SERVICES

The litigators at Stumphauzer, Foslid, Sloman, Ross & Kolaya are healthcare advocates who speak your language and understand your business.  

PRACTICE AREAS

Health Care Fraud and Abuse Matters

Overview

The litigators at Stumphauzer, Foslid, Sloman, Ross & Kolaya are healthcare advocates who speak your language and understand your business.  We represent hospitals, Medicare Advantage Management Services Organizations (“MSOs”), skilled nursing facilities, pharmacies and pharmacists, physicians, clinical laboratories, diagnostic companies, marketing companies, individual marketing agents, telemedicine companies and providers, and FDA-regulated companies and manufacturers in a wide range of civil and criminal disputes and government investigations.    

Accusations of fraud in the healthcare field can result in potentially dire consequences.  These include crippling monetary damages, criminal indictments culminating in lengthy prison sentences, and debilitating collateral consequences, such as the loss of professional licenses and exclusion from federal health care programs.  As a result, you need lawyers who understand the complex landscape of the healthcare industry.  Our former federal prosecutors understand the government’s ever-changing healthcare enforcement priorities and can speak to them the moment you walk through our doors.  We have zealously represented clients caught in the government’s crosshairs during periods of intensified scrutiny on compounding medications, toxicology and urine drug testing, and genetic testing. 

We Know the Healthcare Industry

Our understanding derives from our experience as healthcare lawyers.  As a former Assistant United States Attorney, Ryan Stumphauzer was a founding member of South Florida’s Medicare Fraud Strike Force, which has evolved into a national law enforcement program.  As private practitioners, our lawyers have managed numerous high-profile criminal and parallel health care fraud and abuse matters, from the pre-litigation investigation stage through jury trial and sentencing, including matters involving:

  • Anti-Kickback Statute
  • Health Care Fraud Statute
  • Stark Law (Physician Self-Referral Law)
  • False Claims Act (FCA)
  • Civil Monetary Penalty Law
  • HIPAA
  • Exclusion from Federal Health Care Programs
  • RAC, MAC and ZPIC Audits


Based on this experience, our lawyers understand the complex interaction between federal healthcare laws and the multiple government agencies responsible for their enforcement in any jurisdiction in which our clients may need to interact with the government.
  And we know how to guide clients through simultaneous, parallel criminal and civil investigations.   

We bring this knowledge and our powerful combination of former prosecutors and experienced civil litigators to bear every time we represent a new client in the healthcare space, enabling the firm to anticipate and respond to the many demands created by the joint investigations and proceedings routinely pursued in connection with health care fraud and abuse matters.  Importantly, we have an established track record of resolving complex parallel proceedings involving criminal, civil, and administrative issues favorably to our clients’ satisfaction, without the need for costly and public litigation. 

Medicare Advantage

If you are a Medicare Advantage MSO faced with a sensitive and pressing legal issue, you cannot waste time teaching your lawyer about capitation, risk adjustment, encounter data, and other topics germane to your business.  Our firm has a comprehensive understanding of the Medicare Advantage program.

Our understanding of Medicare Advantage helps us craft creative legal defenses.  For example, federal healthcare fraud, waste, and abuse laws generally aim to curtail overutilization in a fee-for-service setting.  Capitation changes this analysis, as the standard legal theory of overutilization does not necessarily apply.  We will apply our knowledge of Medicare Advantage to help you narrow the factual issues, focus on the right ones, and generate a robust legal defense. 

Compounding Pharmacies

The government often works from a reactive posture in fighting healthcare fraud and abuse.  Take, for instance, its aggressive pursuit of pharmacy owners, pharmacists, marketers, telemedicine companies, physicians, and others involved in the distribution of compounded pain and scar creams.  This pursuit began largely after several media publications featured investigations into the theory that compounding pharmacies regularly defrauded the federal military healthcare program Tricare. 

Our lawyers have defended several clients against the government’s efforts.  Our clients include several compounding pharmacies, prescribing physicians, pharmacists-in-charge, marketing companies, individual marketing agents, and telemedicine companies that have come under government scrutiny.  We can quickly identify the fact patterns and circumstances that triggered the government’s investigation and craft unique and comprehensive defense strategies to help avoid devastating government penalties.   

