Healthcare Dispute Resolution

Overview

For health services companies, our team has developed a playbook of best practices, defenses, and strategies in connection with complex commercial and regulatory disputes, investigations, and restructurings. We assemble our experience in an array of high-stakes, crisis, and bet-the-company matters to represent you in contentious situations, including cases involving contracts, torts, bankruptcy, antitrust, False Claims Act, and CARES Act, among others.

We provide proven counsel on matters involving reimbursements owed from Medicaid, Medicare, and third-party payors, work that involves litigation and Administrative Procedures Act (APA) challenges. We deliver successful results through administrative agency lawsuits against CMS and HHS.

Rely on our team to achieve a successful resolution of your critical issues—enforcement, audits, or disputes.

Representative Experience

• Large hospital in complex civil litigation and a government investigation related to a Hepatitis-C outbreak, with a complex privacy law and privilege overlay. We served as coordinating counsel in the criminal, regulatory, and civil actions arising from the infection of patients with Hepatitis-C, allegedly by a former employee. We secured dismissal of two putative class actions against the hospital and we represented it through the federal criminal investigation, the DEA’s drug diversion investigation, and the HHS regulatory process. We worked closely with the in-house and external communication professionals to provide timely information and restore the hospital’s brand.
• Counsel to hospitals in litigation against CMS regarding the calculation of disproportionate share payments under the Medicaid statute; secured injunction against CMS regarding enforcement of illegally enacted policies, which was upheld by the United States Court of Appeals for the First Circuit. We then won a fee award pursuant to the Equal Access to Justice Act.
• State hospital association in connection with petition filed with CMS under the APA challenging numerous issues surrounding a state’s administration of its Medicaid program in a manner that systematically shifted funds raised by the state’s Hospitals Tax, and matched by the federal government, to other state priorities, abandoning its obligations under Medicaid.
• Health system clients to settle a dispute with a state over reimbursement for the hospitals’ care and treatment of high numbers of indigent patients. We also represented a health system against a state to secure parity reimbursement payments for Medicaid services as those paid to an in-state teaching hospital.
• Health system clients in federal court evidentiary hearing and secured preliminary injunction enjoining $70 million unlawful changes to state Medicaid reimbursements
• Hospital in submitting a demand for bridge loan to CMS. The client was eligible to receive funds pursuant to the Medicare Accelerated and Advance Payment Program under the CARES Act, but agency guidance issued by CMS disqualified it. We sent a detailed pre-suit demand letter to HHS and CMS challenging the agencies’ unlawful positions and guidance and convinced CMS to provide the client with millions of dollars in funding, which was critical to the hospital’s ongoing operations and ensuring it is able to continue to deliver exceptional patient care.
• Compliance advice to hundreds of companies related to the Paycheck Protection Program (PPP) loan program and represent borrowers in potential litigation and pre-suit negotiations with the Small Business Administration (SBA). We also represent multiple clients in administrative appeals regarding SBA PPP loans. For a home care services client, we recently secured the reversal of an SBA decision denying forgiveness of a $10 million PPP loan.
• Providers in connection with compliance advice and disputes with HHS related to the Provider Relief Fund (PRF)
• Hospice care company in SEC False Claims Act investigation regarding Medicare and Medicaid reimbursements
• Hospital in a claim for declaratory and injunctive relief in federal court, and in an attendant proceeding in state court to enforce administrative due process rights, arising from recoupment of Medicaid funds based on an alleged overpayment assessed following a statutorily mandated Medicaid audit
• Bankruptcy litigation: Represented a nonprofit New Hampshire hospital in restructuring—the deal negotiated allowed the hospital to continue its charitable mission of providing healthcare to its community; advised on restructure of group of nursing homes in Chapter 11 proceedings in Massachusetts; and represented St. Francis Hospital in a Chapter 11 restructuring in New York.