Government Inquiries

• Defending a national managed-care organization in a qui tam False Claims Act investigation into compliance with Medicare Advantage regulations, including allegations related to inflated premiums resulting from inaccurate risk-adjustment submissions
• Defending an international biotechnology manufacturer in a qui tam False Claims Act investigation into kickback and off-label allegations (the US Department of Justice declined to intervene and the qui tam plaintiff dismissed the case with prejudice)
• Representing an academic medical center in connection with state and federal investigations into off-label marketing allegations related to pharmaceutical sponsorship of medical research activities
• Defending a national managed-care organization in connection with state attorney general and congressional investigations into cancellations of individual health care insurance policies
• Defending a nationally recognized physician clinic in a False Claims Act investigation involving alleged kickbacks and self-referrals in violation of the Stark laws

Internal Investigations

• Conducting an internal investigation into whistleblower allegations related to a national managed-care organization’s compliance with Medicare Advantage regulations and the federal anti-kickback statute, which has led to disclosures to the US Department of Justice, the Centers for Medicare and Medicaid Services, the Office of the Inspector General of the US Department of Health and Human Services, and state regulatory and enforcement authorities
• Conducting an internal review of a national managed-care organization’s compliance with Medicare Advantage risk-adjustment reimbursement rules
• Conducting an internal investigation into whistleblower allegations related to a national pharmacy benefit manager’s compliance with Medicare Part D regulations
• Conducting an internal investigation into whistleblower allegations related to a state Medicaid plan’s compensation arrangements with its providers
• Conducting an internal investigation into whistleblower allegations concerning the quality-control practices of a biotechnology manufacturer
• Conducting an internal investigation into kickback and Stark self-referral allegations related to a hospital-physician joint venture

Strategic Counseling

• Advising a pharmaceutical manufacturer in connection with its compliance program, sales and marketing practices, and issues related to the Medicaid Rebate Program
• Counseling a pharmacy benefits manager concerning compliance with federal and state regulatory requirements and the enforcement landscape for the pharmacy benefits sector

Transactional Diligence and Structuring

• Representing a private equity fund in an $84 million leveraged buyout of a dental practice management company
• Representing a private equity fund in the $137 million sale of a medical-equipment manufacturer
• Representing a private equity fund in its $455 million sale of a national dental practice management company
• Representing a long-term acute hospital chain in a $180 million asset sale to a competitor
• Advising a hospital system in connection with a $315 million bond refinancing
• Advising a nursing-home chain in connection with a refinanced credit facility

Trial Experience

• Defending Alvarado Hospital Medical Center in US v. Weinbaum, et al. Alvarado and its codefendants were accused of violating the federal anti-kickback statute by paying bribes, disguised as physician-relocation payments, to local doctors in exchange for patient referrals. After a seven-month trial in US District Court and four months of deliberations, the jury deadlocked and the court declared a mistrial. The government thereafter dismissed all criminal charges against Alvarado and its codefendants pursuant to a civil settlement.