Kilpatrick Townsend’s Health Care Litigation Practice Group leverages the collective experience of our Complex Commercial Litigation and Health & Life Sciences practice teams. We are regularly called upon by hospitals, physician practice groups, and health insurers to represent them in business disputes involving managed care contracts, provider reimbursement and billing practices, and federal and state anti-kickback and self-referral (Stark) statutes. We also have significant experience in health care litigation matters arising from the sale and acquisition of hospitals, hospital systems and physician practices, HIPAA related matters, and fiduciary liability of hospital officers and board members arising out of hospital operations.

Regulatory and Reimbursement Practice

Our particular experience in provider reimbursements and the multitude of intertwined issues that complicate this important aspect of a health care entity’s business enables us to assist our clients in ensuring the following with respect to business operations:

  • Billing practices are compliant with current regulations
  • Reimbursements are received in a timely manner and in the amounts owed
  • Regulatory violations discovered internally are dealt with effectively and in a timely manner
  • U.S. Department of Justice and governmental agency inquiries or subpoenas are handled appropriately

Rising costs and shrinking reimbursements have increased the pressure on health care entities, necessitating experienced, savvy legal counsel to provide guidance through the complex and ever-changing regulatory scheme that governs their business operations and entitlement to payment. Failure to understand these rules and procedures can result in leaving funds uncollected or crossing a regulatory line that could subject the provider or insurer to significant civil penalties and possibly criminal sanctions.

Kilpatrick Townsend is well-positioned to counsel clients in matters regarding Medicare, Medicaid, and third-party reimbursement and to represent clients when concerns arise regarding a heath care entity's business practices, whether through internal investigation or governmental inquiry. Collectively, our attorneys have acted as counsel on almost all sides of these health care issues.

  • Our Health Care Litigation team includes former Assistant U.S. Attorneys who prosecuted regulatory violations in the health care arena and supervised criminal health care fraud prosecutions of corporate and individual defendants, including a 2011 case where fraudulent Medicaid billing and other crimes resulted in a 12-year sentence. These Kilpatrick Townsend attorneys now assist clients with internal, special investigations and governmental inquiries.
  • Our attorneys have successfully represented health care providers in claims that third-party payors have underpaid our clients. We have also successfully represented health insurers on claims that providers have submitted fraudulent bills for reimbursement.
  • The group includes attorneys with extensive experience with the American Medical Association Current Procedure Terminology (CPT) code system.
  • Kilpatrick Townsend attorneys have successfully guided clients through the self-disclosure of internally discovered regulatory violations and through governmental inquiries into billing practices and hospital/physician business arrangements.