Health Care

Hospitals and other health care providers, executives, and their patients, face enormous uncertainty in an ever-shifting industry.

We regularly advise our clients concerning new regulatory initiatives, ways to avoid and address allegations of billing or insurance fraud, and strategies to minimize and recover wrongful claim denials and underpayments.

Led by the former general counsel of HHS, the founder of the Florida Health Fraud Task Force, and a nationally recognized legal innovator who has won hundreds of millions of dollars for his clients, our team of trial attorneys and former regulators can go toe-to-toe with government regulators, insurance companies, and their legal counsel.

“. . . the best white collar health care lawyers I have encountered.”Client feedback, U.S. News Best Law Firms


Fraud and qui tam

We handle a broad spectrum of health care fraud cases—regulatory, civil, and criminal—including claims of billing fraud, false claims, kickbacks, off-label promotions, and an array of other matters. We have served as counsel in proceedings filed against health care providers by the DOJ, HHS, and state authorities. 

Our team includes a founding member of the Health Fraud Task Force for the U.S. Attorney’s Office for the Middle District of Florida, a former deputy to the DOJ Special Counsel for Financial and Health Care Fraud, and two current co-chairs of the Health Care Fraud Sub-Committee of the ABA White Collar Crime Committee.

Commercial health insurance disputes

Zuckerman Spaeder has developed a groundbreaking and nationally recognized practice focused on expanding provider and patient rights in their never ending struggle with commercial insurers. 

Drawing upon nearly two decades of experience—primarily involving ERISA, a statute governing federal benefit plans—we have developed a collection of innovative legal theories that are central to this fight and have built strong relationships with the U.S. Department of Labor. We regularly handle disputes concerning misrepresentations of coverage, wrongful denials, attacks on out-of-network services, reimbursement rates, and recoupments and offsets for supposedly overpaid claims.

Investigations

Described as “a haven for clients in trouble” by The American Lawyer, Zuckerman Spaeder has helped hundreds of clients navigate investigations, respond to government inquiries, and work to minimize or avoid enforcement actions and litigation. When going to trial is inevitable, our attorneys are courtroom-ready and bring decades of experience.

We understand the impact these investigations have on our clients’ day-to-day commercial and professional activities. For businesses, the damage to reputation and finances can be significant; for individuals, the toll on their lives and families can be extraordinary. Our representation of clients takes these factors into account in seeking resolutions that can achieve our clients’ goals and objectives.

Mental health coverage

Seeking ways to limit coverage for behavioral care, insurers frequently develop more restrictive internal coverage guidelines for mental health and substance abuse claims than those applied to surgical or medical care. In doing so, they almost certainly violate the Mental Health Parity and Addiction Equity Act.

Zuckerman Spaeder leads a coordinated national effort to restore true mental health parity in insurance coverage for patients and providers. Using innovative legal theories, we have won key cases and represent a number of classes of patients in obtaining the coverage they need for mental health and addiction recovery treatments.

Compliance

Compliance programs not only protect health care providers against misconduct, but also help them demonstrate that they are satisfying statutory and administrative regulations. 

We frequently advise health care transactions attorneys on relevant enforcement initiatives, and we have helped clients design, implement, and document programs to train and monitor employees. We also counsel health care providers on complying with corporate integrity agreements.



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