dcsimg Healthcare Litigation

Healthcare Litigation

Within the nation’s complex healthcare delivery system, disputes arise in countless contexts. Healthcare providers challenge payors’ claims adjudication policies and practices, and health insurance beneficiaries and care providers dispute coverage decisions. As provider groups consolidate and healthcare systems turn toward the direct employment of providers, restrictive covenant disputes are a growing problem.

McGuireWoods represents clients in a full range of healthcare commercial, regulatory and related litigation. Drawing on our decades of experience, we have developed particular concentrations in managed care, medical devices, drugs and pharmaceuticals, risk management, white-collar criminal defense, fraud and abuse, and antitrust matters, among other areas.

In the current heightened regulatory environment, healthcare companies face a significant increase in investigations, inquiries and law-enforcement actions involving federal and state policies, regulations and legislation. We regularly represent clients in matters related to U.S. Food and Drug Administration (FDA), Medicare and Medicaid guidelines, the Hatch-Waxman Act, the Employee Retirement Income Security Act (ERISA), the Health Insurance Portability and Accountability Act (HIPAA), the Consolidated Omnibus Budget Reconciliation Act (COBRA) and related healthcare laws.

In order to minimize the likelihood of litigation, we work proactively with clients to develop and implement compliance programs and corporate integrity agreements, and to conduct internal audits designed to uncover and correct potential non-compliance. When claims of non-compliance do arise, we have represented clients in inquiries opened by the U.S. Centers for Medicare and Medicaid Services (CMS) (formerly the Health Care Financing Agency or HCFA), the Department of Health and Human Services (HHS) Office of Inspector General (OIG), the Federal Trade Commission (FTC), the Department of Justice (DOJ), state health departments, and state professional licensure boards.

Allegations of False Claims Act (FCA) and other regulatory violations can have serious, negative consequences for healthcare providers. At McGuireWoods, we blend our deep industry knowledge as well as our extensive experience with government regulations to assist clients in preventing federal and state fraud and abuse violations, including failures to comply with anti-kickback, self-referral and false claims laws. We also counsel healthcare providers who are being actively investigated for fraud and abuse violations, and represent clients in litigation, at trial, and in appearances before boards and panels of regulatory agencies.

Insurance matters typically require detailed and complex analyses of the language of insurance agreements. We routinely represent clients in various payor-provider disputes over coverage, reimbursement and related disputes. We have counseled and represented a broad range of insurers and all varieties of providers on complex federal and state insurance laws and the ways in which these laws are incorporated into insurance policies. In the area of billing and reimbursement, we regularly counsel providers in setting up and maintaining information systems and procedures.

CONTACTS

David J. Pivnick Associate T: +1 312 750 3585
Jeffrey C. Clark Senior Counsel T: +1 312 750 8636
Jeffrey E. Rogers Partner T: +1 312 750 8686
Edwin E. Brooks Partner T: +1 312 849 3060
Results 1-12 of 12

RESULTS DEPEND ON A VARIETY OF FACTORS UNIQUE TO EACH CASE. PRIOR RESULTS DO NOT GUARANTEE OR PREDICT A SIMILAR OUTCOME.

Representative Matter

Nationwide chain of dental clinics

Obtained emergency and permanent injunctive relief on behalf of nationwide chain of dental clinics against former partner who was violating restrictive covenant prohibiting the solicitation of dental students at specified dental schools.
Representative Matter

National managed care clinic

Obtained emergency injunctive relief on behalf of national managed care client preventing hospital system making public statements that the hospital system was no longer in–network.
Representative Matter

One of the nation's largest dialysis chains

Defeated preliminary injunction In Denver, Colorado brought by one of the nation's largest dialysis chains, for alleged violation of noncompete.  Our client sought to prohibit one of the areas largest nephrology practices from joint venturing with a competitor of DaVita to provide a number of new dialysis facilities in the Denver area.
Representative Matter

Ambulatory surgery center

Defeated claim alleging improper redemption of shares in partnership dispute among owners of ambulatory surgery center.
Representative Matter

