Overview

In recent years, multiple federal and state agencies – including both regulatory bodies and law enforcement – have expanded and intensified their efforts to investigate and prosecute fraud, waste, and abuse in the healthcare industry. As the healthcare business and reimbursement landscape becomes more complex, all signs point to healthcare fraud enforcement remaining a focus for prosecutors and regulators, including an increased reliance upon civil fraud statutes, like the False Claims Act, to further enforcement priorities.

We represent and counsel organizations and individuals in the healthcare industry on implementing compliance programs and practices, conducting internal investigations, responding to government inquiries and investigations, and defending whistleblower lawsuits. Our lawyers have deep experience across a broad range of healthcare fraud and abuse laws, including federal False Claims Act, the Anti-Kickback Statute, the Stark Law, billing and coding requirements, and state analogs. We assist clients at every stage including upfront work building and honing robust compliance programs, business-oriented regulatory advising, investigating, and addressing allegations of misconduct, and responding to government inquiries, regulatory actions, and litigation.

Dorsey’s Healthcare Compliance & Enforcement Team includes former federal and state prosecutors, former judges, and seasoned litigators and regulatory attorneys who work with industry players to balance regulatory risk and promote compliance. We have the experience, capabilities, resources, and national reach to help your organization anticipate, address, and overcome complex challenges. 

Focus Areas

Proactive Regulatory Advisory Services 

Dorsey’s healthcare regulatory attorneys work with clients across the healthcare industry – from providers to payors to manufacturers and suppliers – to provide proactive, business-oriented regulatory advice. Whether responding to day-to-day inquiries or managing significant transactions, our regulatory attorneys bring decades of experience in healthcare reimbursement, research, development, and transactional regulation to the table. Our regulatory attorneys collaborate with our investigation and litigation teams to deliver a tailored response to the myriad regulatory concerns faced by healthcare industry players.

Compliance Program Stand-Up and Review

Members of Dorsey’s Healthcare Compliance and Enforcement Team work with healthcare organizations to implement and improve compliance programs. With an eye towards practical, tailored compliance solutions tailored to your company and its risk profile, we regularly draft policies and procedures and advise on compliance program rollouts. As organizations grow and the regulatory landscape shifts, we work with our clients to review and update compliance programs to promote a proactive approach to risk mitigation.

Monitoring and Internal Investigations

In addition to designing and helping to implement compliance monitoring programs, we conduct internal investigations on behalf of organizations, boards, board committees, officers, directors, and others into potential or suspected misconduct, unlawful practices, and fraud. These investigations often run parallel to or in connection with internal compliance reporting, government inquiries or enforcement actions, or forthcoming or pending litigation. Dorsey’s experienced investigation team conducts right-sized investigations, handling matters of all sizes – ranging from small, single-issue internal investigations to complex, multi-faceted investigations with disclosure considerations – and follow anywhere the investigation takes us. 

Government Investigations and Enforcement

Dorsey attorneys guide clients through government inquiries and investigations, including responses to Civil Investigative Demands, administrative subpoenas, subpoenas from Offices of Inspector General or grand jury subpoenas, requests for information, informal inquiries, inquires and subpoenas from professional licensing boards and self-disclosures to state and federal administrative and law enforcement agencies. By addressing issues early, our clients often resolve matters early, with minimal disruption. Our former federal and state prosecutors and government lawyers bring to bear their unique insight on the government’s prerogatives in representation of clients facing government enforcement actions. We have successfully represented clients in obtaining favorable resolution of enforcement actions and litigations, including with the Department of Justice, Securities and Exchange Commission, state agencies and state licensing boards.

False Claims Act Litigation Defense

The federal government’s principal anti-fraud tool is the False Claims Act, particularly when addressing allegations of healthcare fraud and other unlawful conduct in the healthcare industry. The False Claims Act exposes organizations to liability for treble damages, per-claim penalties, and administrative consequences, including suspension of payment or exclusion from participation in federal programs. Our deep bench of litigators includes former federal prosecutors and government attorneys with extensive experience handling all stages of False Claims Act matters, including investigations, self-disclosure and return of overpayment, and defense in litigation. We often aid clients in persuading the government to decline intervention, as well as securing favorable resolution of litigation through dismissal or settlement.

Criminal Investigations and Proceedings

Often government civil enforcement efforts overlap with or lead to criminal investigations and proceedings. Organizations and individuals facing potential criminal consequences require vigorous and strategic representation. Our litigators include former federal and state prosecutors and former judges with unique experience and perspective on the government’s priorities and how to effectively navigate these fraught situations.