Health Care

Stetler & Rotert, Ltd. is a national leader in producing positive results to health care providers and their employees embroiled in government or qui tam litigation alleging fraud or abuse in the provision of health care. Our clients include practitioners, hospitals, pharmaceutical and medical device manufacturers, insurers and third-party administrators. Our lawyers know and understand the sometimes esoteric practices and vocabulary of modern health care reimbursement so they can respond effectively to evolving standards in the field.

REPRESENTATIVE CASES

SR led the trial defense effort in the nationally significant prosecution of 11 employees of TAP Pharmaceuticals for Medicare fraud. Our client, the senior executive charged in the case, was acquitted on all charges, as were all of the defendants who stood trial with him. The case, which was tried to a jury in Boston, was closely followed by the national media and especially the health care sector, largely because the company had paid what was, at the time, the largest settlement ever in a Medicare fraud case. United States v. MacKenzie, et al.

SR lawyers successfully defended an executive of Blue Cross/Blue Shield in federal court on charges of Medicare fraud. Although our client’s employer previously had entered a plea of guilty and paid millions of dollars in fines and penalties, our client and her three co-defendants stood trial. After a three-month jury trial proceeding, all four defendants were found not guilty. United States v. Bartels, et al.

SR has represented various psychiatrists, home health providers, physical therapy providers and medical transport services in connection with criminal and civil investigations into their billing practices. Complicated and controversial regulations governing the reimbursement of such professionals by Medicare and/or Medicaid for services such as group therapy, pain management, or transportation for dialysis prompt frequent and recurring disputes throughout the industry. SR is experienced in dealing with the inspectors general and other agencies bringing such actions, and we know how to counter their claims of improper billing.

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