Dialysis clinics

Obtained significant damages award on behalf of dialysis clinics for mismanagement against managed company.
Representative Matter

Methadone clinic

Pro bono representation of a methadone clinic that had been essentially zoned out of the City of DuBois by a newly-enacted zoning ordinance. After a six-day federal trial, we invalidated the city zoning ordinance under the Equal Protection Clause of the United States Constitution, won a six-figure judgment, and obtained attorney’s fees for the clinic. However, the district court did not award the clinic its lost profits because it believed that the clinic could have mitigated its damages by locating where the city unconstitutionally zoned it. McGuireWoods appealed this determination to the U.S. Court of Appeals for the Third Circuit. The case was briefed and argued, and appeals court issued a 2-1 decision upholding the district court’s determination. McGuireWoods is considering filing a writ of certiorari to the U.S. Supreme Court.
Case Study

Raleigh litigation team secures defense verdict for OB-GYN

A 12-person jury in Cartaret County, N.C., returned a unanimous defense verdict after only 38 minutes of deliberation following an eight-day trial. This finally concluded litigation in a medical malpractice action that spanned seven years. The plaintiff, a physician herself, initially sued two OB-GYNs and their practice over surgical complications that led to additional surgeries and a 50-day extended hospital stay. After voluntarily dismissing during the first trial, the plaintiff changed counties, re-filed and proceeded to trial against the practice and the attending surgeon, both clients of the firm. The jury verdict, finding no negligence on the part of our clients, upheld the position throughout that these complications, though serious and rare, are a risk of the procedure.

Representative Matter

Defeated summary judgment in a civil antitrust lawsuit alleging illegal tying, bundling, and exclusive dealing

Representation of an ambulatory surgery center in civil litigation in which it alleged the defendant hospital used anticompetitive tying and bundling to secure an exclusive contract from the area's largest employer self-funded health plan.  The case settled after the antitrust claims survived the defendant hospital's motion for summary judgment.
Case Study

McGuireWoods secures jury verdict for academic medical center

McGuireWoods helped an academic medical center secure a defense verdict following a jury trial of claims relating to the alleged improper administration of the drug Phenergan which led to a patient's vasculitis, compartment syndrome and necrosis of an extremity. The litigation arose from treatment in the center's emergency department during which the plaintiff received three IV injections of the medication also known as Promethazine. The plaintiff claimed that in light of the know dangers of the medication – highlighted in the U.S. Supreme Court case Wyeth v Levin – the hospital should have employed heightened standards advocated by drug safety organizations in order to prevent such injuries.

Representative Matter

One of the largest insurers in the world

Representation of one of the largest insurers in the world in the defense of a temporary staffing nurse against claim that she failed to follow protocol and standard of post-op care by alerting physician to patient’s complaints following brain surgery. Partial blindness resulted. After picking a jury and successfully arguing a Daubert motion to exclude plaintiff’s expert, the case was resolved.
Representative Matter

Health insurance company

Declaratory judgment action concerning the meaning of “emergency services” in the Medicaid portion of the Deficit Reduction of 2006 handled before Fourth Circuit Court of Appeals.
Representative Matter

Virginia medical center

Appeal of certificate of public need denial in which a Virginia medical center opposed the project and was good cause party to the original decision, and, thus, a party to the appeal. Our client established good cause party status in the administrative stages of a certificate of public need application cycle. Our client and the State Health Commissioner were successful in arguing that the decision be upheld on appeal.
Results 1-12 of 12
Edwin E Brooks Edwin E. Brooks
Partner
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 849 3060
F: +1 312 920 3681
vCard
Jeffrey C Clark Jeffrey C. Clark
Senior Counsel
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 750 8636
F: +1 312 920 7230
vCard
Joan S Dinsmore Joan S. Dinsmore
Associate
434 Fayetteville Street
Suite 2600
Raleigh, NC 27601

