False Claims Act
The False Claims Act is an increasingly popular enforcement tool of the U.S. Department of Justice (DOJ) to prevent fraud against government programs. DOJ uses the False Claims Act to prosecute companies as well as individuals, and consequences of enforcement can include exclusion from government programs, punitive damages and the potential for criminal exposure.  In some cases, a whistleblower files suit under the qui tam provision of the False Claims Act on behalf of the government with the hope of reaping significant monetary gain.  Qui tam claims can set in motion civil and criminal litigation.  At the outset, a qui tam case is filed under seal during the pendency of government investigation of the claim. 

Any person or entity that receives or spends federal money is a potential target of a False Claims Act violation.  For healthcare providers that bill to Medicare, DOJ investigations often focus on whether surgeries and diagnostic procedures were medically necessary.  Therefore, False Claims Act enforcement can involve subjective interpretation of the reasonableness of care.  The attorneys at Rumberger, Kirk & Caldwell help clients chart the right path through a complex landscape of DOJ enforcement

Medical Malpractice
Our attorneys represent hospitals and medical professionals, including physicians, nurses, radiologists, pathologists and pharmacists in liability actions.  We also represent hospitals in corporate negligence cases and represent nurses and physicians before licensing boards.  We believe that defending medical liability cases requires, not only sound litigation skills, but an understanding and appreciation of the “art” of medicine.  Our attorneys spend nearly as much time in medical books as in law books to fully comprehend the medical issues of each case.  Medical liability cases often become a “battle of the experts.”  We view that knowing the medicine in each case is imperative in order to demonstrate to the jury any inconsistencies, no matter how small, in the plaintiff’s expert's testimony.

While a thorough understanding of medicine is critical to defending medical liability cases, it is equally vital that the attorney understand the nuances of the courtroom.  This is where our attorneys excel, using well-honed trial skills to present the best possible case to the jury.  The use of focus groups, as well as internal sessions among attorneys, help develop the themes that best fit each case. 

Our lawyers remain mindful of the economic realities of medical liability cases.  In some cases, the medical care may meet the standard of care, yet the patient has still suffered serious injuries.  We realize the client may make an economic decision to attempt to resolve the matter early.  Once this decision is made, our attorneys will take its aggressive representation from the courtroom to the settlement table, and make every effort bring the case to an early and economically sound resolution.

HIPAA Consulting
RKC advises health care providers, health plans, and health care clearing houses how to comply with HIPAA's Privacy and Security Rules.  Our attorneys develop policies and procedures for clients necessary for compliance with the Privacy Rules.  Just as important, we can provide efficient, cost effective training to all workforce members.  Further, we can draft and review business associate agreements, authorizations, local government memoranda of understanding, and Notice of Privacy Practices.

With Civil Money Penalty regulations, it is essential to hire an expert to review compliance issues from top to bottom before the a Federal investigator requests an on-site visit and copies of proof of compliance. Many businesses covered by HIPAA wait until a complaint is filed against them to examine their compliance efforts.  We can defend against such complaints. 

However, a pro-active, on-site audit by a third party HIPAA expert can pay big dividends.  We can develop a user-friendly complaint process that allows employees and patients to identify perceived violations of the rules so that the business can react quickly and adjust procedures as necessary.   
HIPAA is a 24/7 concept.  We assist Privacy Officers and Security Officials of businesses covered by HIPAA on a day-to-day basis when confronted with the complex nuances of compliance issues.  Often the question of whether, and to what extent, one can disclose Protected Health Information (PHI) without the patient's knowledge or authorization is a legal question requiring the instant feedback RKC can provide.  The Privacy Rules demand an understanding of their relationship with State and Federal laws. Our lawyers assist its clients in understanding this difficult legal analysis.

Nursing Homes
Rumberger, Kirk & Caldwell lawyers have successfully defended nursing homes and assisted living facilities for many years.  These cases often allege violation of resident's rights, negligence, and wrongful death. The firm's success includes a defense verdict after a two week trial in which the Plaintiff asked the jury to award in excess of $1 million. The firm's experience in intense witness preparation and creative defense strategies are hallmarks of its successful defense of nursing homes and assisted living facilities at all corporate and organizational levels.


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