Experience

Health Care Fraud and Abuse 

• 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.
• Represented two public hospitals in DOJ civil investigation/national pneumonia coding initiative involving alleged improper coding of bacterial pneumonia. Successfully resolved civilly.
• Represented Georgia DME supplier in criminal investigation regarding improper coding and billing of DME. Successfully resolved civilly.
• Represented therapy chain provider in joint criminal and civil investigation regarding alleged improper billing of therapy codes. Successfully resolved civilly.
• Represented public hospital in DOJ civil investigation related to ambulance ALS and BLS billings. Successfully resolved.
• Represented physician in DOJ/OIG investigation regarding alleged improper use of physician extenders and upcoding of E&M services. Successfully resolved with no repayment.
• 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.
• Represented behavioral health provider in joint criminal and civil investigation related to alleged case rate upcoding to MCO in TennCare program. Successfully resolved civilly.
• Represented numerous individual officers in DOJ joint civil and criminal investigations of related healthcare providers for 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 compliance with federal healthcare laws including 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 corresponding retaliatory discharge provisions.

Construction

• Represented GC on large energy project arbitration between GC, owner, and subcontractors involving over $6 million in disputed change orders. Resolved successfully following mediation.
• Represented GC as co-counsel on large student dormitory project dispute involving 15 separate lawsuits between GC, owner, and subcontractors. Following two-week trial, GC was awarded $2.7 million judgment and lien claim.
• Successfully represented GC in subsequent student dormitory project disputes 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.

Managed Care Litigation/Out-of-Network Litigation

• Successfully represented large Tennessee hospital system in litigation with large managed care organization ("MCO") involving out-of-network emergency services.
• Successfully represented large MCO in trial and appellate court litigation seeking over $50 million in out-of-network billed charges. Matter resolved following appellate court decision.
• Represented large MCO in litigation seeking $16 million for alleged nonpayment of the Professional Component 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.

Data Breach

• 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.

Education

• 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

Involvement