In the highly regulated healthcare environment, legal disputes have a broader impact than just an entity’s legal expenses. They disrupt patient care, jeopardize the continuity of critical care delivery, damage an organization’s reputation, and draw unwelcome attention from regulators. NJL’s Healthcare Litigation team is a strong advocate for healthcare providers and health payers. We believe in proactive risk management, working closely with clients to identify potential litigation risks and implement strategies to minimize exposure while ensuring compliance.
We navigate the intricate dance between federal and state regulations, payment models, and the stakes involved in disputes that can influence an entity’s future healthcare delivery. Our team knows how to craft a compelling story that emphasizes our client’s mission to provide quality care to patients and serve the community—an approach that appeals to juries, courts, and regulators.
Our team has deep expertise in the operational, financial, reputational, and regulatory challenges faced by national and regional health plans and providers. Many of our lawyers have government experience, giving our local and national clients unique insights into Minnesota’s regulatory environment. We are recognized for results-driven advocacy, with trial-ready litigators who successfully pursue and defend high-stakes cases, whether through aggressive courtroom battles, strategic settlement negotiations, or alternative dispute resolution methods. Based in Minnesota with a national practice, we are well-equipped to handle complex disputes across multiple jurisdictions.
Healthcare is personal, so is our approach to advising and litigating for our clients, who include physicians, administrators, and executives striving to provide excellent care in systems with complex regulations and competing professional, ethical, legal, and business demands. We partner with them, not just as lawyers, but as advisors who share their commitment to doing what’s right in the balance of those demands.
Our deep expertise includes:
- Regulatory Investigations and Compliance Actions: Beyond traditional litigation, we proactively guide clients through regulatory investigations and administrative actions to help reduce risk and achieve favorable outcomes. This includes taking preventative steps, such as filing healthcare antitrust reports, as well as responding to government inquiries.
- Professional Liability: We defend healthcare providers and entities in complex liability and malpractice claims. We understand the high stakes involved, including their impact on a provider or entity’s professional reputation. We apply our trial skills early in each case, developing a defense strategy that effectively presents our client’s story to a jury. We have experience representing hospitals, clinics, long-term care facilities, and their employees, as well as other licensed healthcare professionals, including dentists, chiropractors, psychologists, nurses, social workers, and physicians.
- Maltreatment Findings: We defend entities and providers against allegations of patient mistreatment in hospitals, clinics, assisted living facilities, and other long-term care settings. We advocate for our clients and help them in revising their policies and guidelines to minimize the risk of future investigations and unfavorable outcomes.
- ERISA Litigation: We provide comprehensive defense for self-funded and fully insured health plans in litigation arising under the Employee Retirement Income Security Act (ERISA), including claims related to benefit denials, breaches of fiduciary duty, and subrogation.
- Class Action Defense: Large health plans are frequent targets of high-exposure class action lawsuits. Our litigators have a proven track record of defending against complex class actions that span a wide range of issues, including allegations of consumer fraud, benefit administration irregularities, and privacy breaches.
- False Claims Act (FCA) and Government Enforcement Defense: As health plans and providers face increasing scrutiny from federal and state agencies, they require a robust defense against allegations of fraud, waste, and abuse. We have extensive experience representing clients in civil and criminal investigations, qui tam actions, and related enforcement proceedings brought by the DOJ, OIG, and CMS, as well as by state attorneys general, Medicaid Fraud Control Units, and Special Investigative Units. We work swiftly to contain risks, respond to investigative demands, and resolve matters discreetly and efficiently, safeguarding our clients’ reputations and regulatory standing.
- Managed Care and Reimbursement Disputes: We represent health plans and payers in disputes with providers, including challenges related to out-of-network claims, medical necessity, coding and billing practices, and the recovery of overpayments. Our team is adept at navigating the specific legal frameworks governing these disputes, including ERISA. Additionally, we take a proactive approach in helping healthcare entities identify and address potential risks of fraud, waste, and abuse, whether through internal audits, vendor litigation, or preemptive compliance strategies.
- Provider Credentialing, Licensing, and Regulatory Agency Disputes: We advise and defend health plans in disputes and investigations with state professional licensing boards and other healthcare regulatory agencies concerning provider credentialing, disciplinary actions impacting network participation, and compliance with related state and federal requirements, safeguarding the integrity of our clients’ provider networks and operations.
- Complex Commercial Disputes. We represent healthcare plans and providers in litigation arising from joint ventures, strategic partnerships, and third-party vendor relationships. Drawing on our deep expertise in sophisticated commercial and contract litigation, we leverage regulatory obligations and constraints on both sides of a dispute to position our clients for the strongest possible outcome.
- Data Privacy and Security Litigation (HIPAA, State Laws): In an era of growing cyber threats and strict privacy regulations, we defend health plans against lawsuits related to data breaches, alleged HIPAA violations, and non-compliance with state-specific privacy laws. We also regularly advise clients on the latest regulations concerning data privacy laws.