Health Litigation and Administrative Advocacy

Overview

Health care providers and companies involved in the health care industry face unique legal and business risks. Keeping pace with the business and regulatory challenges of health care in today's competitive environment is more important than ever in this fast-changing age of health care reform.

Robinson+Cole's Health Law Group offers a dedicated team of litigation lawyers with a comprehensive understanding of health care-related litigation and disputes as well as of the health care industry in general. Our health litigation and administrative advocacy lawyers work with clients not only to achieve success in litigation but also to manage and reduce risk and meet our clients' business objectives. We represent health care entities in civil and criminal litigation, arbitration, administrative agency actions, and appeals.

Our Services and Our Team

The lawyers in our Health Law Group represent all types of clients in the health care industry, including the following:
•  for-profit and nonprofit health care providers and hospital systems
•  home health agencies
•  nursing homes
•  pharmaceutical manufacturers and retail pharmacies
•  outpatient and imaging centers
•  assisted living facilities
•  human services agencies

We deal with all manner of  litigation and regulatory matters, including in these areas:
•  antitrust claims
•  commercial and class action litigation
•  commercial disputes
•  class actions against health system clients
•  state and federal government investigations
•  reimbursement and recoupment actions by government payors and contracted auditors
•  fraud, abuse, and whistleblower claims
•  data breach regulatory investigations and litigation
•  medical staff and credentialing disputes
•  pharmaceutical market conduct litigation

In addition, Robinson+Cole lawyers handle state and federal civil and criminal health care investigations conducted by these entities:
•  state lawyers
•  general and Medicaid fraud units
•  the U.S. Attorney's Office and the Department of Justice
•  the Department of Health and Human Services, Office of Inspector General
•  the Federal Bureau of Investigation

In representing the litigation and risk management needs of our health care clients, members of our Health Law Group appear in matters before state and federal courts, state Medicaid agencies, and state and federal regulatory and licensure agencies.
 

    • Experience
      • Represented one of Connecticut’s largest providers of home health services in connection with a multi-agency federal and state investigation into the company’s billing practices. Worked closely with the client to conduct an internal investigation of the agency’s billing processes to identify potential areas of exposure and to develop a comprehensive corporate compliance program. Successfully persuaded the United States Attorney’s Office not to pursue charges and to issue a formal declination letter.
      • Represented Connecticut hospital in connection with quality of care investigation by the Department of Public Health. Prepared and defended witnesses in interviews with state investigators, coordinated all aspects of compliance with document demands, and appeared in related individual licensure hearings on behalf of the hospital.
      • Represented emergency medical service corporation and principals in criminal investigation involving potential Medicare fraud. Avoided prosecution and termination of Medicare participation status through negotiated resolution of civil monetary penalties.
      • Represented a hospital network and behavioral health center in an investigation of billing practices brought by the Federal Bureau of Investigation and the Office of the Inspector General.
      • Represented hospital in claim by surgeon of wrongful termination of staff privileges. Defended case successfully through administrative hearings, trial and appeal to Connecticut Supreme Court, establishing legal standard of substantial compliance with bylaws hearing procedures.
      • Represented hospital in claim of wrongful failure to certify resident’s successful completion of surgical residency program. Defended case successfully through administrative hearings, trial and appeal, establishing legal standard rejecting educational malpractice claim and establishing hospital’s discretion to make professional competence determinations.
      • Regularly advise and represent hospitals in peer review matters and administrative proceedings under medical staff bylaws to terminate, reduce or suspend clinical privileges.
      • Regularly serve as counsel to hearing committees or as hearing officer in administrative proceedings under medical staff bylaws to terminate, reduce or suspend clinical privileges.
      • Defended hospital in class action case brought on behalf of deaf and hearing impaired community. Negotiated settlement with Connecticut Attorney General and United States Justice Department to improve systemwide access to health services for deaf and hearing impaired patients.
      • Ongoing representation of major pharmaceutical manufacturer in a lawsuit brought by the Connecticut Attorney General seeking recovery of Medicaid and Medicare payments made for certain pharmaceuticals.
      • Represented substance abuse treatment center before municipal land use commissions in defending against zoning enforcement actions. Obtained order from federal court allowing clients to continue making off campus housing available to their patients.
      • Ongoing representation of a physician-hospital organization and affiliated independent practitioner association in a multi-party medical malpractice lawsuit.
      • Defended hospital in class action litigation alleging violation of state statutes relating to medical records requests. Negotiated binding resolution of class action for nominal financial cost.
      • Represented state’s only freestanding children’s hospital in certificate of need proceedings involving relocation of hospital, construction of new facility and combination of fragmented regional pediatric care.
      • Represented hospital in certificate of need proceeding to secure major expansion of cardiac care to include open heart surgery and angioplasty.
      • Regularly appear before the Connecticut Office of Healthcare Access in connection with contested certificate of need matters, change in control, capital expenditures and other regulatory hearings.
      • Regularly advise and represent clients in administrative licensure investigations and proceedings before the Connecticut Department of Public Health. Experience includes negotiation of consent agreements, compliance audit counseling and adverse event investigations.
      • Regularly advise and represent clients in proceedings before the Connecticut Department of Social Services regarding financial audits, administrative sanctions and Title XIX appeals.
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    • News
      • September 21, 2022

