Barclay Damon
Barclay Damon

Barclay Damon Scores Landmark Litigation Victory for Healthcare Provider Community

For the past few years, healthcare providers have been heavily regulated by the New York State Office of the Medicaid Inspector General (OMIG) and the New York State Attorney General's Medicaid Fraud Control Unit, which have been given unprecedented and growing authority to audit providers participating in Medicaid. Barclay Damon attorneys have been successful in taking on cases to challenge aggressive agency audit practices, demonstrating that it is achievable to take on and win legal battles with these agencies that were previously thought to be futile.

In 2010, Barclay Damon scored a victory for the provider community on behalf of a national chain pharmacy fighting large extrapolated audit findings based upon minor paperwork errors and discrepancies. The resulting decision vacated the OMIG's extrapolation methodology in a landmark decision calling into question the agency's auditing methodology. In 2011, the Firm successfully litigated several other Supreme Court Article 78 actions involving exclusions, withholds and other actions against providers on due process and other procedural grounds, obtaining, in several cases, temporary restraining orders to save the provider's business while litigation and settlement discussions proceeded. In 2011, the Firm also pursued Civil Rights claims against OMIG, DOH and several individuals for improperly employing particularly aggressive auditing tactics that damaged the client's business reputation and clientele. The case was recently upheld in a widely reported Federal decision recognizing legal claims of providers when the due process limits applicable to Governmental auditing and investigative techniques are exceeded.

We continue to represent providers ranging from home care and residential institutions to pharmacies, mental health providers and dentists, defending them against the zealous auditing practices of the ever growing array of governmental entities with inconsistent and often overlapping auditing authority including OMIG, OIG, MFCU and HRA, while also working with representative associations to assist in the development of policies to curb improper and abusive auditing practices.

 

For More Information on Barclay Damon's Health Care & Human Services Practice Area:

Melissa Zambri

p: 518-429-4229

f: 518-427-3463

icon_emailmzambri@barclaydamon.com

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Susan Benz

p: 716-858-3812

f: 716-768-2812

icon_emailsbenz@barclaydamon.com

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