Introduction
Key Contacts
Focus Areas
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, and have extensive experience defending clients in matters relating to the qui tam provision of the False Claims Act.
Our team includes former members of DOJ’s Fraud Section and a current co-chair of the Health Care Fraud Sub-Committee of the ABA White Collar Crime Committee.
Commercial Health Insurance Disputes
Zuckerman Spaeder has developed a trailblazing and nationally recognized practice focused on expanding clinician and patient rights in their relationships with commercial health insurers.
Drawing upon nearly three decades of experience—primarily involving Employee Retirement Income Security Act of 1974 (ERISA), a statute governing federal benefit plans—we are at the vanguard of an entirely new health insurance recovery legal practice. We have developed a collection of innovative legal theories that are central to the fight and have built strong relationships with the U.S. Department of Labor (DOL).
We regularly handle disputes concerning improperly assessed administrative fees, attacks on out-of-network services, reimbursement rates, and recoupments and offsets for supposedly overpaid claims, and recover wrongful claim denials and underpayments. These efforts have resulted in the recovery of over $600 million.
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.
We understand the impact these investigations have on our clients’ day-to-day commercial and professional activities. For businesses, the damage to day-to-day operations, 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, while minimizing internal interruptions.
Regulatory and Compliance
Our health care attorneys help clients navigate the process of obtaining advisory opinions and other guidance from the HHS Office of the Inspector General and elsewhere, enabling them to pursue their work while confident about the regulatory process. We also work with the HHS OIG to obtain clarity and resolution for our clients who are under investigation.
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.
