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Insurance and Health Care Fraud Litigation

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Overview

Our Clients

Katten works with insurers across the country to combat fraudulent claims.

Our Services

Katten's Insurance and Health Care Fraud Litigation practice is the preeminent leader in the nation in helping insurers reduce their exposure to systemic fraud through the development of effective claims-handling practices and affirmative litigation against parties responsible for driving fraudulent claims activity. For more than 20 years, Katten has worked extensively with insurers across the country to identify fraudulent claim trends in high-exposure markets, develop multifaceted strategies that substantially reduce clients' exposure to these activities and recover payments that were never owed in the first place. Our attorneys work to combat fraudulent insurance claims by identifying patterns and parties that are driving systemic fraudulent claims activity.

We routinely represent insurers in affirmative litigation directed at the parties who are primarily responsible for fraudulent claims activity and have successfully recovered significant sums on behalf of our clients. We have brought cases and argued many positions that have established controlling legal principles in jurisdictions across the country, which in turn have been used to reduce future exposures.

Our team includes several former federal prosecutors and others with considerable knowledge and experience in the following areas:

  • Patterns and practices of those who engage in insurance and health care fraud
  • Insurance claims operations, company and industry-wide claims databases
  • Various forms of medicine including acupuncture, chiropractic, physical therapy, physiatry, orthopedics, neurology, pain management, surgery, psychiatry, psychology and dentistry
  • Various forms of diagnostic testing including imaging studies, neuropsychological testing, electrodiagnostics, range of motion and muscle strength tests, pulmonology tests, sleep studies and laboratory diagnostics
  • Durable medical equipment, orthotics and pharmaceuticals

Our team has substantial knowledge of and experience with state and federal laws regarding treatment and billing fraud, as well as laws and regulations governing the practices of health care providers including the corporate practice of medicine, fee-splitting, kickbacks, self-referrals, patient brokering and licensing laws for medical professionals, hospitals, ambulatory surgery centers, and multidisciplinary practices.

Experience
  • Representation of health insurer in fraud action alleging Florida ambulatory surgery centers and others fraudulently billed professional and facility fees for manipulations under anesthesia because centers were engaged in patient brokering, kickbacks for patient referrals and the use of improper billing codes.
  • Representation of health insurer in arbitration alleging a New Jersey ambulatory surgery center and others fraudulently billed professional and facility fees for manipulations under anesthesia because the center was not exempt from state licensure requirements and was paying kickbacks for patient referrals.
  • Representation of worker's compensation insurer in RICO and fraud action in Texas against physician and compounding pharmacy, alleging they performed and billed for medically unnecessary pain management injections and topical compounds.
  • Representation of property and casualty insurer in RICO and fraud action in Oregon against chiropractors, acupuncturist, clinics and others, alleging they billed for medically unnecessary chiropractic and acupuncture services.
  • Representation of property and casualty insurer in RICO and fraud action in New York against psychologist and others, alleging professional psychology corporations were not properly licensed and billed for medically unnecessary psychological services.
  • Representation of property and casualty insurer in RICO and fraud action in Michigan against physicians, chiropractors, clinics, MRI providers and others, alleging they performed and billed for chiropractic, medical and MRI services that were medically unnecessary or not performed.
  • Representation of property and casualty insurer in RICO and fraud action in Michigan against an attorney and adjuster, alleging they conspired to cause the insurer to pay millions of dollars more than was owed regarding catastrophic injury claims.
  • Representation of property and casualty insurer in RICO and fraud action in New York against wholesalers and retailers of durable medical equipment and orthotics, alleging they billed for items that were not provided, were not medically necessary and were supported by fraudulent wholesale invoices.
  • Representation of property and casualty insurer in action under the Insurance Claims Fraud Prevention Act in Illinois against chiropractor and clinic, alleging they used billing codes that misrepresented the nature and extent of services.
  • Representation of property and casualty insurer in fraud action in Florida against clinics and referral service, alleging the clinics were not entitled to no-fault benefits because the referrals violated self-referral, kickback and patient brokering laws.
  • Representation of property and casualty insurer in RICO and fraud action in Illinois against lawyers, chiropractors and others, alleging they organized and paid to treat and represent individuals who participated in staged and caused auto accidents.
  • Representation of property and casualty insurer in RICO and fraud action in Texas against lawyers, chiropractors and others, alleging they organized and paid individuals who participated in staged and caused auto accidents.
  • Representation of property and casualty insurer in RICO and fraud action in Florida against physicians, an ambulatory surgery center and others, alleging the physicians performed and billed for medically unnecessary discography and percutaneous disc decompression procedures.
  • Representation of property and casualty insurer in fraud action in New York against physicians and others, alleging professional medical corporations were not properly licensed and thus not entitled to no-fault benefits.
  • Representation of property and casualty insurer in defending against several actions in Michigan seeking no-fault benefits based on alleged traumatic brain injuries.
  • Representation of health insurer in fraud action alleging that physician-owned entities in Texas fraudulently billed for facility fees performed in ambulatory surgery centers by the physician-owners based upon kickback arrangements between the centers and physicians.
  • Representation of property and casualty insurer in RICO and fraud action in New York against dentists and others, alleging professional dental corporations were not properly licensed and billed for medically unnecessary TMJ tests, services and supplies.
  • Representation of property and casualty insurer in litigation before the US District Court for the Eastern District of Michigan alleging submission of fraudulent claims by a physical therapy clinic.
  • Representation of property and casualty insurer in litigation before the Superior Court of California alleging health care providers submitted false and misleading records for services not provided or not medically necessary as well as engaged in upcoding and unbundling billing codes.
  • Representation of property and casualty insurer in RICO and fraud action in New York against acupuncturists and others, alleging the professional acupuncture corporations were not properly licensed and billed for medically unnecessary acupuncture services.
Events
December 4–5, 2017
Insurance and Health Care Fraud Litigation

Recognition

National Law Journal, Elite Trial Lawyers 2015
U.S. News Best Lawyers "Best Law Firms" – Insurance Law (National)
Insurance Law (National), 2014–2016
U.S. News Best Lawyers "Best Law Firms" – Insurance Law (Chicago)
Insurance Law (Chicago), 2014–2019
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Recognition

Insurance Law (National), 2014–2016
Insurance Law (Chicago), 2014–2019
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