Health Care Litigation

The health care industry is again in a period of consolidation and increased M&A activity.  Managed care contracting and complex payment arrangements are also on the rise.  Government scrutiny of health care spending and qui tam lawsuits show no signs of slowing down.  Each of these forces has the potential to draw health care institutions and companies into complex disputes with significant financial and strategic business implications. 

Key Contacts

Maren R. Norton Partner Seattle, WA
Jeremy D. Sacks Partner Portland, OR
Kelly Knivila Partner Portland, OR
Amy Edwards Partner Portland, OR
See all contacts
Overview

Our health care litigation team has substantial experience advising and defending payers and providers across the spectrum of litigation issues that affect health care businesses. This includes reimbursement disputes, civil and criminal fraud investigations, contract claims, governmental contracting challenges, non-compete disputes, antitrust issues and subpoena responses. We handle all aspects of these claims, from government investigations and pre-litigation disputes through trial and appeal.  We help clients navigate government administrative proceedings and resolve disputes through arbitration, mediation and settlement.

Our clients are managed care organizations, hospitals and health systems, specialty clinics, health care networks, federally qualified health centers, diagnostic facilities, ambulatory surgery centers, academic medical centers and physician groups.

Our Services

  • Fraud & Abuse Advice and Defense
  • Government and Commercial Reimbursement Disputes
  • Enforcement Actions
  • Government Administrative Proceedings
  • Payer-Provider and Other Health Care Disputes
  • Class Action Defense
  • Employment Litigation and Arbitration
  • Tax Controversy

Fraud & Abuse Advice and Defense

Our core health care litigation team includes former trial attorneys for the U.S. Attorney’s offices in southern California, Washington and the District of Columbia; a former trial counsel for the U.S. Department of Justice; and a former Oregon Department of Justice Senior Assistant Attorney General.  When combined with our broader government investigations team, we have considerable background on both the prosecution and defense sides of government investigations.  We bring this experience to bear when helping health care businesses prepare for and defend against civil and criminal investigations and prosecutions. We have broad experience defending investigations and claims related to the Stark Law, Anti-Kickback Statute, False Claims Act and similar state laws that carry the risks of civil and criminal penalties and serious business disruption.

Payer-Provider and Other Health Care Disputes

When representing providers in payment disputes, the complex framework of health care payment systems creates dual challenges: the need to advocate for providers pursuing reimbursement for their services and to defend them against claims of inappropriate billing or over-charging. We offer a sophisticated team familiar with Medicaid and Medicare rules, government investigations, managed care contracting and payment, and class action defense to help providers navigate this balance and present a strong defense.  We also represent managed care plans in negotiating and defending payment disputes with providers.  Our experience representing both payers and providers gives us a unique perspective that allows us to both resolve cases quickly and present a strong defense.  Additionally, we represent health care industry participants in traditional commercial disputes involving fiduciary duties, breach of contract claims and business torts.

Labor Relations, Employment Litigation and Arbitration

We have extensive experience representing hospitals, clinics, long-term care providers, physician groups and health care companies in employment litigation and traditional labor relations—both those common to any employer and those unique to the health care industry.  We understand how the mission and work functions of a health care facility have an impact on wage and hour issues, discrimination claims, relationships with independent contractors, executive agreements and non-compete protections.  In particular, we understand how common employment disputes have the potential to develop into a whistleblower claim and how best to manage this risk.  We appreciate  the need to maintain the highest quality patient care with minimal disruption or inefficiency that can arise during employment disputes.

Tax Controversy

Our first goal is to help health care entities avoid tax controversies, but when a dispute arises our tax litigators are standing by with the negotiation and litigation skills needed to resolve the matter as favorably as possible.  We have extensive experience advising both taxable and tax-exempt health care organizations on complex audits, administrative appeals and proceedings in federal and state courts.  Representative issues include all variety of federal and state income tax disputes, classification of health care workers as employees for federal tax purposes, state property tax exemption for nonprofit providers, and application of real estate transfer taxes to nonprofits.

Matters

Health Care Litigation

  • Represented a group of Medicaid nonprofit health care providers in litigation to stop the state’s plan for an across-the-board Medicaid rate reduction. Representation resulted in withdrawal of the rate cut and a settlement agreement providing for additional future favorable rate increases.
  • Represented a Medicaid managed care organization in an American Health Lawyers Association arbitration proceeding involving claims of breach of contract, intentional interference with business relationships and fraud. The contract provision at issue involved application of the federal Physician Incentive Plan regulation. Representation included extensive discovery, expert work and a five-day arbitration hearing.
  • Represented a Medicaid managed care plan in litigation to challenge the state’s decision to retroactively reduce rates. Representation concluded with a favorable settlement agreement.
  • Represented a nephrology clinic in a case brought by a former employee (a nephrologist) alleging that the clinic systematically overbilled Medicare for treatment of hospitalized dialysis patients. The case was successfully resolved after mediation.
  • Represented a managed care organization in obtaining reimbursement from a dialysis facility for overpayments related to end-stage renal dialysis services subject to Medicare regulations. We successfully negotiated settlement of the claims before litigation was filed.
  • Defended a managed care organization against a cease and desist order with significant negative financial impact. We resolved the matter prior to initiation of the hearing.
  • Represented a dialysis facility in obtaining reimbursement for end state renal disease services from a managed care organization after several high-value claims were erroneously denied as untimely. We negotiated a settlement that included recovery of all claim amounts withheld before litigation was filed.
  • Defended a managed care organization that was a major shareholder in a Medicare Advantage health care service contractor in litigation relating to distributions from the organization to its shareholders.
  • Defended a neurosurgical practice against compensation claims by a departing physician.
  • Represented a nonprofit provider of physical and mental health services and substance abuse treatment in responding to subpoena requests for information protected by HIPAA and other health care regulations.
  • Obtained a favorable settlement for a medical center in a suit brought in the U.S. District Court for the District of Oregon by a disgruntled physician alleging misappropriation and emotional distress. The plaintiff’s claims grew out of a U.S. government investigation involving an allegation of False Claims Act violations. We obtained dismissal of state RICO claims on a motion to dismiss, and dismissal of identity theft and trade secret claims on partial summary judgment.

Health Care Labor & Employment Litigation

  • Represented a large health care system in a series of related lawsuits, labor arbitrations and injunctive proceedings to defend the employer’s program of mandatory vaccination against influenza, resulting in repeated rejections of motions for injunctive relief and successes in arbitration.
  • Represented a large health care system in defense of a class action claim for unpaid rest and meal breaks, resolving the case before certification of the class.
  • Represented a hospital client in federal court, turning back a union effort to force the hospital to arbitrate in one proceeding grievances arising under multiple collective bargaining agreements.
  • Represented a hospital in a claim of race discrimination, resulting in dismissal on summary judgment.
  • Represented a hospital in response to a union election petition under the new “quickie” election rules resulting in obtaining substantial time for the employer to tell its side of the story.
  • Represented a hospital in a claim over the proper rate of pay for missed rest breaks, successfully turning back claims for massive overtime back pay.
Team
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