Health Care

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.

Guided the company through a criminal DOJ investigation into alleged Medicare fraud at HealthSun Health Plans—an entity acquired by Elevance Health—culminating in the DOJ’s formal decision not to prosecute HealthSun, marking the first time DOJ has applied its Corporate Enforcement Policy to decline bringing criminal charges against a health insurer. 

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.

Advised HCSC, the country’s largest customer-owned health insurer, on the healthcare regulatory aspects relating to its definitive agreement to acquire the Medicare Advantage, Medicare Supplemental Benefits, Medicare Part D, and CareAllies businesses from Cigna, a global health company, for US$3.3 billion. 

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.