Healthcare is one of the largest and most vital industries in our society, and yet also one of the most complex and prone to legal risk. Providers and market participants across the industry – including physicians, nurses, staff, executives, hospitals, skilled nursing facilities, pharmaceutical companies, and other providers – face many evolving legal challenges. These changes include, but are not limited to, regulatory compliance issues and the threat of civil and criminal litigation.
The healthcare defense attorneys of Zweiback, Fiset & Zalduendo skillfully guide clients across the healthcare industry through an array of legal challenges. Our attorneys rely on our extensive legal and regulatory experience in the industry and our unrivaled civil and criminal litigation skills. We have significant experience negotiating criminal, civil, and administrative settlements in healthcare defense proceedings before many government entities, including the U.S. Department of Justice’s Criminal and Civil Divisions, the Office of Inspector General of Health and Human Services (HHS), state attorneys general, and various licensing boards.
How Zweiback, Fiset & Zalduendo Approaches Healthcare
Our approach is to prioritize decisive action to mitigate the immediate and long-term negative consequences to our clients’ financial and reputational interests. Our attorneys employ an efficient and streamlined approach that protects our clients’ resources and focuses on expeditious resolution of issues wherever possible. Our attorneys have consistently provided positive and efficient results for our healthcare clients in negotiating criminal, civil, and administrative settlements before government entities, as well as in winning courtroom victories and reaching favorable settlements in civil and criminal litigation.
When Do You Need a Healthcare Defense Attorney?
Speaking with an experienced healthcare defense attorney at the first sign of a potential legal risk can be the best approach for defending your reputation, livelihood, and/or business interests. Our attorneys counsel and represent individuals and both for-profit and non-profit healthcare entities across a wide variety of legal challenges.
False Claims Act
The False Claims Act or “FCA” allows private individual “whistleblowers” to bring lawsuits against individuals and companies for alleged fraudulent acts against the government. Such actions commence when the government and/or a whistleblower brings forth alleged evidence of fraud in pursuit of a portion of the recovered penalties, and the government has the option of joining the lawsuit. This can include a company insider such as an employee or executive, or someone completely outside the organization such as an industry observer. A “whistleblower”, however, may have little, if any, connection to the alleged underlying acts.
Each year, numerous healthcare providers, among others, find themselves facing expensive litigation for FCA claims based on alleged acts such as unnecessary treatment, upcoding, unbundling, kickbacks, insufficient physician services, and so on. Defendants in FCA cases face steep penalties at trial including high monetary damages, and criminal penalties may ensue.
Qui Tam Lawsuits
Zweiback, Fiset & Zalduendo also provides comprehensive counsel and representation of plaintiffs in FCA and other whistleblower healthcare fraud lawsuits involving a state or federal government. In such cases, a whistleblower can collect between 15% to 30% of the recovery in a successful FCA proceeding. Our attorneys work with potential whistleblower plaintiffs to assess and collect evidence, move forward with litigation, and protect their financial and reputational interests throughout the process.
Physicians face significant financial and reputational consequences for alleged violations of the various federal “STARK Laws”. STARK Laws aim to prevent medical professionals from referring patients to healthcare providers in which those professionals have a perceived financial interest. It is not always clear when a physician’s actions have potentially run afoul of the STARK Laws. A “financial benefit” that may trigger government enforcement action can take a number of forms that may have seemed innocuous or standard operating procedure to those involved. The penalties for even unintentional violations, however, can be great, including steep fines, denials of payments, and exclusion from Medicare and other government healthcare programs.
If you suspect you may face enforcement action for a potential STARK violation, are already under investigation, or are seeking counsel in avoiding STARK enforcement action, our attorneys will counsel and guide you through every step of the process. We will assist you in developing and implementing compliance practices and procedures as well as defending you in governmental enforcement actions to protect your practice, reputation, and financial interests.
Bribery & Kickback Schemes
Many investigations and lawsuits in the healthcare industry involve allegations of bribery and kickbacks, whether in the context of governmental investigations and enforcement actions or in lawsuits between private parties. Such allegations often relate to payments and/or the conferral of benefits between physicians, pharmaceutical companies, hospitals and other healthcare providers related to the referral of patients, prescriptions or equipment and supplies. Our attorneys have significant experience in dealing with the complex legal and factual scenarios often present in kickback and bribery proceedings. We can provide skilled counsel and representation throughout the healthcare defense process.
Fraud and Abuse
State and federal governmental agencies and private plaintiffs including insurers often bring costly legal proceedings against healthcare providers and professionals for alleged acts of fraud and abuse. A successful fraud investigation or lawsuit can be devastating to the finances, livelihood, and reputation of a professional or healthcare provider. The response to such a fraud proceeding can be just as critical as the underlying facts that may come to light. Our attorneys bring a measured yet assertive approach to defending our clients against healthcare fraud proceedings, with a focus on defending and protecting both present and long-term interests.
Licensing & Employment
We have worked with professionals facing threats to their licensing status over perceived misconduct as well as healthcare providers and other entities to address their own liability in licensing and employment legal proceedings. Our experience includes representing clients before the California Medical Board, California Health Authority, California Board of Pharmacy, and California State Board of Nursing.
In addition to representing parties in white collar investigations and FCA claims involving the government, our attorneys also represent private individuals and companies engaged in civil litigation between private parties in the healthcare industry. We provide counsel and representation to professionals, healthcare providers, pharmaceutical companies and medical suppliers in all types of civil litigation. Litigation relating to healthcare issues can be enormously costly for all involved. Our guiding mission throughout the process is to provide comprehensive defense services focused on our client’s long-term sustainability while employing an efficient approach that conserves client resources.
Speak with an Experienced Healthcare Defense Lawyer
Healthcare providers and professionals face unique and complex legal risks, and our attorneys have the legal experience and industry knowledge to counsel and protect clients in all aspects of the industry. It is important to respond properly to legal risks as soon as they arise. Our attorneys are here to provide counsel and representation to mitigate risk at the earliest possible moment. Contact our office to speak with an experienced healthcare defense attorney regarding your situation today.