Health Care IndustryExperience
Defense of a Supplier Through a Health Care Fraud Investigation
Defended a DME supplier in an extensive federal criminal/civil health care fraud investigation involving the alleged submission of false claims (FCA) to the federal and state health care programs by upcoding, improperly using billing modifiers, and other allegedly fraudulent billing practices. The matter was resolved with civil payback and client avoided criminal penalties.
Representation of Large National Health Insurer in ERISA Litigation
Handled all aspects of health plan denial of benefits issues in numerous lawsuits and administrative claims, in particular analyzing whether plans were ERISA or non-ERISA plans, whether claims were governed by federal or state law, whether administrative process was followed, and defended against claims brought by participants for denial of benefits, breach of fiduciary duty, and other ERISA-related and/or state law claims.
Edward Hamilton v. Ohio Department of Health
Three Ohio AIDS patients filed a lawsuit against the director of the Ohio Department of Health (ODH) to prevent enforcement of proposed rules that would arbitrarily deny funding for potentially life-saving medications to Ohio residents infected with HIV or suffering from AIDS-related symptoms. Defendants claimed that ODH failed to follow statutory rule-making process and the proposed rules were unenforceable. Court agreed that public interest would be served by protecting the right of a public hearing, and issued preliminary injunction preventing ODH from implementing new rules pending resolution of the lawsuit.
Subpoena and Internal Investigation in False Claims Act case Involving Medicaid Drug Rebates
Our attorneys represented a major pharmaceutical distributor in a qui tam case involving the alleged failure to pay Medicaid rebates for repackaged drugs. All of the relator’s claims were dismissed.
Anonymous Plaintiff v. Community Medical Center
Dinsmore & Shohl represented a church whose control of a hospital was challenged by community residents in a class action. The case was settled.
Health Care
I have acted as preventative counsel for various hospital and medical practice groups with regard to labor and employment matters, including the review of employee handbooks, policies and advice concerning discipline and discharge of employees.
United States of America v. Bluefield Regional Medical Center
We represented a hospital in a federal antitrust investigation by the United States Department of Justice regarding an agreement between two hospitals relating to the provision of open heart surgery and cancer services.
Anonymous Plaintiff v. Owners of Nursing Home
The Plaintff sued our client, the owner of a nursing home, for $100,000 for negligence related to a slip and fall. The claim was dismissed on summary judgment.
Acquisition of Acute Care Hospital
Dinsmore represented a non-profit health care enterprise in the multi-million dollar acquisition of a closely-held acute care hospital and related multi-million dollar financing transaction.
Sale of Closely-Held Health Care Enterprise
Dinsmore served as lead counsel representing the sellers of a closely-held health care enterprise in the multi-million dollar asset sale of multiple nursing homes.
Home Health Agency
Filed a lawsuit against the Ohio Department of Medicaid to reinstate a home health agency summarily suspended from the Ohio Medicaid program. The suspension was cancelled, and the home health agency was reinstated.
Representation of National Insurer/Third-Party Administrator in ERISA Litigation
Successful handling and resolution of short-term and long-term disability denial of benefits claims under ERISA. Representative cases:
- Storer v. Prudential Insurance Co. of America, et al.
- Early resolution of case after successful mediation.
- Wheeler v. Prudential Insurance Co. of America, et al.
- Obtained decision in favor of long-term disability benefits plan leading to resolution on appeal.
Dismissal of Federal Criminal Tax Indictment
We represented the owner of a Columbus-based home health agency who, along with others, was the subject of a federal criminal indictment alleging 43 counts of federal tax violations. The case was scheduled for a two week trial, but was dismissed with prejudice by the Government two weeks prior to trial. The investigation and prosecution were conducted by the United States Attorney’s Office and the Internal Revenue Service.
Fairmont General Hospital v. United Hospital Center
Mr. O'Neil and Ms. Bentz represented a hospital before the West Virginia Health Care Cost Review Authority, the Office of Judges, the Circuit Court of Marion County, and the West Virginia Supreme Court of Appeals in the successful prosecution of the hospital's application for a certificate of need to develop a $285,000,000 replacement hospital.
St. Elizabeth Medical Center / Dr. James C. Burt
Represented SEMC in nearly 50 lawsuits alleging injuries from Dr. Burt’s infamous “Love Surgery.” Plaintiffs alleged that SEMC was negligent in its credentialing of Dr. Burt and that it should not have allowed him to do the surgery. Defense verdict for SEMC obtained in the only case tried. Several summary judgments obtained in favor of SEMC. Three of these cases ultimately reached the Ohio Supreme Court.
