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Health Care Fraud and False Claims

false claims

Scott Grubman, CW Hall, and James Marcus talk healthcare fraud.

Health Care Fraud and False Claims

I hosted 2 False Claims Act legal experts on this week’s MAG edition of Top Docs Radio.  You’re going to want to check out what they have to say, as it could mean the difference between practicing medicine or not, in the end.

Scott Grubman is a partner with the law firm of Chilivis Cochran Larkins & Bever in Atlanta. He represents health care providers of all types and sizes with government investigations and audits, False Claims Act, and other complex litigation and various regulatory and compliance matters.  Prior to joining private practice, Scott served as a trial attorney with the U.S. Department of Justice in Washington, D.C., and as an assistant U.S. attorney in Savannah – where he served on a district health care fraud taskforce.  Scott also serves as an adjunct professor at Georgia State University’s College of Law, where he teaches a course in health care fraud and abuse.

Jason Marcus is among a select group of lawyers who devote their practice to qui tam and related retaliation claims under federal and state False Claims Acts. He has practiced FCA law exclusively since 2008, and he formed the firm of Bracker & Marcus in January of 2015 with partner Julie Bracker, who is dedicated to representing whistleblowers nationwide. Jason is a 2006 graduate of the University of Georgia School of Law, a former clerk to the honorable Magistrate Judge G.R. Smith of the Southern District of Georgia, and a member of Taxpayers Against Fraud Education Fund and the Georgia affiliate of the National Employment Lawyers Association.

Health care is one of the fastest growing and most heavily-regulated industries in the United States.  Given that government payers (Medicare, Medicaid, etc.) finance a significant portion of the system, regulators and law enforcement have dedicated tremendous resources to rooting out and punishing fraud and abuse in health care.  In fiscal year 2015 alone, the federal government recovered nearly $2 billion in settlements and judgments from health care providers under the federal False Claims Act, which does not include recoveries through audits and other administrative avenues.

Moreover, not only are the actions of healthcare providers constantly scrutinized by federal and state auditors

and law enforcement, but also by competitors, commercial insurance companies, private whistle blowers, and the public. Big hospitals and health care entities with “deep pockets” have historically carried the bulk of the liability in government enforcement actions.  But beginning in 2015, the federal government announced a new policy which focuses on holding individuals – particularly individual health care providers – responsible and liable for unlawful conduct. A lot of the laws governing health care fraud and abuse do not require a specific intent to defraud or even actual knowledge of the unlawful nature of the conduct. In fact, one of the major laws governing health care fraud and abuse (the physician self-referral law or “Stark law”) requires no culpable mindset whatsoever.  Accordingly, it is crucial for health care professionals of all types to be aware of the various statutory and regulatory schemes that govern health care billing and to act accordingly.


Special Guests:

Scott Grubman

false claims

Jason Marcus

false claims

Representative Sharon Cooper

Sharon Cooper

Georgia State Representative, Dist. 43, Sharon Cooper

Representative Sharon Cooper

I hosted MAG CEO/Executive Director, Donald Palmisano, Jr., and Georgia State Representative, Sharon Cooper.  We talked about 2016 legislative priorities affecting healthcare in the state.  More information soon!

Special Guests:

Sharon Cooper, Rep. Dist 43, Georgia State House of Representatives (R) 


Representative Sharon Cooper

  • MA Education
  • MSN, Nursing
  • Authored 2 books on psychiatric nursing
  • Chair, Georgia Health and Human Services Committee

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC


Medical Malpractice Lawsuits

Huff Powell & Bailey

Dan Huff talks medical malpractice

Medical Malpractice Lawsuits

The phrase medical malpractice causes most people’s pulse to quicken. For a physician being named in a medical malpractice case is one of the worst events in their life. This week we discussed medical malpractice in Georgia and how physicians can avoid it.

For the past 23 years, Dan has specialized in representing physicians and hospitals in medical malpractice lawsuits.  As one of the founding partners in the Atlanta law firm of Huff, Powell & Bailey, LLC, he has represented defendants in more than 90 jury trials.

Dan has defended and successfully tried cases for every specialty of medicine and numerous hospitals throughout Georgia. His trial record would be a proud career for any defense lawyer and is remarkable because Dan has tried and won this many cases before turning 50.  Many of those cases have been against the best plaintiffs’ attorneys in the state. Dan is also a regular contributor to MAG’s quarterly Journal.

Huff shared what malpractice is, and why he chose this area of focus for his legal career.  He offered some advice on how healthcare practitioners can avoid a malpractice lawsuit.  We discussed his professional advice for how to handle conversations with patient and/or family after a sentinel event has occurred.  And we talked about how health professionals need to handle patient records and what to do if served with a lawsuit.

Dan explained how defendants in a suit should behave during the proceedings of the case to reduce the likelihood a jury will rule against them.

Special Guest:

Dan Huff, JD, and co-founder, Huff, Powell, and Bailey

Huff, Powell, & Bailey