Richard Rose concentrates his practice in the areas of healthcare fraud and abuse, construction litigation and commercial litigation. He represents and counsels hospitals, physicians, SNFs, home health agencies, hospice providers, DME providers, mid-level providers and other healthcare providers in healthcare fraud and abuse issues and litigation. He represents and counsels construction general contractors and subcontractors in construction litigation, contract reviews and disputes. Mr. Rose also represents and counsels both large and small businesses relating to general business and commercial litigation. Mr. Rose also represents and counsels clients in the insurance, healthcare, retail, real estate and manufacturing sectors regarding Information Security and Privacy, including responses to major data breaches as well as compliance with HITECH, HIPAA, GLBA and other data retention and compliance laws.
Health Care Fraud and Abuse Experience
- Represented public hospital in grand jury investigation involving alleged improper cost shifting to home health cost center on cost reports. Successfully resolved civilly on ability to pay basis, with 5 year CIA.
- Represented two public hospitals in DOJ civil investigation/national pneumonia coding initiative involving alleged improper coding of bacterial pneumonia. Successfully resolved civilly with 3 year CIA.
- Represented Georgia DME supplier in criminal investigation regarding improper coding and billing of DME. Successfully resolved civilly with no CIA.
- Represented therapy chain provider in joint criminal and civil investigation regarding alleged improper billing of therapy codes. Successfully resolved civilly with no CIA.
- Represented public hospital in DOJ civil investigation related to ambulance ALS and BLS billings. Successfully resolved with 3 year CIA.
- Represented physician in DOJ/OIG investigation regarding alleged improper use of physician extenders and up coding of E&M. Successfully resolved with no repayment or CIA.
- Represented pain management practice in DOJ joint criminal and civil investigation involving TPIs allegedly billed as TOIs. Successfully resolved civilly.
- Represented physician group in OIG administrative investigation regarding alleged PDMA violations relating to sale of drug samples. Successfully resolved civilly with 3 year CIA.
- Represented behavioral health provider in joint criminal and civil investigation related to alleged case rate upcoding to MCO in TennCare program. Successfully resolved civilly with three year CIA.
- Represented numerous individual officers in DOJ joint civil and criminal investigations of the healthcare providers which employed such officers including alleged Stark, AKA and FCA violations. No action taken against officers.
- Represented numerous SNFs, hospice, hospital, home health, DME, physicians, physician extenders and other healthcare providers in voluntary disclosures to DOJ/OIG/MACs, compliance matters, internal investigations, CIA compliance, overpayment audits, ZPIC/RAC audits, qui tam defense and federal healthcare compliance related to the FCA, Stark, and AKA.
- Represented relators in qui tam cases filed in federal district courts alleging violations of the FCA as well as state FCAs and retaliatory discharge provisions thereunder.
Managed Care Litigation/Out-of-Network Litigation
- Successfully represented large managed care organization in trial and appellate court litigation seeking over $50 million in out-of-network billed charges. Matter resolved following appellate court decision.
- Currently represent large managed care organization in significant out-of-network as well as provider contract disputes.
- Currently represent self-insured health plan in out-of-network dispute with hospital providers.
- Represented large managed care organization ("MCO") in litigation seeking $16 million for alleged nonpayment of the PC of pathology billings. Successfully resolved following mediation.
- Represented large MCO in declaratory judgment action seeking declaration that MCO was not liable for millions of dollars for out-of-network TennCare services. Successfully resolved.
- Represented large health insurer in the first HITECH breach case with HHS, including investigation, notification, remediation and negotiations with OCR and over 40 state AGs.
- Represented large casualty insurer in investigation of data breach by former employee.
- Represented and counseled retail and other large clients relating to compliance with civil and criminal laws governing data storage, transmission and interception.
- Represented GC on large energy project arbitration between GC, owner and subcontractors involving over 6M in disputed change orders. Resolved successfully following mediation.
- Represented GC as co-counsel on large student dormitory project dispute between GC, owner and subcontractors. Case involved 15 separate lawsuits. Following two-week trial, GC was awarded $2.7 million judgment and lien claim.
- Subsequently successfully represented GC on student dormitory project as co-counsel in one-week trial involving drywall subcontractor seeking $3.3 million in damages, and in collateral lien priority litigation with a major bank regarding priority of GC's lien.
- J.D., University of Tennessee College of Law, 1995
- Member, Tennessee Law Review
- Law clerk to the Honorable W. Frank Crawford, Tennessee Court of Appeals, Western Section
- B.A., cum laude, University of Georgia, 1992
- Listed in The Best Lawyers in America© - Health Care Law; Litigation-Construction Law since 2013
- Best Lawyers® "Lawyer of the Year" - Litigation-Construction Law 2015 & 2017
- American Inns of Court, Justices Ray L. Brock Jr. and Robert E. Cooper, Chattanooga Chapter - President, 2016
- Chattanooga Bar Association
- Tennessee Bar Association
- 56 Miller & Martin Attorneys Listed in The Best Lawyers in America 2018 Edition
- Nine Miller & Martin Attorneys Named Best Lawyers® "Lawyer of the Year" for 2017
- 54 Miller & Martin Attorneys Listed in The Best Lawyers in America® 2017 Edition
- 54 Miller & Martin Attorneys Listed in The Best Lawyers in America® 2016 Edition
- Six Miller & Martin Attorneys Named Best Lawyers® "Lawyers of the Year"
- 55 Miller & Martin Attorneys Listed in The Best Lawyers in America® 2015 Edition
- 50 Listed in The Best Lawyers in America® 2014 Edition
- 49 Listed in The Best Lawyers in America® 2013 Edition