Shelby Cummings represents healthcare clients in complex litigation, regulatory, enforcement, and transactional matters, with a particular focus on payor provider disputes, False Claims Act litigation, and issues arising from Medicare Advantage reimbursement. She also advises clients on transactions with significant healthcare components and brings a litigation informed approach to structuring, diligence, and risk assessment.
Shelby is experienced in defending FCA matters and advising clients in connection with government investigations, including responding to civil investigative demands and other enforcement inquiries. She represents payors in high stakes disputes involving reimbursement and contractual issues and develops strategic solutions grounded in a deep understanding of healthcare operations and regulatory frameworks.
Earlier in her career, Shelby represented hospitals and health systems, working closely with provider clients on everything from peer review proceedings to government investigations. That provider side experience gives her a comprehensive understanding of how healthcare organizations operate and allows her to approach disputes and enforcement matters with a nuanced, cross industry perspective.
In addition to her litigation practice, Shelby advises clients on mergers, acquisitions, and strategic affiliations involving healthcare entities. She leverages her regulatory and enforcement experience to assist with healthcare focused due diligence, identifying potential compliance and reimbursement risks and helping clients navigate regulatory considerations throughout the transaction lifecycle.
- Counseled healthcare clients on Anti‑Kickback Statute and Civil Monetary Penalties Law compliance, including assessing proposed transaction structures, referral arrangements, and attendant False Claims Act risk.
- Defended a national health insurance company in a series of payor‑provider disputes brought by emergency department and anesthesia staffing companies challenging reimbursement for out‑of‑network services.
- Conducted internal investigations for a major healthcare organization regarding compliance with state and federal healthcare laws, including issues implicating reimbursement, quality oversight, and regulatory reporting obligations.
- Advised a managed care organization on Medicare compliance program requirements and regulatory obligations, including counseling relevant to operational changes and business initiatives.
- Represented a Medicare Advantage insurer in a False Claims Act action brought by the U.S. Department of Justice alleging improper submission of risk adjustment data to CMS.
Admissions
Bar Admissions
- California
Education
- University of Southern California Gould School of Law, J.D.: Charles and Betty S. Wilson Endowed Scholar
- University of Southern California, B.A.
Professional Activities
Speaker
- ABA Health Law Section “Part 1: Healthcare ADR Basics”