Disputes involving healthcare providers are on the rise given a complex and quickly evolving regulatory and business environment. Tapping into our five decades of experience serving healthcare providers, our healthcare litigation team serves clients facing high-stakes government and business disputes.
Our attorneys appreciate the unique nature of disputes involving healthcare clients and believe strong, effective advocacy and prompt resolution to be essential to their operational success. Our clients value our understanding of the intersection of healthcare operations, regulation and litigation and benefit from our ability to tap into our healthcare compliance attorneys to analyze the applicable statutes, rules and regulations. In the end, clients hire Waller for our deep healthcare experience and proven track record of winning results.
Our team works collaboratively with clients to plan and implement dispute resolution strategies in a variety of areas, including:
False Claims Act Defense
When confronted with allegations of fraud, whether from a whistleblower or government agency, clients lean on Waller's attorneys to provide aggressive advocacy in False Claims Act investigations and litigation. Clients throughout the healthcare industry - including one of the largest for-profit hospital companies, a leading pharmacy benefit manager, a prominent medical device manufacturer and a behavioral health provider - rely on Waller's counsel and advocacy in these situations. In this complex and dynamic practice area, Waller's attorneys are up-to-date with the evolving legal and regulatory changes that can mean the difference between a successful outcome and a significant loss.
ZPIC Audits and Medicare Appeals
The Zone Program Integrity Contractors (ZPICs) program and more recently, the Unified Program Integrity Contractors (UPICs) program, were created by the Centers for Medicare and Medicaid Services (CMS) to identify cases of suspected fraud and recoup alleged overpayments. In both instances, our litigation attorneys represent healthcare clients in challenging ZPIC and UPIC audits, particularly when large extrapolated overpayments are at stake. Waller's attorneys have extensive experience challenging ZPIC overpayments through the byzantine Medicare appeals process. Our track record in fighting ZPIC overpayments speaks for itself, as demonstrated by recent wins where we were able to reduce a ZPIC overpayment from $27 million to $6,900 and another ZPIC overpayment from $16 million to $20,000.
As a result of healthcare reform and other transitions in the healthcare industry, payors are creating narrower networks. Our healthcare litigation attorneys focus on representing providers in their dealings with payors, including contract negotiation and strategy, contract disputes, out-of-network disputes and responses to attempts to recoup payments. Waller's attorneys possess the critical knowledge to understand every aspect of the healthcare provider's contractual and non-contractual relationships with payors, as well as the laws that affect these relationships.
We understand the unique interplay between physicians and the healthcare organizations with which they work. We represent healthcare organizations in physician disputes involving peer review and credentialing as well as matters involving partnership disputes. Healthcare business disputes are not like any other generic business dispute. Our healthcare litigation attorneys are able to apply their deep knowledge of healthcare regulations, especially the Stark Law and Anti-Kickback Statute, to matters involving physician ownership and partnership structures, and they are also able to provide more effective representation in healthcare business litigation because of that specialized knowledge.
Represented CRMC in a multi-year investigation regarding claims that the medical center violated the Anti-kickback Statute and Stark Law and negotiated a favorable settlement with the Department of Justice.
Representing CleanSlate Centers, Inc. and its affiliates in prosecuting an arbitration claim against United HealthCare and certain of its affiliates regarding contract payment agreements.
Represented two physician emergency groups in recovering lost compensation from an HMO for services performed out of network.