Jonah D. Retzinger

My focus

I represent healthcare entities in FCA matters, government investigations, and other civil litigation involving issues related to regulatory noncompliance and reimbursement. My clients span the health sector and include national physician practice management organizations and affiliated medical groups, academic medical centers, hospitals and integrated health systems, and Medicare Advantage Organizations (MAOs).

Acting as a trusted advisor, I help healthcare entities navigate an increasingly complex regulatory landscape. I implement creative litigation management plans and work with tailored teams of attorneys and subject-matter experts to advance my clients’ positions. I also conduct in-depth exposure analyses and compliance reviews and frequently engage state and federal government agencies in connection with enforcement actions and the imposition of civil monetary penalties and other integrity obligations.

In addition to my FCA practice, I have significant experience representing healthcare entities in disputes involving the reasonableness of charges for healthcare services. I also regularly advise clients on the applicability and implementation of various healthcare laws, including the federal No Surprises Act (NSA) and associated regulations and guidance.

Representative experience

The below representative experience includes representations from a prior firm.

• 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

Clerkship

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

Looking ahead

Health sector participants are subject to ever-expanding regulations governing the revenue cycle for healthcare services, and recent government funding sources (e.g., the CARES Act Provider Relief Fund) have created new avenues for relators to pursue opportunistic claims. In the coming years, I expect an increase in qui tam cases, as well as a real commitment from federal agencies to NSA enforcement.

Insights

• “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