Health Care
In a complex industry that faces continuous legal and regulatory challenges, O’Melveny defends health care clients against financial and reputational harm while working to advance their business objectives.
“Exceptional in every way”—Client Testimonial, The Legal 500 US, Healthcare
In a complex industry that faces continuous legal and regulatory challenges, O’Melveny defends health care clients against financial and reputational harm while working to advance their business objectives.
“Exceptional in every way”—Client Testimonial, The Legal 500 US, Healthcare
Our lawyers understand both the law and business of health care. That perspective helps us guide clients from every sector—managed care, hospitals, home health care providers, and health care investors—through the challenges of a complex, highly regulated industry. Our clients benefit from our team’s insider perspective, which includes a number of former senior governmental appointees, regulators, investigators, and prosecutors. This allows us to pursue a wide range of goals for clients, from standing up to scrutiny by federal and state enforcement and regulatory agencies, defeating critical class action allegations, defending companies in jury and bench trials, protecting intellectual property, and completing strategic acquisitions.
We have unmatched experience defending managed care organizations against actions brought by federal and state enforcement authorities, insider whistleblowers, and opportunistic relators alleging violations of Medicare Advantage, Medicare Part D, and Medicaid managed care. We defend companies against alleged False Claims Act violations, RICO allegations, kickback and misbranding claims, and other disputes over claims submissions and reimbursement rates. We represent numerous Medicare Advantage insurers involved in ongoing civil DOJ investigations, HHS OIG investigations and audits, and internal investigations that extend to a wide variety of business practices, including payments to providers, government claims submissions, and medical loss ratio compliance.
We routinely help clients develop and enhance compliance programs to assess and mitigate risks before they face government inquiries or civil litigation. And we counsel clients on proposed regulation response strategies in preparation for administrative procedure act challenges to new rules reflecting shifts in health care policy.
We have particular experience advising on health care-specific issues in the context of strategic and crisis management situations, including regulatory compliance audits and enforcement agency investigations. We also have experience interpreting and reconciling varying state laws governing the distribution of opioids and advising clients on HIPAA compliance and other privacy issues that arise in the course of business, internal investigations, and litigation
On the corporate side, we guide health care companies and industry investors through a range of transactions, from large-scale strategic acquisitions to private and public financings to debt restructurings and reorganizations.
Erased judgment exposing the client to US$10 million in insurance liability for the costs of defending a host of lawsuits alleging that a hospital engaged in fraudulent billing practices. After a series of trial court rulings found a duty to defend and ordered Allied World to begin paying hospital defense costs, we persuaded the Kentucky Court of Appeals that a policy exclusion for previously reported losses eliminated any possibility of coverage for the hospital’s costs.
Advised private equity sponsor Allomer Capital Group on its acquisition of an 82% interest in pharmacy automation solutions provider Innovation Associates and in the subsequent US$450 million sale of a majority interest in the company to Walgreens.
Defending against litigation launched by the DOJ in the Southern District of New York over the company’s Medicare Advantage risk-adjustment practices. The DOJ’s lawsuit is part of an industry-wide inquiry into risk-adjustment practices under Part C of the Medicare program.
Represented HCSC against the federal government before the Federal Court of Claims, resulting in a US$2 billion award to HCSC for unpaid risk corridor payments related to the Affordable Care Act.
Defended Humana in U.S. ex rel. Olivia Graves v. Plaza Medical Centers Corp. et al., a False Claims Act case and related investigation by the DOJ involving allegations that the Company failed to comply with certain Medicare Advantage reimbursement requirements.
Winning a significant victory on behalf of Humana in a relator’s appeal to the Eleventh Circuit, which affirmed the district court’s dismissal of the lawsuit with prejudice. The case represents an important holding for defendants in the FCA’s public disclosure bar jurisprudence. U.S. ex rel. Osheroff v. Humana, 776 F.3d 805 (11th Cir. 2015).
Secured a DOJ declination and a dismissal of a False Claims Act lawsuit brought against a major pharmaceutical company regarding its patient support services.
Conducted a proactive compliance review of a client’s interactions with patient groups and its arrangements with specialty pharmacies.
Supported Ripple Health, an innovative online platform for physical, mental, and social health, in all aspects of its growth, from corporate counseling to technology and capital-raising transactions to its merger with Calm, the leading app for sleep and meditation.
Represented the State in two complex transactions to quickly acquire two underutilized hospital facilities in order to expand its capacity to treat COVID-19 patients at the outset of the pandemic. California entered into these agreements with Verity Health Systems of California, a nonprofit hospital operator in bankruptcy proceedings before the US Bankruptcy Court for the Central District of California. The court approved the agreements just eight days after the State retained O’Melveny.
Secured the dismissal of Gozdenovich v. AARP, a putative class action brought against UnitedHealth challenging licensing arrangements for United’s AARP-branded Medigap insurance, an attempt by the plaintiff to discount his legally mandated Medigap insurance premiums.
Representing UnitedHealth subsidiaries in multiple lawsuits filed by out-of-network provider groups affiliated with one of the nation’s largest physician staffing and management companies in disputes over reimbursement rates.
O’Melveny is “strategically and practically amazing to work with. The team provides high-quality legal advice in a very user-friendly way irrespective of whether they are dealing with lawyers, the C-Suite or our frontline staff.”
—Client Testimonial, The Legal 500 US, Healthcare: Health Insurers
“They are outstanding in every way—exceptional at client service.”
—Client Testimonial, Chambers USA, Healthcare: California
“The infrastructure of the firm is very strong allowing them to be nimble and have access to all resources needed for superior legal representation.”
—Client Testimonial, The Legal 500 US, Healthcare: Health Insurers
“Their particular strengths are knowledge and expertise in complex healthcare law issues.”
—Client Testimonial, Chambers USA, Healthcare: California