        Conor Duffy and Ben Daniels Author Article on Second Circuit Interpretation of the Anti-Kickback Statute for Physicians Practice

        • » more info

          Conor Duffy and Ben Daniels Author Article on Second Circuit Interpretation of the Anti-Kickback Statute for Physicians Practice

          Health Law Group member Conor O. Duffy and Business Litigation Group member Benjamin M. Daniels authored the article “Second Circuit affirms HHS rejection of direct copayment assistance under anti-kickback statute,” published in Physicians Practice on September 16, 2022. The article examines the recent decision by the U.S. Court of Appeals for the Second Circuit that rejected an appeal brought by Pfizer, Inc., regarding possible violation of the Anti-Kickback Statute (AKS). The decision addressed a proposed direct copayment assistance program where reimbursements would go directly to the patient looking to buy Pfizer’s own drugs. The Second Circuit upheld the Department of Health and Human Services’ (HHS) interpretation of the AKS as prohibiting the arrangement, which reiterates for health care organizations the importance of adhering to HHS guidance concerning federal fraud and abuse laws. The decision also emphasizes the government’s continued concerns with patient copayment assistance programs associated with pharmaceutical manufacturers that can directly influence purchases of the manufacturers’ drugs. This decision represents an important affirmation of HHS’ interpretive authority over the scope of the AKS and implicitly reinforces recent HHS guidance. Read the article.

        • View article
      • October 24, 2018

        Robinson+Cole Recognized by Benchmark Litigation

      • April 28, 2017

        R+C Attorneys Present an Update on Managed Care Litigation

        • » more info

          R+C Attorneys Present an Update on Managed Care Litigation

          Health and Benefits Litigation lawyers Ted Tucci and Jean Tomasco presented a webinar on April 19, 2017 entitled, “Managed Care Litigation Update 2017” for a firm client in the specialty risk insurance industry. The webinar began with an overview by Ms. Tomasco of recent claims regarding data breaches, HIPAA, and wage and hour class actions in the health care industry.  After a brief discussion on the status of health care reform under the new administration, Mr. Tucci spoke about several cases against insurers and pharmacy benefit managers regarding pricing issues and hidden fees in the administration of health plans. He also discussed litigation involving overpayment, reimbursement, and subrogation claims. Ms. Tomasco provided an overview of benefit claim litigation and an update on False Claims Act litigation. Professionals from across the healthcare industry, including hospitals, long-term care facilities, and managed care organizations, participated in the webinar.

      • November 7, 2016

        Robinson+Cole Lawyers Present Webinar on False Claims Act Liability Following Recent Supreme Court Case

        • » more info

          Robinson+Cole Lawyers Present Webinar on False Claims Act Liability Following Recent Supreme Court Case

