Gregory N. Pimstone

Representative Health Plan and Insurance Matters

• Representation of health plan in several federal RICO class actions by nation-wide classes of physicians and non-MD health care professionals regarding the means by which they were paid by the plan.  
• Representation of Medicare Part B carrier in criminal and civil qui tam actions arising from obstruction of HCFA CPEP audits.
• Representation of health plan in federal and state class actions regarding the calculation of subscriber co-payments. 
• Representation of health plan in class actions regarding the revision of subscriber rating tiers.
• Representation of health plan in class action regarding the mid-year revision of copayment and deductible plan provisions.
• Representation of health plan contractor in federal RICO and ERISA class action regarding the assertion of claims and liens under plan reimbursement provisions in member agreements.
• Representation of health insurer in class action regarding the calculation of physician reasonable and customary charges.
• Representation of health plan in class action regarding payments to non-contracted emergency room physicians.   
• Representation of health plan in class action regarding the calculation of subscriber deductibles.
• Representation of health plan in multiple high profile lawsuits concerning the rescission of policies.
• Representation of health plan in audits and investigations by the Departments of Insurance and Managed Health Care.
• Representation of insurer in bad faith and unfair competition action arising from rescission of long-term care policy.
• Representation of health plan in action brought by California Medical Association regarding the payment of providers under the Knox-Keene Act following the insolvency of intermediaries; published appellate decision widely cited for the court’s interpretation of California’s unfair competition statute.
• Representation of health plan in numerous ERISA actions regarding the denial of benefits.
• Representation of health plan in numerous actions involving claims of bad faith denial of benefits, and related unfair competition and other tort claims.
• Representation of health plan in wrongful death actions.
• Representation of health plan in actions by multiple actions by members and providers regarding experimental and investigational treatments. 
• Compliance reviews, counseling and audits re educational grants from drug companies.
• Advice and counseling re HIPAA and other privacy issues.
• Representation of health plans in arbitrations with providers regarding various types of contract disputes, including the reasonable value of services rendered.

Representative Provider Matters

• Representation of providers in HHS and DOJ investigations in a variety of areas.
• Fraud and abuse investigations regarding alleged misconduct at home health facilities and nursing homes.
• Fraud and abuse compliance reviews and audits regarding multiple home health facilities.
• Representation of hospitals in actions in numerous disputes with physicians and medical groups regarding allegations implicating the Anti-Kickback and Stark Acts, including partnership disputes, loan disputes, recruitment disputes, lease and rent disputes and other commercial disputes.  
• Representation of hospital in connection with medical privileges disputes.
• Representation of hospitals in connection with physician disputes concerning Professional Services Agreements and Administrative Services Agreements.
• Representation of hospital in rural health clinic Medicaid fraud and abuse matters.
• Representation of health plans and hospitals in numerous unfair competition actions.
• Representation of medical group in connection with disputes with management company.
• Representation of Northern California hospital system in connection with internal investigation into potential non-compliance with Medicare and Medicaid regulations.
• Defense of hospital stemming from allegations including breach of contract, kick-backs, improper referral payments, Medicare violations, Knox-Keene Act violations, and tax violations.
• Representation of healthcare provider in internal investigation and shareholder litigation stemming from allegations of widespread financial misconduct.
• Representation of provider in matters including conflicts of interest under the Government Code by member of Board of Directors.
• Defense of investigations by the Office of the Inspector General regarding improper overhead charging and compliance with FMS fraud regulations.
• Defense of civil action and related investigation by the OIG regarding government contract kick-backs and improper charging.
• Representation of numerous hospitals in complex contract and tort disputes.

Representative Other Matters

• Defense of criminal investigation and civil qui tam action stemming from allegations that a defense contractor submitted inflated price proposals in violation of the Federal False Claims Act.
• Defense of civil qui tam action stemming from allegations of false claims in connection with the construction and outfitting of a major government semiconductor manufacturing facility.
• Defense of refiner and gasoline marketer in multiple tort actions, including product liability actions involving the gasoline oxygenate, MTBE, actions under Prop. 65, defense of injuries and wrongful death actions following refinery explosion, and a variety of other business disputes.
• Defense of petroleum franchisor in antitrust and PMPA action challenging the acquisition of Union 76 assets.  Successful summary judgment affirmed in published 9th Circuit decision.
• Defense of petroleum franchisor in PMPA action challenging the re-branding of all west coast BP stations to the Union 76 brand.  Successful summary judgment affirmed in published 9th Circuit decision.