For more information, please see our Compounding Pharmacy Defense page.

Skilled Nursing Facilities

We regularly represent Skilled Nursing Facilities (“SNFs”).  We understand the consolidated billing requirement mandated under the Balanced Budget Act of 1997, the distinctions between Medicare Part A and Part B covered stays, therapy billing processes and procedures, medical director requirements, and other issues particularized to the SNF setting. This understanding will allow us to get up to speed quickly and provide you with informed and actionable advice about your matter.

Pain Management, Toxicology, and Urine Drug Testing

Our lawyers have vast experience defending toxicology laboratories, interventional pain management physicians, sober homes and addiction treatment centers throughout the nation against parallel civil and criminal investigations involving alleged urine drug testing (“UDT”) fraud schemes.  We know that pain management practitioners face unique clinical and legal challenges, especially when using UDT to monitor patients that are prescribed controlled substances.  Proper application of UDTs allows providers to continue treating patients with legitimate needs while reducing the potential for diversion of prescription medications.  But UDT overutilization or physician UDT self-referrals can lead to ruinous legal consequences.   

In defending against allegations that our clients engaged in UDT fraud schemes, we have a deep understanding of proper UDT screening and confirmation protocols for pain management practices.  This comprehensive understanding of the UDT landscape positions our lawyers to quickly and effectively combat and defend against aggressive parallel investigations into alleged UDT fraud.

Genetic Testing

We have defended laboratories, diagnostic companies, marketing companies, telemedicine companies, physicians, and other healthcare providers against allegations of excessive or improper genetic testing.  We regularly defend those being scrutinized by law enforcement agencies for various genetic testing scenarios. Our decades of trial and investigative experience as former federal prosecutors specializing in healthcare fraud related matters have made us uniquely qualified to defend you and/or your companies.

  • Defended a senior executive of a publicly-traded hospital management corporation in connection with an investigation by the Department of Justice and the Department of Health & Human Services into alleged violations of the Anti-Kickback Statute and Stark Law.
  • Defended several large Florida Medicare Advantage Management Service Organizations in a variety of government investigations involving unlawful patient inducements, risk adjustment data manipulations, member discrimination or “cherry picking,” and several other topics. 
  • Defended dozens of physicians—including neurologists, cardiologists, dermatologists, oncologists, orthopedic surgeons, interventional pain specialists, endocrinologists—in civil and criminal investigations involving allegations of upcoding, overutilization, self-referrals, and violations of the Anti-Kickback Statute by the Department of Justice, HHS-OIG and the Florida Attorney General.  We have not only defended the government investigation, but also carefully manage collateral consequences including discipline by the State Board of Medicine and potential exclusion by government and private payors.
  • Represented the Chief Executive Officer of a large Florida hospital in parallel civil and criminal investigations by the Department of Justice, Department of Health & Human Services, and the Federal Bureau of Investigation involving alleged violations of the Anti-Kickback Statute and Stark Law.
  • Represented the Compliance Committee of a large Florida hospital in conducting an internal investigation after a Board member raised concerns regarding potential violations of federal health care laws.
  • Represented a prominent national health care provider in conducting an internal investigation of alleged violations of the Civil Monetary Penalty Law, and in voluntarily reporting those violations to the Department of Health & Human Services pursuant to the Self-Disclosure Protocol.
  • Successfully represented the founder and senior executive officer of one of South Florida’s largest MSOs in connection with an investigation alleging violations of the Anti-Kickback Statute, the Medicare Marketing Guidelines, and the Civil Monetary Penalty Law. The firm further assisted the senior executive officer in assessing complex health care compliance issues.
  • Represented multiple Skilled Nursing Facilities (SNFs), as well as executives and physical therapy companies that service SNFs, in connection with investigations alleging therapy upcoding, therapy overutilization, and violations of the Anti-Kickback Statute and Stark Law through medical director agreements and other financial arrangements with referral sources.
  • Defended a marketing representative in one of the largest criminal compounding pain and scar cream fraud cases in South Florida history.

Our understanding derives from our experience as healthcare lawyers.  As a former Assistant United States Attorney, Ryan Stumphauzer was a founding member of South Florida’s Medicare Fraud Strike Force, which has evolved into a national law enforcement program.