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Health Care Government and Internal Investigations

Defense of Government Investigations
We represent many health care organizations, including hospitals, nursing homes, home health companies, medical device companies and pharmaceutical companies, in defending government investigations by the Department of Justice, U.S. Attorneys, OIG, Medicaid Fraud Divisions and other state and federal regulatory agencies.  The extensive experience of our former federal prosecutors, along with our in-depth understanding of all segments of the health care industry and regulatory issues arising in that industry, allows us to develop a strategy for achieving prompt and favorable resolutions of government investigations and prosecutions, or, if necessary, for vigorous defense of our clients’ rights.

Conducting Internal Investigations
We have substantial experience in conducting internal investigations for our health care industry clients.  Internal investigations directed by legal counsel have various advantages for our clients — most importantly, the ability of a facility to find out the breadth of and potential exposure with respect to a particular area of potential noncompliance, with the results being protected by the attorney-client privilege, depending on the circumstances.

Our attorneys’ experience, gained as government prosecutors and private defense counsel, allows us to strategically structure internal investigations, to swiftly gather information and synthesize complex documents, and most importantly, to provide our clients with sound and practical guidance regarding resolutions to sensitive issues.

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Representative Matters

  • Defense of Government Investigations
  • Representation of a major hospital in a Department of Justice criminal investigation regarding Medicare billing practices and leasing arrangements with physicians.
  • Representation of a major hospital in a Department of Justice investigation regarding Medicare billings for cardiac devices.
  • Representation of several hospitals in Department of Justice investigations of Medicare and Medicaid billing fraud and related improprieties.
  • Conducted an internal investigation of a pattern of overpayments, and advised a major hospital regarding refunding payments to the Fiscal Intermediary and notifying the OIG.  The OIG accepted our explanation and did not pursue the matter any further – i.e., no penalties, etc.
  • Defense and settlement of a hospital system in an OIG investigation relating to same day surgical and medical services.  Our efforts were highly successful.  After suggesting various modifications to the system’s compliance program, which were implemented, we sent a comprehensive submission which convinced the OIG that the hospital had an “effective” compliance program, thereby obviating the need for a draconian corporate integrity agreement.  Also, we filed a submission requesting that monetary penalties not be included in the settlement amount, and the OIG agreed to allow the system to pay an amount which was substantially less than twice the overpayment amount, when many other hospitals in New Jersey and around the country were required to pay twice the overpayment amount (or greater) under their settlement agreements.
  • Representation of a major New York hospital in an investigation of vendor bid rigging by the Department of Justice.
  • Representation of officers and employees of a major New York hospital in connection with a Medicare and Medicaid investigation of alleged fraudulent billing for pharmaceuticals provided to the hospital’s patients.
  • Representation of a major hospital system in an Attorney General investigation of suspected homicides perpetrated at the facility.  This matter was closed with little adverse publicity and no findings of misconduct by the hospital as compared to health care facilities in other states that were the subject of related investigations.
  • Representation of a major hospital system in an investigation by the Attorney General of whether it improperly diverted resources and equipment from certain facilities.  The investigation was resolved with no finding of wrongdoing by the hospital system.
  • Defense of a major hospital in an investigation by the Office of Civil Rights (of the United States Department of Health and Human Services) regarding allegations of discriminatory treatment of Hispanic patients.
  • Defense of a hospital and nursing home in connection with a quality of care investigation by the United States Department of Justice under the federal civil rights laws.  Our efforts were successful and led to a favorable settlement.
  • Successfully represented a home health company in an audit by the Medicaid Fraud Division regarding the provision of ventilators.  The Division ultimately revised its audit report from demanding the return of several hundred thousand dollars to no demand for the return of any monies.
  • Defense of a home health agency that was the target of a federal grand jury investigation into health care fraud, involving the alleged filing of false cost reports to Medicare, and various violations of Medicare billing rules.  Our efforts were successful and resulted in no indictment being returned by the grand jury.
  • Defense of a commercial pharmacy in a Department of Justice investigation of allegations that the pharmacy improperly sold prescription samples to the public.
  • Representation of several retail pharmacies in a Medicaid fraud investigation involving allegedly fraudulent billing for AIDs medications.
  • Conducting Internal Investigations
  • An internal investigation on behalf of a major health system of allegations by the federal government that the system’s facilities improperly billed Medicare for same day surgical and medical procedures.
  • An internal investigation on behalf of a health care system, prompted by the results of a voluntary internal audit, relating to federal health care program billings for cardioversion and related procedures.
  • Internal investigations for several hospitals relating to Stark and Anti-Kickback compliance of their professional services, medical director and leasing arrangements with physicians.
  • An internal investigation of a New York home health company regarding the educational qualifications of home health aides, which led to the implementation of new policies and procedures for the screening and training of aides.
  • An internal investigation of alleged deficient psychiatric services at a major hospital.  The investigation led to a reform of practices at the hospital.
  • An internal investigation on behalf of a major hospital of alleged improper administration of psychotropic drugs.
  • An internal investigation on behalf of a large hospital into allegations by a former officer (turned whistleblower) that the hospital: (i) engaged in the payment of “kickbacks” to physicians in exchange for referrals; (ii) provided inaccurate records to the federal government; and (iii) submitted false, fraudulent and otherwise improper bills to Medicare and other governmental programs.
  • An internal investigation on behalf of a major hospital system of alleged improper cost report accounting of housekeeping and food service functions.  The matter was resolved without any government investigation or civil litigation after internal investigation established no wrongdoing by the hospital.
  • An internal investigation on behalf of a major hospital system of malfunctioning ICU monitors.  A substantial recovery was obtained from the manufacturer of the equipment as a result of the investigation.
  • An internal investigation on behalf of a major hospital system of alleged improper cardiac stress tests in response to a whistleblower’s allegations.  The investigation revealed that the allegations were baseless and no action was brought against the hospital in question.
  • An internal investigation on behalf of a major hospital system of alleged misconduct by management and the Board of Trustees.
  • An internal investigation at a long term care facility of alleged upcoding by a provider of psychological services.  The investigation led to the reform of practices at the facility.
  • An internal investigation at a long term care facility of alleged phantom dental services provided by an outside provider.  The investigation led to the selection of a new provider and cooperation with the Department of Justice against the dentist in question.
  • An internal investigation of alleged alterations of medical records at a long term care facility.  The investigation led to a reform of practices and changes in supervisory staff at the facility.
  • An internal investigation on behalf of a major home health company of suspected unqualified home health aides.  The matter resulted in a self-disclosure to the Medicaid Fraud Division.
  • An internal investigation on behalf of a major home health company of alleged patient abandonment.
  • An internal investigation on behalf of a major home health company of alleged harassment of home health aides.
  • An internal investigation on behalf of a medical device maker of alleged improper exports of medical devices to Iran.

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