Robins Kaplan

Robins Kaplan LLP: Standing Up Against Fraud in Health Care

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Robins Kaplan Story

More than 80 years after its inception, Robins Kaplan LLP is still doing exactly what its founders set out to do — making justice attainable, no matter the odds. Today, more than 250 attorneys in seven cities from coast to coast are rewriting the odds, whether they are vigorously representing clients in the courtroom or negotiating resolutions out of the public eye. Noted for their varied expertise and high-impact casework, Robins Kaplan attorneys have garnered much acclaim, propelling the firm into the national spotlight and making it the firm of choice for many distinguished companies.

Robins Kaplan has built a unique practice around helping health insurers combat fraud, waste and abuse. Powered by experienced attorneys with a deep, firsthand understanding of the industry’s regulatory, legal and business systems, the Health Care Litigation Group is serving payor clients — including such notables as United, Anthem, Humana, Aetna and other BlueCross Blue Shield Plans — in both affirmative and defensive engagements in courts around the country in single and multi-party litigation, as well as complex arbitrations.

The formation and success of the Health Care Litigation Group are testaments to Robins Kaplan’s longstanding custom of playing to the strengths of its attorneys and adapting to the needs of its clients. A few years ago, three attorneys — Thomas Mahlum, Jeffrey Gleason and Jamie Kurtz — saw an opportunity to form a health care practice group with an emphasis on representing payors in proactive litigation against suspected perpetrators of fraud and abuse. When they approached Robins Kaplan with the idea, they received enthusiastic support for their endeavor.

Thomas Mahlum has spent the entirety of his 26-year law career at Robins Kaplan as a member of the business litigation group. He has litigated a broad range of commercial disputes, including those involving trade secrets, unfair competition, false advertising, antitrust, non-compete covenants, real estate and a variety of intellectual property cases. Mahlum is a firm partner, has served on the executive board and is now co-chair of the Health Care Litigation Group.

“Several years ago, Jeff, Jamie and I made a conscious effort to build a health care practice,” Mahlum said. “There were two motivations for this effort. First, there was an opportunity. Our firm had an existing relationship with a few payors, and there was significant interest by those clients to expand their use of litigation as part of a broader effort to weed out fraud, waste and abuse by providers and to help control rising health care costs. Second, because of our firm’s medical malpractice practice group, as a general matter, our firm does not represent providers. Therefore, if we are going to represent parties in the health care sector — a sector which is roughly 18% of the economy — it is a natural fit for us to represent payors. And payors can be assured that as a firm, we are generally free of any conflicts in actions involving providers.”

Jeffrey Gleason is a partner at Robins Kaplan and co-chair of the Health Care Litigation Group. His practice emphasizes health care law, government investigations and complex business litigation.

“I spent a number of years as a trial attorney in the civil frauds section at the Department of Justice, where I pursued health care fraud cases on behalf of the United States,” Gleason said. “At Robins Kaplan, I have been able to continue that work on behalf of health insurers.”

Jamie Kurtz is the third co-chair of the Health Care Litigation Group. A pharmacologist as well as a lawyer, Kurtz began her career at Robins Kaplan representing clients in intellectual property matters. She is now a firm partner who represents various health care plans in high-stakes litigation with providers involving claims of improper billing, breach of contract and fraud.

“For a long time, Robins Kaplan has done work for companies like Blue Cross Blue Shield and others, so we already had established relationships with payors,” Kurtz said. “But we did not have a practice group dedicated to representing them until around 2015. We realized that while there was a lot of health care fraud being committed against commercial insurers, it was not getting the attention that fraud against Medicare, Medicaid and other government health care programs was getting. Jeff brought that perspective to the group.”

Nathaniel Moore is a partner and trial attorney at Robins Kaplan. After working for a large New York firm, where he was a member of the white collar crime and government investigations and business litigation practices, he relocated to Minneapolis and was introduced to Mahlum, Gleason and Kurtz. Moore said he jumped at the chance to help grow the health care practice.

“We have the opportunity on a daily basis to unwind some of the most complicated and high-cost problems in the health care industry. Our clients are the target of increasingly sophisticated efforts to cause them to pay (or to pay more) for health services. We have a deep understanding of their operations, and that understanding is critical to unwinding and solving their problems. It also makes us more effective advocates; we can distill complex operational issues for judges, arbitrators and juries in order to get to the heart of the issue.”

While the public often sees big insurance companies as the bad guy, representing their interests is helping everyone in the long run. Kurtz put it into perspective. “We know billions of dollars in claims are paid because of fraud or abuse by providers. A lot of the dollars we are pursuing are not the dollars of the payor. They’re the dollars paid by small employer plans, school districts and municipalities. It may not be logical or economical for those small entities to pursue the fraud directly, but those insurance contracts are administered by large payors. So we’re pursuing not just damages to a large entity like United health care and their members, but also damages suffered by employers who offer health care plans to their employees.”

“The cost of health care fraud and abuse is borne by everyone who participates in the industry,” Moore added, “including individual consumers and employers who offer health insurance to their employees. We work closely with our clients to help them solve their biggest challenges and to protect their members and customers.”