          Health Law Litigation Team lawyers Theodore J. Tucci and Jean E. Tomasco presented a webinar entitled "Escobar: Mitigating Risk of Implied Certification Liability Under the False Claims Act" for a firm client in the specialty risk insurance industry on October 19, 2016. Mr. Tucci provided an overview of the False Claims Act (FCA) and the various theories of liability that have advanced under the law, including the “implied certification” theory whereby each entity that submits a claim for payment to the government (such as through Medicaid) is deemed to implicitly certify compliance with the statutes, regulations, and contract terms applicable to the subject matter of the claim. Ms. Tomasco summarized the facts of the Escobar case, which involved the death of a teenage patient who had been treated by unlicensed providers, and how it wound up before the U.S. Supreme Court. She explained the Supreme Court’s decision, where the Court unanimously concluded that implied certification is a basis for FCA liability provided that (1) the claim does not merely request payment but also makes specific representations about the goods or services provided and (2) the submitter’s failure to disclose noncompliance with material statutory, regulatory, or contractual requirements makes those representations misleading half-truths. The Court further determined that misrepresentations must be material to the government’s payment decision to be actionable. Mr. Tucci concluded with a review of lower court decisions after Escobar, noting that most courts have strictly construed Escobar and the materiality standard as requiring plaintiffs to allege specific details to support “implied certification” FCA claims. The presentation also included practical tips for health care organizations in minimizing the risk of such claims and strategies for litigation. Professionals from across the nation and from a wide range of health care settings, such as hospitals, long-term care facilities, and managed care organizations, participated in the webinar. 

      • April 22, 2015

        Robinson+Cole Lawyers Present Update on Managed Care Litigation

        • » more info

          Robinson+Cole Lawyers Present Update on Managed Care Litigation

          Health and benefits litigation lawyers Theodore J. Tucci and Jean E. Tomasco presented a webinar entitled "Managed Care Litigation Update 2015" for a firm client in the specialty risk insurance industry on April 8, 2015. Mr. Tucci covered litigation concerning provider reimbursement and network management, benefits recoupment cases under ERISA, and potential antitrust exposure from consolidation and new market models. He also spoke about possible claims arising under the Affordable Care Act. Ms. Tomasco provided an overview of recent cases concerning benefits coverage discrimination claims and mental health parity, as well as an update on litigation under the False Claims Act and lawsuits arising from recent data breaches in the health care industry. Well over 80 professionals from across the nation and from a wide range of health care settings, including hospitals, long-term care facilities, and managed care organizations, registered for the webinar.

      • October 21, 2013

        Super Lawyers® Names 61 Robinson & Cole Attorneys to 2013 List

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          Super Lawyers® Names 61 Robinson & Cole Attorneys to 2013 List

          A total of 61 Robinson & Cole attorneys were named Super Lawyers® in the states of Connecticut, Massachusetts, New York, and Florida for 2013. The Super Lawyers® designation is based on regional balloting by attorneys, third-party research, and a peer review process encompassing myriad practice areas.

          In addition, 19 attorneys at the firm were recognized as "Rising Stars." Read an explanation of the Super Lawyers methodology here.

        • View article
      • June 30, 2012

        Theodore J. Tucci to Participate in the Metro Hartford Alliance’s Panel Discussion on the U.S. Supreme Court’s Ruling on Health Care Reform

        • » more info

          Theodore J. Tucci to Participate in the Metro Hartford Alliance’s Panel Discussion on the U.S. Supreme Court’s Ruling on Health Care Reform

          Join leading health lawyers and professionals at Metro Hartford Alliance’s Rising Star Breakfast series on July 10, 2012, at The Bushnell Center for the Performing Arts in Hartford, Connecticut.

          The Metro Hartford Alliance Rising Star Breakfast series will host a panel discussion on the U.S. Supreme Court’s ruling on health care reform featuring:

          • Theodore J. Tucci, Partner, Robinson & Cole LLP
          • Kevin Counihan, Chief Executive Officer, Connecticut Health Insurance Exchange
          • J. Bruce Boisture, Of Counsel, Day Pitney LLP
          The program runs from 8:00 to 9:00 a.m. Registration, networking, and continental breakfast begins at 7:30 a.m.

          For more information and to register, click here.
      • June 15, 2012

        Robinson & Cole Attorneys Win False Claims Act Cases

        • » more info

          Robinson & Cole Attorneys Win False Claims Act Cases

          Business litigation attorneys Michael J. Kolosky, Theodore J. Tucci, and Jean E. Tomasco obtained dismissal of all qui tam charges before discovery in two federal court cases in March 2012 involving the federal False Claims Act.

          In the first case, Mr. Kolosky and Ms. Tomasco represented a Federally Qualified Health Center (FQHC) in a qui tam case brought by a former billing manager alleging the FQHC violated the federal False Claims Act by submitting false claims for reimbursement and by making false statements in federal grant applications.

