Healthcare

Pugh, Jones & Johnson lawyers combine broad healthcare expertise with deep trial experience that includes high-exposure cases.  Our healthcare trial lawyers include former federal and state prosecutors, and others who have decades of trial experience.  We litigate in court, before juries, in administrative proceedings, before arbitration panels, in appellate forums and also serve as arbitrators and hearing officers. 

Our experience covers a wide range of contracting, regulatory and payment issues between payers and various providers.  We understand the complexities of healthcare payment regulation, the unique business environments that providers and suppliers face, and the overlay of laws and agency oversight that affect the way that our healthcare clients work.

Our health care practice group spans most facets of the industry and various areas of the country.  We represent insurers and other managed care organizations, healthcare benefit plans and administrators of self-funded plans, for-profit and non-profit health care providers, pharmaceutical companies, medical device manufacturers, HMOs,  pharmacy benefit managers, medical school faculty, hospitals, physicians, nurses, a leading provider of dialysis services, healthcare staffing agencies and other healthcare providers.  Our lawyers have litigated and investigated numerous disputes on behalf of healthcare entities, including regulatory compliance challenges, managed care disputes, government inquiries arising from merger-related activity, reimbursement disputes, SEC challenges to accounting practices, as well as other suits that are government-initiated or related to suits filed under the qui tam provisions of the False Claims Act.

 Areas of Expertise:

  • Managed care network disputes, including actions concerning efforts to recover for fraudulently billed charges
  • Defense of ERISA benefits claims, including preemption issues
  • Medicare fraud claims brought against physicians under the False Claims Act
  • Trials of medical malpractice claims against physicians practicing in high risk specialties including obstetrics, anesthesia and emergency medicine
  • License revocation proceedings (physicians, physician assistants, dentists, nurses and nurse practitioners) before the Illinois Department of Professional Regulation
  • Medicaid privileges revocation proceedings and billing audits before the Illinois Department of Healthcare and Family Services
  • Revocations of Medicare privileges proceedings before the Centers for Medicare & Medicaid Services
  • Billing issues under Affordable Care Act, Stark Act and anti-kickback laws
  • Risk management counseling to providers and educational institutions
  • Counseling on compliance issues including HIPAA, HITECH and other laws regulating the confidentiality of healthcare information
  • Management or services contract disputes
  • Arbitration and mediation of healthcare contract issues
  • Government civil proceedings including whistleblower suits brought under the federal False Claims Act
  • Representation of pharmaceutical and medical device manufacturers in commercial and tort litigation
  • Medical Staff Credentialing
  • Internal compliance investigations, including Stark issues, anti-kickback issues, FCPA and FCA
  • Licensure disputes and proceedings
  • Medicaid and Medicare reimbursement appeals
  • Employment claims of employees and administrators
  • Temporary restraining orders
  • Commercial litigation including commercial fraud, contract, corporate governance, fiduciary, professional liability, RICO, securities, and tax matters