Overview
American health care is transforming. While battles over health care reform continue to be waged in the legislative arena, a host of issues are being decided in the courtroom.
Our health care litigation practice is committed to protecting the interests of providers and payors.
We offer an unparalleled combination of deep understanding of the complex and dynamic health care field; strong relationships with and high-level access to the regulatory, legislative and enforcement entities and officials critical to your business; and the ability and experience to take complex matters to trial.
Our ability to provide outstanding service to our clients is significantly enhanced by our extensive and practices. Our experience in the nation’s two most innovative and complex health care law environments—California and New York—combined with our respected government advocacy capabilities in the District of Columbia, Sacramento and Albany enable us to provide health care clients with unsurpassed legal and business advice. We have been at the forefront of virtually every major provider and health plan litigation issue in California in the past five years. Our health care regulatory and corporate practitioners also help our health care industry clients structure their operations to avoid litigation down the road.
The fact that our litigators have addressed your issues before not only gives us an edge in the courtroom, but it yields considerable cost savings for you.
Who we work with
We work with some of the most successful health care companies in the U.S., including:
- Managed care organizations and insurers
- Hospitals and health systems
- Long-term care and post-acute care providers
- Pharmaceuticals
- Medical devices
- Ancillary services providers
What we do
At the end of the day, results are what count, and simply put, we win cases. Over the past five years we have prevailed for our clients in noteworthy, precedent-setting lawsuits, including some that pundits (and sometimes even our clients) considered unwinnable. Our wide-ranging work includes:
- Provider-payor disputes
- Enrollee-plan disputes
- Claims and bad faith disputes
- qui tam claims
- Rate disputes
- Class actions and complex civil litigation
- ERISA/FEHBA
- Fraud and abuse/reimbursement
- False Claims Act
- Internal investigations
- Medicare and Medicaid reimbursement
- Privacy and data security
- Governmental investigations and recoupment actions
Experience
At the end of the day, results are what count and, simply put, we win cases. Over the past five years we have prevailed for our clients in noteworthy, precedent-setting lawsuits, including some that pundits (and sometimes even by our clients) considered unwinnable. Some examples:
- California's entire HMO system was on trial in a lawsuit against our client, a major California health plan. At issue was whether the state's health plans could be held responsible for decisions they delegated to medical groups. The plaintiff had been denied certain medical services by the delegated medical group, including an MRI, and later was found to have a brain tumor. We prevailed before a Los Angeles jury at trial while also blocking filmmaker Michael Moore from turning the jury trial into a circus. The court of appeals subsequently handed down a unanimous opinion, adopting our legal arguments and making new law in California.
- We recently prevailed on behalf of a hospital system in an important published appellate decision involving medical staffing. The decision affirmed the ultimate authority of our client's governing body to decide who gets to practice at the hospital. In Ellison v. Sequoia Health Services, a judicial review committee (JRC) refused to recommend corrective action regarding a physician who was dishonest about his professional background and qualifications. The JRC had itself found the physician was dishonest, but it would not recommend any remedy to match its finding. That left it to the hospital's board to act, which it did by terminating the physician's medical staff membership and privileges.
- In the first health plan rescission case tried to a jury, we prevailed for a California health plan in a much-watched jury trial in California concerning the carrier's right to rescind a plan agreement based on misrepresentations made by the plaintiffs in their application for coverage.
- We successfully defended a nursing home management company and several affiliates in a putative class action challenging the standard of care at the facilities and alleging violations of various state and federal regulations. The court sustained our demurrer without leave to amend, concluding that the plaintiff lacked standing to pursue a Consumers Legal Remedies Act claim.
- We obtained summary judgment for a multihospital system in a class action suit claiming that our clients' hospitals throughout Southern California conspired to suppress salaries for nurses. The lawsuit is similar to other cases pending across the United States and was the first one where summary judgment was obtained.
- We have acted as lead counsel for a variety of health care entities in more than 25 Medicare- or Medicaid-related matters, including cases brought under the federal False Claims Act, and in more than 100 Medicare- or Medicaid-related civil and criminal investigations. The subject matters of these cases has ranged from billing, quality of care and wrongful death issues to failure by government agencies to follow applicable statutes and regulations. We have also litigated a variety of cases for Medicare Advantage plans, including successfully establishing federal preemption and obtaining dismissals for failure to exhaust the Medicare Advantage review procedures.
- We represented a health plan in a RICO action brought by a nationwide class of 900,000 physicians. Filed in 2003, the suit alleged that every one of our client's health plans in the country had engaged in a RICO conspiracy to systematically underpay physicians. Over the years this suit was pending, almost every other insurer decided to settle for hundreds of millions of dollars in cash payments to the class, along with commitments to make important business changes over a multiyear period. Similarly, almost all the defendant health plans opted to settle, but our client did not. In early 2009, the district court in Miami granted our client's motion to dismiss with prejudice.
- After a decade of unsuccessful attempts to merge and having dealt with prosecutions filed by the DOJ and the state of Florida, a Florida-based hospital system hired Manatt. Working with the government, we secured early termination of the waiting period under the Hart-Scott-Rodino Act and, within a year, handled a merger of the two hospital systems without litigation.
- We prevailed for a health plan client on ERISA preemption grounds in a class action that asserted various state law causes of action alleging that our client had violated the emergency care provisions of the Knox-Keene Act. The plaintiff argued that ERISA could not preempt claims arising under California's unfair competition law, which at the time did not require a plaintiff to have suffered any injury in order to maintain a claim. Among other arguments, the plaintiff asserted—in a question of first impression—that if anyone, including an uninjured person, could bring a UCL claim under California law, persons in ERISA plans certainly could do so as well. The trial court rejected this argument, holding that ERISA preempted the claims. The Ninth Circuit affirmed in a published decision.
- In a case of first impression affirming dismissal of a UCL action against our health care provider client, the appellate court held that the trial court properly abstained from adjudicating claims that would have required the court to usurp the assigned state agency's regulatory authority over nurse staffing.
- On behalf of a New York health plan, we challenged denial by the New York State Insurance Department regarding proposed reconfiguration of our health insurer client's rating region and obtained an order from the New York State Supreme Court requiring the department to grant our client's request.
- We successfully represented a major health care system in a first impression decision affirming dismissal of a proposed class action complaint that alleged system wide violations of the California Labor Code and UCL based on alleged failure to pay for rest and meal breaks for labor and delivery nurses.
- We represented hospitals and nursing facilities in obtaining dismissal of litigation brought by Erin Brockovich seeking to recover sums allegedly due the federal government under the Medicare Secondary Payer Act.
- On behalf of a nursing home provider, we obtained dismissal of a UCL class action alleging unlawful and unfair practices relating to the purchase of indemnity insurance for claims made under California's Elder Abuse Act.
- We represented a dental service provider in litigation concerning regulatory compliance and corporate governance.
- On behalf of a physician group, we obtained a permanent injunction under the UCL prohibiting a competitor from accepting unlawful kickbacks for patient referrals, as well as an award of attorneys' fees.
Related Practices
Class Actions
Employment and Labor
Health Care Transactions
Investigations, Compliance and White Collar Defense
Manatt Health
Select Clients
Blue Shield of California
Dignity Health
HealthNet
HealthNow New York
Kaiser Permanente
Kindred Healthcare
St. Joseph Health System
Tenet Healthcare Corp.
