Healthcare

Healthcare providers and institutions play an increasingly important role in our economy and our lives, and they are subject to a dizzying maze of regulations, restrictions and reporting obligations. Ward Greenberg lawyers are familiar not just with the law, but with the industry, and they provide value and skill to academic medical centers, medical, dental and nursing schools, hospitals, nursing homes, senior living facilities, medical groups and individual healthcare professionals. We maintain an active healthcare practice providing assistance in the defense of governmental and third-party payor investigations, corporate compliance counseling and litigation, corporate integrity reviews, Medicare and Medicaid reimbursement disputes and audits, representation of physicians and other professionals in licensure investigations and hearings, fraud and abuse counseling, the defense of qui tam cases, internal and governmental investigations, medical staff credentialing disputes, internal disciplinary matters, the defense of serious professional liability and medical malpractice claims, institutional representation in vendor disputes, specified transactional and corporate governance issues, and a number of other regulatory and administrative matters.

We represent many of the largest healthcare providers in New York, as well as numerous regional and local providers. As a result, we have in-depth familiarity with the business, regulatory and administrative environment in which our healthcare clients operate.

Representative engagements include:

• Representing nine hospitals in joint laboratory billing investigation conducted by the Office of the Inspector General and by the United States Attorney’s Office.
• Representing group of academic medical centers with respect to the retention of a favorable Medicaid reimbursement methodology.
• Prosecuting, on behalf of a group of approximately 60 hospitals in New York, claims that resulted in issuance of injunction against threatened recoupment of more than $80 million in previously paid Medicaid reimbursement.
• Assisting large teaching hospital in termination of hospital-based physician group, and securing dismissal of contract, staff credentialing and restrictive covenant claims.
• Securing dismissal of a multi-plaintiff qui tam case brought against major teaching hospital.
• Representing numerous hospitals, nursing homes and individual healthcare professionals in investigations by the New York Attorney General’s Medicaid Fraud Control Unit.
• Representing large group of New York hospitals (180 in total) challenging assessment of substantial reimbursement penalty based upon erroneously calculated changes in case mix.
• Defending medical colleges alleged to have violated NIH grant administration and grant reporting procedures.
• Prosecuting hospital provider claims resulting in $4 million of additional Medicaid reimbursement relief.
• Representing medical school in the investigation of alleged scientific misconduct by several faculty members.
• Conducting investigation of allegedly improper clinical actions by departmental chairperson at academic medical center.
• Representing numerous nursing homes seeking rebasing of Medicaid reimbursement rates.
• Securing change in geographic placement of nursing home for purposes of calculation of its wage equalization factor, in case of first impression in New York.
• Representing large, for-profit long-term care provider in connection with challenges to numerous regulatory actions, as well as pertinent regulatory and legislative activity.
• Representation of more than 170 hospitals, and the Healthcare Association of New York State, in efforts to recover for uncompensated and under-compensated care provided to victims of tobacco-related illnesses.
• Representing numerous healthcare institutions in connection with self-disclosures of Medicare and Medicaid overpayments to the United States Attorney, the HHS Office of the Inspector General (“OIG”), and the Office of the Medicaid Inspector General (“OMIG”).
• Assisting in or coordinating institutional responses to audits by the New York State Department of Health, OMIG and the HHS OIG.
• Representing individual physicians and allied healthcare professionals in connection with investigations conducted by Office of Professional Medical Conduct and Office of Professional Discipline.
• Assisting institutional healthcare clients in connection with internal investigations into allegations of sexual harassment, gender discrimination, resident and staff abuse, unsafe clinical conduct, Medicaid billing abuse, Medicare billing abuse, research fraud, scientific misconduct, the provision of allegedly unnecessary clinical care and various other matters.
• Providing corporate compliance advice and services to numerous hospitals, nursing homes and physician groups.