T: +1 919 755 6693
F: +1 919 755 6592
vCard
Richard T Greenberg Richard T. Greenberg
Partner
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 750 5755
F: +1 312 558 4377
vCard
Jason S Greis Jason S. Greis
Partner
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 849 8217
F: +1 312 698 4550
vCard
Steven D Hamilton Steven D. Hamilton
Associate
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 849 8232
F: +1 312 698 4526
vCard
Sidney Kanazawa Sidney Kanazawa
Partner
1800 Century Park East
8th Floor
Los Angeles, CA 90067-1501

T: +1 310 315 8238
F: +1 310 315 8210
vCard
Jeffrey D McMahan Jr Jeffrey D. McMahan Jr.
Associate
One James Center
901 East Cary Street
Richmond, VA 23219-4030

T: +1 804 775 1132
F: +1 804 698 2092
vCard
Patrick M Meacham Patrick M. Meacham
Partner
434 Fayetteville Street
Suite 2600
Raleigh, NC 27601

T: +1 919 755 6674
F: +1 919 755 6578
vCard
Claire A Modlin Claire A. Modlin
Counsel
434 Fayetteville Street
Suite 2600
Raleigh, NC 27601

T: +1 919 755 6605
F: +1 919 755 6564
vCard
Lee B Muench Lee B. Muench
Associate
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 849 3694
F: +1 312 698 4566
vCard
Thomas W Murrell III Thomas W. Murrell III
Counsel
201 North Tryon Street
Suite 3000
Charlotte, NC 28202-2146

T: +1 704 343 2205
F: +1 704 444 8758
vCard
H. Wayne Phears H. Wayne Phears
Partner
Promenade
1230 Peachtree Street, N.E.
Suite 2100
Atlanta, GA 30309-3534

T: +1 404 443 5718
F: +1 404 443 5770
vCard
David J Pivnick David J. Pivnick
Associate
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 750 3585
F: +1 312 698 4539
vCard
Brian E Pumphrey Brian E. Pumphrey
Partner
One James Center
901 East Cary Street
Richmond, VA 23219-4030

T: +1 804 775 7745
F: +1 804 698 2018
vCard
Jeffrey E Rogers Jeffrey E. Rogers
Partner
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 750 8686
F: +1 312 558 4385
vCard
Angelo Russo Angelo M. Russo
Partner
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 849 8168
F: +1 312 849 8169
vCard
James J Schanaberger James J. Schanaberger
Associate
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 750 2781
F: +1 312 698 4543
vCard
Gilbert E Schill Jr. Gilbert E. Schill Jr.
Partner
One James Center
901 East Cary Street
Richmond, VA 23219-4030

T: +1 804 775 4345
F: +1 804 698 2166
vCard
Patricia K Smoots Patricia K. Smoots
Senior Counsel
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 750 2759
F: +1 312 920 6169
vCard
Andrew R Woltman Andrew R. Woltman
Associate
77 West Wacker Drive
Suite 4100
Chicago, IL 60601-1818

T: +1 312 750 2772
F: +1 312 698 4560
vCard
Results 1-5 of 5
Event

10 Key Concepts and Recent Developments in False Claims Litigation

Wednesday, October 1, 2014
Complimentary Webinar
Event

Healthcare Litigation Conference

August 14, 2014
Raleigh, NC
Event

Healthcare Litigation Conference

May 29, 2014
Richmond, VA
Event

Healthcare Litigation Conference

April 8, 2014
Chicago, IL
Event

8 Key Trends in Healthcare False Claims and Antitrust Litigation

March 12, 2014
Complimentary Teleconference
Results 1-5 of 5
Results 1-8 of 8
Article

Expensive Mistakes

Preventing Technical Violations of the Stark Law

E-Briefings
May 2014
Holly Carnell, Anna M. Timmerman, The Governance Institute
Legal Alert

When ERISA May Not Apply

Three Key Points from a Hospital’s Contract Suit Against an Insurance Company

October 8, 2012
Legal Alert

Supreme Court Declines Review of Medicare Secondary Payer Decision

Three Key Takeaways

October 8, 2012
Results 1-8 of 8