The Health Care Litigation Group has enjoyed many triumphs. In the past four years alone, it has recovered more than $250 million on behalf of its clients. These examples demonstrate the impact Robins Kaplan is making across the country:

Pass-Through Billing by Hospitals and Third-Party Labs

Robins Kaplan has represented several payors in cases related to alleged pass-through billing schemes conducted by various hospitals and third-party laboratories and their owners. In the suits, the payors alleged that labs illegally contracted with rural hospitals to bill for urine toxicology and other types of tests that hospitals did not perform and were not performed on behalf of the hospitals’ patients. According to the complaints, the payors paid hundreds of millions in claims that were the product of this allegedly fraudulent scheme. These matters quickly became a subject of national attention, including a CBS News special investigation report in March 2018.

Dialysis Providers’ Use of a Third-Party to Pay Patient Premiums

Robins Kaplan has represented several payors in cases related to for-profit dialysis providers’ use of donations made to a third-party to pay their patients’ insurance premiums. Under the alleged scheme, for-profit dialysis providers would donate hundreds of millions of dollars to a third-party charity. That charity would then use those donations to pay for the insurance premiums of the donors’ patients. The dialysis providers are accused of engaging in the conduct in order to induce their patients to enroll in, or remain enrolled in, commercial insurance plans rather than government plans for which they were eligible. According to the complaints, the dialysis providers allegedly did this because the commercial insurance plans reimbursed them at substantially higher rates than government plans. The conduct at issue has been the subject of reporting in both the New York Times and Wall Street Journal. One of the cases resolved in a $32 million public settlement.

Omnicare, Inc. v. UnitedHealth Group, Inc., 06-cv-00103 (E.D. Ky.)

Robins Kaplan represented defendants UnitedHealth Group, Inc. and PacifiCare, Inc. in an antitrust lawsuit involving alleged price-fixing and fraud related to prescription drug reimbursement under the federal Medicare Part D program. Plaintiff Omnicare sought damages exceeding $1 billion and permanent injunctive relief. Summary judgment was granted to defendants on all claims, which was later affirmed by the Seventh Circuit. This case has been recognized as the leading authority on liability under Section 1 of the Sherman Act for “gun jumping” the regulatory approval of a merger.

Achieving results like these would not be possible without the cooperation of an extraordinary team. Kurtz said, “We’ve tried to create a group where the focus is on teamwork in terms of who we’ve asked to join and the hires we’ve made. It’s such an enjoyable experience working with these intelligent, kind people, not only at Robins Kaplan, but within our clients’ companies as well. Our clients work with us like we’re on a team, working with them not for them. This job can be difficult and adversarial, but ultimately very enjoyable.”

“Leaving government, I had no desire to work at a law firm again,” Gleason said. “When I was introduced to Robins Kaplan, I changed my thinking entirely. Our team is collaborative, creative, bright, energetic and not afraid of a fight. We are fortunate to work with phenomenal clients who share those same attributes. It makes coming to work both rewarding and fun. We try to be very proactive with our clients—presenting opportunities to them and trying to anticipate what potential disputes could lie ahead. We spend considerable time learning as much as we can about our clients overall business so that we can account for objectives that lie outside litigation.”

The world is still waiting to see what new legal challenges may be ahead for payors as a result of the COVID-19 pandemic. “Our clients are trying to figure out how it will impact them,” Kurtz said. “We’ll see what it looks like and how health care patterns may change when the COVID haze fades away. I just saw an article talking about 250 individuals charged with health care fraud associated with COVID. It will be interesting to see if this is a trend. Right now, I think everyone’s focus is on vaccinating people and getting them the health care they need.”

The attorneys at Robins Kaplan work every day to ensure that justice is within reach at every echelon of society. Gleason said, “The cost of health care continues to increase at rates that seem unsustainable. Fraud, waste and abuse are a substantial factor in that trend — which, in turn makes insurance less affordable and less available to those in need. I am proud to help our clients identify and address the significant abuses of the system, knowing that, in turn, those savings and that deterrence are critical to a high-functioning health care system.”

Robins Kaplan Expands Health Care Litigation Group in New York

The success of Robins Kaplan’s Health Care Litigation Group has created demand for more attorneys to join its ranks. In the past six months, the group has expanded with the addition of two partners, both practicing in the New York office.

Gregory Voshell is an experienced commercial litigator whose practice focuses on health care. He frequently represents payors in disputes with providers on a range of issues, including kickbacks, improper billing, fraud, ERISA-based claims and other related matters. In addition to his health care litigation practice, Voshell handles a broad spectrum of commercial matters, including financial litigation, class action litigation, appellate representation and other complex legal disputes.

Paul Weller is a trial attorney with deep roots in the health care industry. He also represents payors in complex litigation stemming from claims of fraud, improper billing, breach of contract and other related actions. Prior to joining Robins Kaplan, Weller held senior litigation positions at various national managed care organizations, including head of litigation, head of provider litigation, as well as special counsel to a corporate ethics committee.

“Collectively, they add to the depth of our bench and bring a broad range of experience in the health care field, including significant defensive work, which allows us to further expand our efforts on the defensive side,” said Thomas Mahlum, co-chair of the Health Care Litigation Group.

“We were very fortunate to add Paul Weller and Greg Voshell to our team,” said Gleason. “Both are talented trial lawyers with deep expertise in managed care litigation. Paul brings the in-house knowledge that he acquired over the many years he spent handling provider disputes for major payors. Greg has lived and breathed provider-payor litigation for over a dozen years and knows his way around a courtroom — whether a trial court or an appellate court.”

Mahlum said he anticipates further expansion of the practice group. “We are currently in the process of adding additional associates to our ranks and will continue to keep our eye out for lateral partner talent that would be a good fit.”

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