Nelson Hardiman has earned a national reputation for its work defending healthcare businesses and institutions from licensing, operational, and reimbursement lawsuits. Our preeminent litigators draw on their trial strengths and relevant government backgrounds to help healthcare providers and suppliers facing diverse legal challenges. On behalf of our clients, we anticipate the impact of state and federal healthcare policies and provide powerful litigation defense reflecting the surging demand for healthcare regulatory expertise amidst the ongoing transformation of the U.S. healthcare system.
Our team defends healthcare providers sued by whistleblowers and/or the federal government for violations of the False Claims Act, and defend against accusations of fraud and abuse. We litigate on complex business issues that financially impact the operation of healthcare facilities, including precedent-setting decisions that clarify industry-wide standards of practice. With a proven track record of success, Nelson Hardiman attorneys are on the frontline of the challenges facing the healthcare industry to win decisive victories for our clients.
Nelson Hardiman has successfully represented healthcare facilities, providers, professionals, life sciences and technology businesses in arbitrations. Our lawyers are well-versed in the different models of alternative dispute resolution (ADR) in healthcare, and employ ADR as the first line of defense to resolve claims effectively.
Because we know the healthcare system and the laws, regulations and agency guidelines that govern healthcare entities, we leverage arbitration and mediation to help our clients resolve claims fairly and cost-effectively. We also handle subsequent litigation that may arise in federal or state courts in the United States in enforcing arbitral awards or pursuing other lines of defense, contributing to the overall acceptance of ADR by the healthcare industry.
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Nelson Hardiman’s team of seasoned litigators and former federal prosecutors zealously protect healthcare and life sciences entities and individuals threatened by business litigation and commercial disputes. We harness our in-depth knowledge of the healthcare industry and related business operations to align our winning litigation strategies with your business objectives.
Recognized leaders in healthcare law, we blend our national reputation for business expertise and deep experience with underlying regulatory issues to tackle the most complex issues in healthcare. We defend mergers and acquisitions, and litigate contract, operational and intellectual property disputes. We channel our passion and focus for healthcare and life sciences to fiercely defend our clients’ business interests. We fight to win.
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Business Litigation Represented a hospital system in a contract dispute over the sale of one of California’s biggest Catholic hospital systems.
Nelson Hardiman’s marquee False Claims Act (FCA) practice has a national reputation for protecting healthcare systems and related entities sued by whistleblowers and/or the federal government under the FCA. Our market-leading litigators defend healthcare entities from charges of submitting false claims for medical services and items to Medicare and other federal healthcare programs in violation of the FCA.
Our legal team blends a wealth of government experience in healthcare fraud with extensive knowledge of complex statutory, regulatory and agency requirements. We harness the dogged determination of dedicated trial lawyers to decisively resolve FCA claims. Our tenacious stance and industry knowledge make Nelson Hardiman the go-to law firm for defending healthcare whistleblower lawsuits.
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Allegations of health care fraud or abuse, whether alleged by state or federal government or private entities, can be devastating. There has been a steady expansion in the definition of what constitutes “fraud”; what was once considered a “billing error” is increasingly treated as fraud and abuse. The increasing size and scope of recent Medicare fraud investigations and prosecutions is emblematic of this trend and the increasing aggressiveness of not only the federal government, but also the State of California and private health insurers, making the need for experienced and sound counsel greater than ever.
Few law firms can boast as much experience as Nelson Hardiman in defending healthcare providers against allegations of fraud and abuse. Mark Hardiman, who leads Nelson Hardiman’s fraud and abuse practice area, spent eight and a half years with the United States Attorney’s Office in Los Angeles before entering private practice, where he was assigned to the Major Frauds and Major Crimes section. Mark is widely known among healthcare providers as the go-to defense lawyer for difficult and high-stakes Medicare and Medi-Cal fraud cases and is regarded as one of the most prominent fraud and abuse defense attorneys in California, a reputation he has earned, case-by-case, through victories and favorable resolutions he has obtained over more than a decade of representing and advising health care providers with respect to all facets of criminal investigations and charges, civil False Claims Act (FCA) and fraud lawsuits.