          In the second case, Mr. Kolosky and Mr. Tucci represented a national specialty pharmacy company in a qui tam case brought by the former sales manager of a pharmaceutical manufacturer. The sales manager alleged violations of the Anti-Kickback Statute and the federal and state False Claims Act arising out of kickbacks the pharmaceutical manufacturer allegedly paid the specialty pharmacy to induce its purchase of Risperdal Consta, an antipsychotic medication.

          The June 2012 issue of the Health Law Pulse newsletter has full summaries of each case.
      • June 7, 2012

        Chambers USA Ranks Robinson & Cole in Five Practices, Names 16 Attorneys as Leading Lawyers

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          Chambers USA Ranks Robinson & Cole in Five Practices, Names 16 Attorneys as Leading Lawyers

          Robinson & Cole LLP announced today that the legal directory Chambers USA: America's Leading Lawyers for Business has recognized the firm in five practice area categories in its 2012 edition and has individually recognized 16 of the firm's attorneys.

        • View article
      • June 8, 2011

        Robinson & Cole Attorneys Present Webinar on Accountable Care Organizations (ACOs)

        • » more info

          Robinson & Cole Attorneys Present Webinar on Accountable Care Organizations (ACOs)

          Theodore J. Tucci, Michael J. Kolosky, and Jean E. Tomasco presented a webinar entitled "ACO Liability and Risk Management Issues: The Managed Care Perspective," hosted by OneBeacon Professional Insurance (OBPI). The webinar addressed the ACO regulations recently proposed by the federal government, identified potential liability issues faced by ACOs and payers in the commercial health insurance market, and provided practical guidance for managing those risks in the contracting, risk management, and litigation contexts.
      • May 14, 2010

        Robinson & Cole Attorney Speaks at Healthcare Reform Program

        • » more info

          Robinson & Cole Attorney Speaks at Healthcare Reform Program

          Health litigation and administrative advocacy attorney Michael J. Kolosky recently spoke at the program “Health Care Reform Update: Impact on Professional Liability” hosted by the Hartford chapter of the Professional Liability Underwriting Society (PLUS). Mr. Kolosky participated in a panel discussion regarding the impact of health care reform in the managed care and hospital liability context. Former Connecticut Governor Lowell Weicker, Jr. was the keynote speaker. Other speakers included Stephen Geib, senior vice president and health care industry practice leader for Willis; Susan Angelo, vice president and managed care division leader for OneBeacon; Josh Stein, chief underwriting officer of IronHealth; and Kevin Dean, assistant vice president for health care management claims for Allied World Assurance.
      • August 13, 2008

        Robinson & Cole Attorneys Publish Article in Connecticut Medicine Magazine

        • » more info

          Robinson & Cole Attorneys Publish Article in Connecticut Medicine Magazine

          Health Litigation attorney Theodore J. Tucci and Health Law attorney Brian D. Nichols recently published the article "A Guide to Connecticut’s Certificate-of-Need Process" in the June/July issue of Connecticut Medicine Magazine. To read article, please click here.
    • Publications + Presentations
    • "Managed Care Litigation Update 2017," co-presented by Jean E. Tomasco and Theodore J. Tucci, a webinar for a firm client in the specialty risk insurance industry. (4/19/2017)
      • » more info

        • Managed Care Litigation Update 2017

        "Managed Care Litigation Update 2017," co-presented by Jean E. Tomasco and Theodore J. Tucci, a webinar for a firm client in the specialty risk insurance industry. (4/19/2017)

        The webinar began with an overview by Ms. Tomasco of recent claims regarding data breaches, HIPAA, and wage and hour class actions in the health care industry.  After a brief discussion on the status of health care reform under the new administration, Mr. Tucci spoke about several cases against insurers and pharmacy benefit managers regarding pricing issues and hidden fees in the administration of health plans. He also discussed litigation involving overpayment, reimbursement, and subrogation claims. Ms. Tomasco provided an overview of benefit claim litigation and an update on False Claims Act litigation. Professionals from across the healthcare industry, including hospitals, long-term care facilities, and managed care organizations, participated in the webinar.


