Health Care Compliance, Fraud and Abuse
Wiggin and Danaโs Health Care Compliance, Fraud and Abuse Practice Group is uniquely suited to represent health care providers in matters involving health care fraud and abuse, a top law enforcement priority at the federal and state levels.
Indeed, through tighter collaboration and sophisticated data-mining tools, federal and state enforcement authorities have intensified initiatives to combat fraud, waste, and abuse in health care programs. Moreover, federal and state laws provide substantial financial incentives to current and former employees, competitors, contractors, and others to initiate civil proceedings alleging fraudulent and abusive practices through โwhistleblowerโ or qui tam actions. Health care providers have paid billions of dollars in restitution, penalties, and fines because of governmental and private enforcement efforts, and entered into corporate integrity agreements with federal and state enforcement authorities.
What makes us unique is our ability to combine a robust health care practice with a White Collar Defense, Investigations and Corporate Compliance Practice Group comprised of seasoned former federal prosecutors and Assistant United States Attorneys. For example, Co-Chair Jolie Apicella is the former Assistant United States Attorney, Chief of Healthcare Fraud for the Eastern District of New York. Another member of our team served for two decades with the United States Attorneysโ Office for the District of Connecticut as Counsel to the U.S. Attorney, Chief of the Criminal Division, and Chief of Appeals.
We bring to each matter lawyers with decades of experience conducting internal investigations and protecting clients during government investigations, backed by a team with unparalleled substantive experience in all areas of health care law, including reimbursement, the federal and statesโ False Claims Act, the Stark Law, the Anti-Kickback Statute, and other fraud and abuse laws.
Our experienced and well-respected team has handled a wide variety of complex health care compliance matters, where we craft effective strategies for self-disclosing identified compliance issues, responding to audits and investigations, and working with government attorneys and regulators to bring cases to successful conclusions. We also work closely with clients to develop and monitor compliance programs that help our clients avoid government scrutiny and whistleblower actions.
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We have represented:
- A high-profile New York surgeon in a federal whistleblower investigation that resulted in the governmentโs decision to decline intervention against our client
- A hospital in a federal investigation initiated by a former physician employee into alleged DRG upcoding. Based on our presentation to the government, it declined to prosecute and the whistleblower action was settled for nuisance value
- A pain management specialist in a state criminal investigation into controlled substance prescribing practices, resulting in a negotiated plea deal
- A multi-state behavioral health practice in a joint federal/state False Claims Act investigation, resulting in declination by the U.S. Attorneyโs Office and the state Attorney Generalโs Office
- A multi-site physical therapy practice in criminal and civil investigations into billing practices, resulting in the governmentโs decision not to pursue criminal charges, and a favorable civil settlement
- A hospital physician executive in California, successfully defending against a U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) imposed exclusion
- A pharmacist in regard to a state investigation into allegedly illegal practices โ the investigation was concluded with no adverse findings
- A hospice in a state and federal investigation into drug control practices โ the investigation concluded with no disciplinary actions or penalties
- Multiple self-disclosures on behalf of different types of providers to the Connecticut Department of Social Services and pursuant to the United States Department of Health and Human Services (HHS) Office of Inspector General (OIG) self-disclosure protocol
- Numerous hospitals in Stark Law Self-Disclosures, including successful settlements for hospital clients
- Various hospitals, home health care agencies, mental health and substance abuse providers, dentists, physicians, clinical laboratories, dialysis centers, pharmacies and service providers for the developmentally disabled in Medicaid audits where we consistently achieve successful results. In many cases, we have settled audits during the appeal stage for significantly less than the audit disallowance, and in one proceeding that went before a hearing officer, we obtained a ruling that struck down the stateโs $1 million audit finding