On a daily basis, Nelson Hardiman counsels health care providers on how to avoid allegations and how to respond when they arise. Charges of healthcare fraud and abuse are inevitably challenging and sensitive; there are many areas of healthcare regulatory compliance where providers are at risk of such charges. For example, we have represented multiple providers in major “civil RICO” lawsuits brought by out-of-state health insurance companies against California physicians accused of cooperating with dishonest clinic managers in performing unnecessarily. We have defended countless fraud investigations by federal and state government agencies. Our experience includes defense of:
We have successfully represented countless individual physicians and healthcare facilities against such allegations in many of the leading cases filed in Southern California. We have won significant victories at trial and on appeal. When in our clients’ best interests, we have also negotiated favorable settlements with federal and state regulatory agencies.
In handling such cases, we are able to draw upon our vast knowledge and experience of healthcare compliance issues, including Medicare, Medi-Cal, and private insurance coverage Our track record of good results in these cases are a testament to our ability to leverage that knowledge and experience In addition, our experience provides us ample resources to assist in development of compliance programs to minimize the risk of fraud and abuse litigation.
Accelerated healthcare reform has transformed the landscape of practice for all healthcare providers and professionals. Nelson Hardiman has first-hand experience in adroitly handling labor and employment disputes that arise in this challenging new environment.
Our litigators defend against claims from all phases of the employment cycle, including peer review, wrongful termination, administrative proceedings, agency investigations and enforcement, licensing and other areas of regulation. From physician contract disputes to professional claims and medical staff issues, we combine business acumen with litigation strengths to provide our healthcare and life sciences clients with labor and employment representation they can count on.
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Nelson Hardiman is a leader in reimbursement litigation for healthcare providers ranging from large hospitals to individual physicians. Because our talented litigators have a firm grasp on federal and state healthcare regulatory law, we frequently represent both providers who are suing to obtain payment and providers defending claims that they have been overpaid for health care services.
We are one of the most experienced firms in Southern California handling Medicare and Medi-Cal administrative proceedings. We litigate against insurance companies in state and federal court and in arbitration proceedings. We represent hospitals suing health plans and defend physician practices against reimbursement litigation by insurers. We obtain drastic reductions of overpayment claims, with a track record of success built on in-depth knowledge of the agencies, their reimbursement policies, and our integration of problem-solving skills and expert resources. While we fiercely litigate on behalf of healthcare providers, Nelson Hardiman also works hard to resolve disputes with federal healthcare programs and healthcare payors. We meet regularly with decision-makers and administrative agencies to reach consensus on reimbursement-related disputes.
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In dealing with state and federal healthcare agencies, Nelson Hardiman regularly files writ proceedings to compel compliance with the law. At the state level, Nelson Hardiman has significant experience in writs of mandamus and administrative mandate proceedings against various state agencies, including the California Department of Health Care Services, Medical Board of California, and others. California law affords two primary avenues of recourse: Code of Civil Procedure Section 1085, which permits challenges to arbitrary and capricious failures to perform ministerial duties, and Section 1094.5, which allows recourse when administrative hearings are conducted unfairly or end in results that do not comport with the evidence presented. In addition to use of writ proceedings against governmental entities, occasionally, Nelson Hardiman utilizes mandamus proceedings to challenge private administrative actions by hospitals and others.
At the federal level, Nelson Hardiman has made pioneering use of writ proceedings on behalf of clients who cannot obtain satisfactory relief in the ordinary course of administrative practice.
Nelson Hardiman has been widely recognized for its appellate practice. We have made significant contributions to the development of California healthcare law in both state and federal appellate courts. On behalf of physicians and hospitals, Nelson Hardiman has won landmark decisions before the California Supreme Court, the Ninth Circuit Federal Court and the California Appellate Courts. As a leader in the area of healthcare law, Nelson Hardiman’s appellate victories have established precedents that have greatly expanded the rights of physicians and healthcare providers.
We regularly represent physicians and other healthcare providers in appeals concerning such topics as peer review, medical staff privileges, and the rights of providers against federal, state, and local government and third party payors. Some representative successes on appeal include:
These cases are but a few of the many important appeals that Nelson Hardiman has secured victories on behalf of providers. We have also secured victories for hospitals, including reinstating a lawsuit against an insurance company in San Joaquin Hospital v. Pacificare. We are frequently requested to file amicus briefs in leading healthcare cases.
In addition to our appellate practice in the courts, our extensive writ practice involves many appeals of administrative actions by such agencies as the Medical Board of California, the Department of Health Care Services, and other state and federal agencies.