Jonah D. Retzinger

/My focus

My clients span the health sector and include national physician practice management organizations, hospitals and integrated health systems, academic medical centers, large physician associations, medical foundations, revenue cycle management companies, and health technology companies.

No Surprises Act

I advise and represent healthcare providers and other healthcare entities in complex matters involving the No Surprises Act (NSA), the landmark federal legislation that created the federal independent dispute resolution (IDR) process to resolve certain out-of-network payment disputes between healthcare providers and healthcare insurers. I counsel clients nationally on NSA compliance and have appeared and argued on behalf of healthcare providers and their partners in courts throughout the country. I served as lead counsel for the lead defendants in one of the first major lawsuits brought by a commercial healthcare insurer attempting to impose RICO liability based on the initiation of IDR proceedings, in which we successfully obtained a complete dismissal of all claims.

False Claims Act

In addition to my NSA practice, I represent healthcare entities in federal False Claims Act (FCA) litigation and investigations relating to alleged noncompliance with healthcare laws and regulations, including the federal Anti-Kickback Statute (AKS), the Physician Self-Referral Statute (the Stark Law), and the Civil Monetary Penalties Law (CMPL). I began my career clerking in law school at the US Department of Health & Human Services Office of the Inspector General (OIG) and refined my FCA practice under the tutelage of former prosecutors, assistant US attorneys, and US Department of Justice (DOJ) trial attorneys. I often appear before DOJ, OIG, and other federal and state agencies in enforcement actions.

I frequently publish articles and speak on novel issues involving the NSA, the FCA, and the healthcare regulatory enforcement landscape. I serve on the Nixon Peabody Firm Innovation Strategy Committee and advise on best practices for using artificial intelligence and project management applications in investigations, litigation, and legal practice generally.

/Representative experience

The following representative experience includes representations from a prior firm.

• Secured a complete dismissal on behalf of a healthcare revenue cycle technology vendor and its founders in a RICO lawsuit brought by a large commercial healthcare insurer based on the initiation of IDR proceedings under the No Surprises Act.
• Secured a complete dismissal on behalf of a large health system in an action brought by a physician group alleging that the defendants interfered with the group’s business relationships and engaged in unfair business practices under California’s Unfair Competition law.
• Secured a complete dismissal with prejudice at summary judgment for a national operator of wound care centers in an FCA qui tam action in which a former employee alleged noncompliance with regulations regarding the provision of hyperbaric oxygen therapy.
• Secured complete dismissals with prejudice for a national physician practice management organization and affiliated medical groups in multiple purported nationwide class actions alleging liability based on unreasonable charges for physician professional services.
• Conducted an internal investigation for a world-renowned academic medical center in response to allegations of grant fraud brought by the former chair of a major academic department.
• Negotiated a favorable resolution without the imposition of integrity obligations for an MAO in an FCA qui tam action in which a subcontractor’s chief compliance officer alleged the MAO failed to comply with federal regulations regarding oversight of first-tier vendors.
• Secured a favorable resolution for an integrated healthcare system at arbitration against a national health insurer that impermissibly steered beneficiaries to freestanding imaging centers in breach of the integrated healthcare system’s facility agreement.
• Negotiated a favorable resolution for a national dialysis services provider in a contractual dispute with a regional Medi-Cal managed care health plan over reimbursement for dialysis services for dual-eligible beneficiaries.

Clerkships

• Office of Counsel to the Inspector General (OCIG), Department of Health and Human Services (HHS)

/Looking ahead

The NSA’s IDR process has been a revelation. As healthcare pricing adapts to rapidly changing market power dynamics and transparency initiatives, I expect healthcare insurers to increasingly target healthcare providers that refuse to accept unfair payment rates.

Given the increasing use of artificial intelligence in healthcare claims analysis and the DOJ’s prioritization of the FCA as its primary civil enforcement tool, I expect the volume of FCA filings, by both the DOJ and relators, to continue to grow.

/Insights

• “Federal Scrutiny of State Medicaid Integrity Effort and Enforcement Implications,” American Health Law Association, May 28, 2026
• Guest Panelist, National Association of Medicaid Fraud Control Units, 2026 Team Leader & Lead Analyst Symposium, April 21, 2026
• Panelist, The New Front Line of Healthcare Enforcement: State Level Enforcement and Health Privacy, Health Law Roundtable, January 24, 2026
• “The National Institutes of Health: Navigating and Managing Grant Risk in Uncertain Times,” California Society for Healthcare Attorneys, California Health Law News (Fall 2025)
• “Navigating False Claims Act Developments and Risk in the Medicare Advantage Program in 2025 and Beyond,” American Health Law Association, May 27, 2025
• “Navigating Tariffs and False Claims Act Risk in the Healthcare Supply Chain,” California Society for Healthcare Attorneys, California Health Law News (Spring 2025)
• “Medicare Advantage Fraud and Abuse Enforcement Update: Key Developments and Compliance Strategies,” 2025 Health Law Roundtable, February 7, 2025
• “Leveraging Your Legal and Compliance Departments to Encourage Cooperation and Mitigate Risk,” California Society for Healthcare Attorneys Fall Seminar, November 15, 2024
• “False Claims Act Update: What Healthcare Entities and Practitioners Need to Know,” LACBA Healthcare Law Section, April 3, 2024
• “The No Surprises Act: What is Happening?” Healthcare Financial Management Association (HFMA) Council of Revenue Cycle Executives Meeting, February 8, 2024
• “The Latest on Healthcare Price Transparency,” Healthcare Financial Management Association (HFMA) Webinar, November 8, 2023
• “White-Collar Trends in 2023: A Year in Review,” ABA White- Collar Crime Committee, October 17, 2023
• "The Future of Hospital Transparency," American Bar Association (ABA) Health Law Section, August 28, 2023
• “Executive Panel: The Next Wave of Mergers and Acquisitions,” Healthcare Financial Management Association (HFMA) Annual Conference, June 26, 2023
• “The Power and Pitfalls of Price Transparency Data,” American Bar Association (ABA) Health Law Section 24th Annual Emerging Issues in Healthcare Law Conference, March 9, 2023
• “No Surprises Act: Implementation and Recent Developments,“ American Association of Healthcare Administrative Management (AAHAM) Educational Event and Legislative Update, November 10, 2022
• “No Surprises Act: Provider Directory and Continuity of Care Requirements,“ Healthcare Financial Management Association (HFMA) Facilitated Learning Program, November 7, 2022
• “The Federal IDR Process: Phases, Developments, and Status,“ Healthcare Financial Management Association (HFMA) Facilitated Learning Program, October 31, 2022
• “Federal Price Transparency: Monitoring and Enforcement,“ Healthcare Financial Management Association (HFMA) Facilitated Learning Program, October 24, 2022
• “The No Surprises Act & California: Federal and State Balance Billing Prohibitions, IDR Processes, and Enforcement,” American Association of Healthcare Administrative Management (AAHAM) and the Healthcare Financial Management Association (HFMA) Webinar, February 24, 2022