Estate of Palmer Landram v. Suburban Medical Center, et al.
We obtained a jury verdict for the defense, which was affirmed on appeal, in a suit for hospital negligence in excess of $1,000,000.
Anonymous Plaintiff v. Neurosurgery Practice
I represented the Defendant, a neurosurgery practice, in a suit seeking $2.1 million for medical malpractice. The case resulted in a zero verdict.
Kathy Bergman v. State of Ohio Mental Health Workers, et. al.
Successfully argued for and obtained dismissal of medical malpractice lawsuit stemming from alleged physical, verbal, and mental abuse of psychiatric patient.
Bond Finance
Our firm represented the Monongalia County Building Commission in a $48,145,000.00 bond financing for construction projects, capital improvements, and refunding prior bonds for a regional hospital system.
Bowman v. Charleston Area Medical Center
Ms. Rice represented a hospital in a class action filed by four uninsured patients who alleged that a hospital's charging of uninsured patients at full charges, while charging Medicare, Medicaid, and insured patients at less than full charges, was unlawful.
Cable Television Company v. Owner of Nursing Home
A cable television company sued our client, the owner of a nursing home, for $500,000 for utilizing the cable company's interior wiring for the nursing home's own use. The parties settled after protracted litigation.
Health Care
I have provided representation with respect to collection efforts for a large hospital pertaining to patient services for various state agencies such as regional jails and the West Virginia Department of Health and Human Services. Through the initiation of collection suits and negotiations, we have collected in excess of $500,000 of unpaid charges for a large state-wide hospital group.
Bond Finance
Our firm represented the Monongalia County Building Commission in a $4,645,000 bond financing for construction projects, capital improvements, and refunding prior bonds for a nursing home.
Estate of Henry Persley v. Anonymous Physician and Samaritan Hospital
Our firm represented the Defendants, Samaritan Hospital and an employed physician, in a lawsuit seeking in excess of $2 million for medical malpractice. The case resulted in a jury verdict for the defense.
Schirmer v. Children's Hospital Medical Center
Represented Children's Hospital Medical Center in medical malpractice action seeking to recover for "wrongful birth". Argued on behalf of all defendants and obtained decision that Ohio does not recognize a "wrongful birth" cause of action.
Thoracic and Cardiovascular Associates v. Charleston Area Medical Center and Charleston Area Medical Center v. Rashid
Mr. O'Neil and Ms. Bentz represented the state's largest hospital in state litigation brought by cardiovascular surgeons on the hospital's Medical Staff demanding $2,000 per day to provide on-call coverage to the hospital's trauma center and in related federal litigation brought by the hospital against the cardiovascular surgeons for alleged price fixing and an alleged concerted refusal to deal.
Mergers and Acquisitions - Health Care Industry
Represented clients in the health care industry with respect to mergers and acquisitions, including:
$27 million divestiture of 11 long term care nursing home facilities.
$4.7 million acquisition of competitor for home infusion and specialty care pharmacy provider.
$12 million acquisition of competitor for home infusion and specialty care pharmacy provider.
$4 million divestiture of pediatric private nursing duty business.
$6.4 million acquisition of competitor for home infusion and specialty care pharmacy provider.
$5.5 million acquisition of competitor for home infusion and specialty care pharmacy provider.
Medical Malpractice Defense Litigation
The cases involving our client, a large regional pediatric medical center and its employees and employed physicians, have ranged from simple personal injury claims to allegations of catastrophic injury and death. All cases were fully litigated and either dismissed, settled or tried. Dinsmore & Shohl has developed special skill in the handling of pediatric medical negligence claims, including analysis of complex pediatric medical issues, and development of and relationship with numerous experts nationwide.
Claridge House, Inc. v. USDHHS, 795 F. Supp. 1393 (1991)
Filed a complaint for declaratory and injunctive relief against the United States Department of Health and Human Services on behalf of a nursing home. The federal government alleged the nursing home failed to meet Medicare/Medicaid certification criteria, and it wanted to terminate the nursing home’s participation in the federal payment programs. On behalf of the nursing home, I argued the federal law did not permit the termination. The court agreed with the argument, stating the federal regulations were beyond the scope of federal law, and stated that defendants were enjoined from terminating the nursing home from federal payment programs. This was first lawsuit challenging the validity of federal regulations filed in the United States.
Anonymous Plaintiff v. Anonymous Dentist
I represented a dentist and his practice in suit seeking $850,000 for dental malpractice. The case resulted in a $53,000 judgment, which failed to exceed the $60,000 offer of judgment made seven months prior to trial.
