Representative Experience
  • HIPAA and State Breach Reporting
    • Outside compliance and risk counsel to several large publicly traded healthcare companies on privacy, security, breach and HIPAA matters.

      Briefing on successful motion for summary judgement on behalf of healthcare provider that no private right of action exists under HIPAA.

      Review HIPAA incidents and complaints to determine whether privacy or security breaches occurred under federal and state law, assessed mitigation strategies, and counseled on breach reporting obligations.

      Represent U.S. company in managing 50 state analysis and reporting of HIPAA privacy and security and data breach reporting.

      Conduct compliance reviews of HIPAA standards and implementation specifications and client uses and disclosures of patient information, identity risk management tools, and develop corrective action plans for noncompliance.

      Represented numerous covered entities under HIPAA to successfully resolve dozens of alleged HIPAA violations with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR).

  • Medicare Billing and FCA Investigations
    • Represented providers and management company in satisfactorily resolving allegations in civil False Claims Act liability and claimed damages of $180 million related to Medicare upcoding, supervision and “incident to” billing noncompliance.

      Successfully represent providers in pre-indictment illegal remuneration (anti-kickback) criminal investigations by the OIG.

      Conduct internal investigations in responding to allegations from employee whistleblowers relating to billing fraud.

      Represent physician and related companies owned by physician in obtaining decision by the U.S. Department of Justice not to indict on allegations of lack of medical necessity as a false claim.

      Co-counsel with criminal defense attorney on post-trial hearing to successfully overturn convictions for upcoding based on perjury by Illinois Medicaid auditor.

      Represent physician-principal investigator at a major academic medical center in investigation and qui tam allegations of improper off-label promotions as a false claim.

      Represented dozens of providers in responding to routine audits, appeals, fair hearings, and administrative law judge hearings on Medicare and Medicaid audits and overpayment demands, payment suspensions, and loss of provider numbers.