Health Care Fraud

Williams & Connolly has established itself as a firm that many large healthcare companies turn to when faced with high-stakes government investigations and litigation. The firm has represented entities and individuals in criminal investigations, agency investigations, civil False Claims Act litigation, and trials. Williams & Connolly clients in this area have included pharmaceutical companies, hospitals, nursing homes, pharmacy benefit management companies, insurance companies, distributors of health care products, retailers, clinics, doctors, pharmacies, and high-level corporate executives, among others. These matters have covered a range of issues and statutes, including anti-kickback statutes, the Food Drug and Cosmetic Act, federal and state False Claims Acts, Medicare and Medicaid fraud, and a variety of other state and federal statutes. 

Representative Experience

  • Represented major healthcare company in jury trial in which the Texas Attorney General alleged Medicaid fraud under Texas’s version of the False Claims Act; obtained a directed verdict for our client.   
  • Represented individual charged with anti-kickback, heath care fraud, and wire fraud violations in connection with dental practice; client was acquitted on all counts following trial.
  • Represented an industry-leading manufacturer and distributor of pharmaceutical and medical/surgical products in a False Claims Act investigation by the Department of Justice regarding alleged pricing violations. Obtained declination and dismissal.   
  • Represented a health care company in a multi-year criminal investigation concerning alleged kickbacks from a pharmaceutical company. No charges were brought against the company.   
  • Represented a major pharmacy in a lawsuit brought by the Mississippi Attorney General’s office alleging that the company submitted false reimbursement claims to the Division of Medicaid. Obtained dismissal of the action and admission by the State that the company had complied with the relevant legal provisions.
  • Represented a home infusion pharmacy company in a lawsuit brought by the Delaware Department of Justice and a relator alleging false claims premised upon state unclaimed property reporting. 
  • Represented multiple different industry participants in government investigations relating to the Controlled Substances Act.
  • Represented online/telehealth provider in False Claims Act investigation relating to Medicare Advantage services. Obtained declination and dismissal.
  • Represented a healthcare provider in criminal and civil investigations by the Department of Justice and a United States Attorney’s Office regarding the company’s cold-chain shipping practices for temperature-sensitive drugs.   
  • Represent a Medicare Advantage plan in an investigation by the Department of Justice and a United States Attorney’s Office regarding the company’s submission of risk adjustment claims to CMS under Parts C and D of the Medicare program.   
  • Represented a hospital in two False Claims Act investigations and litigation relating to the Anti-Kickback Statute and CMS regulations regarding supplemental reimbusements. Obtained declinations in both actions.
  • Represent a long-term-care pharmacy in an intervened False Claims Act case regarding the pharmacy’s prescription refill practices. 
  • Represent a health insurance carrier in a joint criminal and civil investigation by a United States Attorney’s Office regarding the use of brokers to market and sell Medicare Advantage plans. 

Primary Contacts

Recognitions

Healthcare: Service Providers, The Legal 500, 2019-2024

“Health Care Practice Groups of the Year,” Law360, 2015, 2018-2019, 2021-2023

Recognized Practitioner: Healthcare (DC), Chambers USA, 2017-2019

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