Healthcare Litigation

Disputes among the numerous stakeholders in the healthcare industry, with its complex regulatory framework, evolving business relationships and economic issues are unavoidable. Our healthcare litigation team has a wealth of experience in the forums in which these disputes are played out – whether they be internal medical staff hearing panels, state or federal administrative agency proceedings, AAA or AHLA arbitrations, or state and federal courts.

Our representation of clients in healthcare litigation includes disputes related to regulatory and reimbursement issues, contracts, business and real estate disputes, employment matters, allegations of federal antikickback statute, Stark Law, and False Claims Act violations, as well as the defense of claims related to professional negligence and ethics violations. Members of our team have expertise in hospital staff and physician privilege matters involving denial, suspension, or revocation of a physician’s medical staff privileges, which may include issues involving physician competency, ethical conduct, or adherence to medical staff bylaws.

Practice Team

Experience

Representative Matters

Representing two New Jersey health systems in high-stakes litigation against multiple Medicare Advantage plans seeking recovery of approximately $5 million in underpaid 340B drug reimbursements, following a U.S. Supreme Court decision invalidating the Center for Medicare and Medicaid Services’ reimbursement reductions; matters are proceeding toward mediation and arbitration.
Representing a major healthcare system in litigation brought by a former physician alleging wrongful termination of privileges and antitrust and Lanham Act violations, resolving the matter through a favorable settlement.
Representing 170 hospitals nationwide before the Medicare PRRB in challenges to CMS’ historical calculation of IPPS rates dating to federal fiscal year 1986. The matter, valued at hundreds of millions of dollars, seeks correction of longstanding reimbursement underpayments and remains pending before the PRRB.
Representing over 300 hospitals nationwide in Medicare PRRB and federal court litigation challenging CMS’ application of the rural floor budget neutrality factor affecting federal fiscal year 2024 wage indices. The firm’s team secured expedited judicial review and filed suit in the U.S. District Court for the District of Columbia seeking declaratory relief and damages.
Defending a major New Jersey health system against physician privilege-termination claims, including allegations of discrimination and improper peer review, where reinstatement would raise patient safety concerns; discovery completed and summary judgment pending.
Representing an emergency medicine physician practice in a dispute exceeding $11 million against UnitedHealthcare and affiliated entities arising from post-breach recoupment efforts following the Change Healthcare cyber incident, advising on recovery of lost revenue and structuring a resolution to preserve the practice’s financial viability.
Representing a physician practice owner in a seven-figure action for diversion of assets against a practice management company, seeking recovery of misappropriated funds and restoration of operational control.
Representing a New Jersey healthcare system and its leadership in litigation arising from termination of a surgeon’s staff privileges, defending claims for alleged wrongful suspension and lost income.
Represented a medical supply distributor and affiliated entities in a federal False Claims Act qui tam action alleging Medicare fraud, securing dismissal prior to the pleading stage through documentary evidence and sworn submissions, while claims against other defendants continued.
Successfully defended a company operating a post-acute network of skilled nursing and assisted living facilities in federal court, securing an order to dismiss a complaint alleging $10 million in damages for a range of due process and emotional distress claims.
Successfully defended a client in an arbitration hearing against allegations of legal malpractice, resulting in all claims being dismissed and no award being issued.
Represented a physician charged with conspiracy to commit healthcare fraud involving fraudulent billing for medically unnecessary compound medications submitted to New Jersey state and local health benefits programs and private insurers.
Represented a coalition of New Jersey hospitals in a $300 million constitutional challenge to the State of New Jersey’s charity care and Medicaid reimbursement regime, defending the hospitals’ takings claims through summary judgment, Appellate Division review, and New Jersey Supreme Court proceedings, resulting in published decisions affirming dismissal of the claims. The hospitals filed a petition for certiorari with the Supreme Court of the United States, which was denied.
Represented an unlicensed owner of a licensed clinical social worker practice in a state fraud and abuse investigation with potential seven-figure reimbursement exposure and possible criminal referral.
Represented a New Jersey healthcare system in defense of antitrust and tort claims brought by a pediatric surgeon following revocation of privileges, securing a negotiated resolution.
Represented a New Jersey healthcare system in defense of fraud, breach of contract, age discrimination, and CEPA retaliation claims brought by three physicians and their surgical group seeking more than $9 million.
Represented a New Jersey healthcare system and its Chair of Surgery in litigation brought by a trauma surgeon challenging a summary suspension of medical staff privileges. Following reinstatement through internal proceedings, the firm continued to defend the client in this $2.4 million action, which settled before trial.