contracted. Ultimately, the claim was resolved on favorable terms in the pre-litigation phase.
- Represented an Oklahoma hospital against the Oklahoma Health Care Authority in a novel Section 1983 claim alleging that the state failed to provide the hospital with the monies owed under CMS's Direct Graduate Medical Education funding regulations. We defeated the authority’s motion to dismiss and ultimately negotiated a favorable settlement for the hospital. (AHS Tulsa Regional Medical Center LLC v. Fogarty, 2007 WL 3046441 (N.D. Okla. Oct. 16, 2007))
- Brought suit against the Georgia Department of Community Health on behalf of a national hospital chain to overturn a state rule exempting ambulatory surgery centers from Georgia’s certificate of need laws.
- Currently representing a major pharmaceutical company in ongoing antitrust litigation with the Federal Trade Commission (FTC) and private parties related to a brand-generic drug patent settlement. We successfully sought dismissal of the FTC and indirect purchasers’ claims.
- Represented a national hospital chain in administrative and state court proceedings to obtain payment for unreimbursed Medicaid expenses.
- Represented hospitals and their medical staff committees in peer review hearings held pursuant to medical staff bylaws. We have also successfully resolved a number of physician-hospital disputes without litigation.
- Represented hospitals in Emergency Medical Treatment & Labor Act (EMTALA) administrative hearings before CMS Quality Improvement Organizations (QIOs). Over the course of the last year, we successfully represented one client during the QIO administrative hearing process, and the Office of Inspector General closed the matter without further action and with no monetary fine.
- We successfully defended a complaint filed by a physician after a hospital denied him reappointment to the hospital’s medical staff. The complaint alleged several causes of action against a total of seven defendants, including tortious interference, medical staff bylaw violations, defamation and false light. The trial court dismissed the complaint, and the Georgia Court of Appeals affirmed the dismissal on March 4, 2014. We also successfully defended against the physician’s request for a temporary restraining order that had sought reinstatement to the hospital’s medical staff.
False Claims Act and Related Litigation
- Obtained dismissal with prejudice of a qui tam suit filed against a hospital that alleged the hospital violated the FCA by billing Medicare for services that should have been billed to a clinical trial.
- Represented a hospital in a qui tam investigation involving allegations that the hospital admitted patients as inpatients who should have been treated as outpatients or for observation. Negotiated a favorable settlement, including the first Corporate Integrity Agreement to mandate use of the Case Management Protocol.
- Obtained a voluntary dismissal prior to answering in a qui tam lawsuit against our client, a major health plan. After we filed our motion to dismiss, the relator voluntary sought and received permission from the government and the court to dismiss our client from the suit.
- Represented a large for-profit hospital chain in the investigation and ultimate settlement of claims against its medical transcription service. The case arose out of an FCA investigation and follow-on class actions against the transcription service. We recommended that the hospital chain opt out of the class action and proceed independently, ultimately securing a settlement substantially in excess of that which the hospital could have recovered as a class member.
- Obtained a monetary award for a health system in an arbitration against a qui tam relator who removed hospital property, including documents containing patient identifying information, in violation of a severance agreement.
Health Care Payment Disputes
- Negotiated a favorable settlement for a health benefit plan in a commercial arbitration with a dialysis provider alleging breaches of national network contracts.
- Secured summary judgment for a health benefit plan in a commercial arbitration with a revenue recovery consultant and hospital for breach of network contract.
- Obtained a multimillion-dollar settlement for a national hospital chain in a payment arbitration with a Medicaid managed care organization.
Antitrust and Trade Regulation Actions
- Currently representing a national group purchasing organization in an antitrust lawsuit alleging anticompetitive exclusive dealing arrangements with large providers of medical equipment in violation of the Sherman Act and related state law claims.
- Represented a national operator of occupational health care centers in a South Carolina litigation involving physician terminations and allegations of unfair trade practices and corporate practice of medicine.
- Currently representing a national dialysis services provider in a lawsuit against a third-party administrator for unfair trade practices and tortious interference in connection with Medicaid claims processing.