      "Escobar: Mitigating Risk of Implied Certification Liability Under the False Claims Act," co-presented by Theodore J. Tucci and Jean E. Tomasco, webinar, for a client in the specialty risk insurance industry (10/19/2016)
      • » more info

        • Escobar: Mitigating Risk of Implied Certification Liability Under the False Claims Act

        "Escobar: Mitigating Risk of Implied Certification Liability Under the False Claims Act," co-presented by Theodore J. Tucci and Jean E. Tomasco, webinar, for a client in the specialty risk insurance industry (10/19/2016)

        Mr. Tucci provided an overview of the False Claims Act (FCA) and the various theories of liability that have advanced under the law, including the “implied certification” theory whereby each entity that submits a claim for payment to the government (such as through Medicaid) is deemed to implicitly certify compliance with the statutes, regulations, and contract terms applicable to the subject matter of the claim. Ms. Tomasco summarized the facts of the Escobar case, which involved the death of a teenage patient who had been treated by unlicensed providers, and how it wound up before the U.S. Supreme Court. She explained the Supreme Court’s decision, where the Court unanimously concluded that implied certification is a basis for FCA liability provided that (1) the claim does not merely request payment but also makes specific representations about the goods or services provided and (2) the submitter’s failure to disclose noncompliance with material statutory, regulatory, or contractual requirements makes those representations misleading half-truths. The Court further determined that misrepresentations must be material to the government’s payment decision to be actionable. Mr. Tucci concluded with a review of lower court decisions after Escobar, noting that most courts have strictly construed Escobar and the materiality standard as requiring plaintiffs to allege specific details to support “implied certification” FCA claims. The presentation also included practical tips for health care organizations in minimizing the risk of such claims and strategies for litigation. Professionals from across the nation and from a wide range of health care settings, such as hospitals, long-term care facilities, and managed care organizations, participated in the webinar. 


      "Managed Care Litigation Update 2016," co-presented by Jean E. Tomasco and Theodore J. Tucci, a webinar for a firm client in the specialty risk insurance industry (3/30/2016)
      • » more info

        • Managed Care Litigation Update 2016

        "Managed Care Litigation Update 2016," co-presented by Jean E. Tomasco and Theodore J. Tucci, a webinar for a firm client in the specialty risk insurance industry (3/30/2016)

        After starting with a brief summary of managed care market trends and litigation data for the past year, Mr. Tucci spoke about cases brought by patients and plan members against insurers and managed care entities, such as lawsuits involving alleged misrepresentations concerning plan networks and claims for benefit parity. He also addressed litigation brought by insurers and other payors, including cases brought against providers for unfair billing practices, waiver of cost-sharing requirements, and referral incentives. Ms. Tomasco provided an overview of trends in litigation brought by providers against managed care organizations, for example, antitrust claims, suits involving claims for payment under benefit assignment agreements, network participation claims, and contract disputes. The presentation also included an overview of recent cases concerning ERISA preemption and the False Claims Act as well as regulatory initiatives for 2016. Professionals from across the nation and from a wide range of health care settings, such as hospitals, long-term care facilities, and managed care organizations, participated in the webinar.


      "Managed Care Litigation Update 2015," co-presented by Theodore J. Tucci and Jean E. Tomasco, a webinar for a firm client in the specialty risk insurance industry (4/8/2015)
      • » more info

        • Managed Care Litigation Update 2015

        "Managed Care Litigation Update 2015," co-presented by Theodore J. Tucci and Jean E. Tomasco, a webinar for a firm client in the specialty risk insurance industry (4/8/2015)

        Mr. Tucci covered litigation concerning provider reimbursement and network management, benefits recoupment cases under ERISA, and potential antitrust exposure from consolidation and new market models. He also spoke about possible claims arising under the Affordable Care Act. Ms. Tomasco provided an overview of recent cases concerning benefits coverage discrimination claims and mental health parity, as well as an update on litigation under the False Claims Act and lawsuits arising from recent data breaches in the health care industry. Well over 80 professionals from across the nation and from a wide range of health care settings, including hospitals, long-term care facilities, and managed care organizations, registered for the webinar.


      "CMS Releases Final Sunshine Act Rule" (03/12/2013)

      "FTC Issues Favorable Advisory Opinion to Clinically Integrated PHO" (02/28/2013)

      "HIPAA Omnibus Rule Released" (02/13/2013)

      "CT DSS Issues Proposed Audit Regulations" (10/18/2012)

      "Health Law Pulse" (06/01/2012)

      "ACO Liability and Risk Management Issues: The Managed Care Perspective," co-presented by Jean E. Tomasco, Theodore J. Tucci and Michael J. Kolosky, webinar (5/2011)

Our Team

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