Practice Areas & Industries: Fredrikson & Byron, P.A.

Practice/Industry Group Overview

We are a cross-disciplinary team that represents hospitals, device manufacturers, clinics, physicians, and other health care providers in civil and criminal investigations and litigation, Medicare and Medicaid overpayment claims and appeals, and the development of compliance plans. We assist clients in working with health care regulators and in responding to a wide range of investigations involving the FBI, DOJ, the HHS Office of the Inspector General, State Attorneys General, the Food and Drug Administration, and other governmental agencies. For example, we have successfully represented numerous clients in criminal fraud trials, qui tam litigation, Medicare "upcoding" and documentation cases, hearings before professional boards, and in national health care fraud initiatives. We help our clients understand how federal regulations will affect their personal and business interests and how to protect those interests.

Services Available

"We help our clients understand how federal regulations will affect their personal and business interests and how to protect those interests."

Areas of Expertise Include

• Medicare and Medicaid Investigations
• Attorney General Investigations
• Civil Investigations and Litigation
• Criminal Investigations and Litigation
• FDA Matters
• Anti-Kickback and Stark
• Investigations by the HHS Office of the Inspector General ("OIG"), FBI and DOJ
• Overpayment Claims
• Overpayment Appeals
• PATH Investigations
• Professional Board Hearings
• Clinical Trials
• Upcoding Cases
• Research Grants

Compliance

We represent clients in the health care industry in actual and prospective governmental investigations. We also develop and implement compliance plans and other risk management tools, so that clients are less likely to face government inquiry in the first place. We educate our clients on the issues by helping them handle much of the compliance work independently, ensuring they will be more likely to recognize potential warning signs and reduce legal expenses. We will work with the client in the capacity that works best for their organization in the short and long term.

Overpayments

The Medicare and Medicaid programs, as well as many private insurance companies, often seek to recoup money from health care professionals. We have found that the payor often bases its case on an invalid rule or misinterprets a rule. As a result, it may be possible to successfully challenge an overpayment.

Representative Cases

• A nursing home chain was prosecuted for fraud in submitting cost reports that allegedly contained personal, non-reimbursable items. After we submitted legal argument and documentation, the criminal charges were dismissed.
• The manufacturer of a medical device was raided by agents of the FBI who had received a tip from a disgruntled employee that records had been falsified and test results misreported. After careful investigation, we persuaded the government that charges should not be brought.
• A well-respected surgeon was prosecuted for allegedly illegally charging third-party payors for an investigational new drug. As a result of our thorough investigation and persuasive presentation of the evidence at trial, the court threw out the charges.
• The CEO of a device manufacturer was prosecuted for conspiracy and health care fraud. After seven weeks of trial, all felony charges were dropped.
• A major academic health center was sued for illegally seeking Medicare reimbursement for investigational devices. The case was dismissed, without any payment.
• A medical clinic was investigated by the FBI and DOJ for allegedly upcoding charges. The investigation was dropped and the related qui tam suit dismissed based upon our presentation.
• Medicare sought repayment of nearly $70,000 from an audiologist claiming service was not medically necessary. After appeal, the alleged overpayment was reduced to approximately $10,000.
• Medicare asserted an overpayment of $300,000 from a clinical lab. After hearing, the overpayment was reduced by more than half.