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Mike Paulhus is a litigation partner who focuses his practice on defending healthcare and life sciences clients in civil and criminal government investigations and crisis management.  He has represented clients in more than 50 high-stakes federal and state healthcare false claims and qui tam matters, and Chambers USA has recognized him as "a go-to attorney for providers facing external investigations and enforcement actions, as well as False Claims Act suits."  In recent FCA cases, Mike has led teams that secured two motions to dismiss with prejudice, two government declinations and dismissals, grant of a motion to sever and transfer to a more favorable venue, and a precedent setting win in the California Court of Appeals and Supreme Court, establishing no right to a jury trial for California Insurance Fraud Prevention Act cases (i.e., state private insurance False Claims Act).  Mike is a national thought leader, having spoken on the FCA and healthcare fraud more than 100 times.  He also serves as an adjunct faculty member, teaching a Healthcare Fraud & Abuse seminar at Georgia State University School of Law and is a member of the Board of Directors of the American Health Law Association.

Consulting firm, BTI, named Mike a Client Service All-Star in 2022 as one of the attorneys nationwide “who stand above all the others in delivering the absolute best in client service.”  In 2019, Mike took to trial and won a significant healthcare fraud case against the California Department of Insurance (CDI) and a relator in a major Insurance Frauds Prevention Act trial in Los Angeles County Superior Court, which was recognized as one of the Daily Journal’s 2019 Top California Verdicts and established key precedent for future litigants.

Mike represents a wide range of healthcare and life sciences clients including academic medical centers, national and regional hospital systems, health IT software developers, pharmaceutical, medical device and biologics manufacturers, physician group practices, retail and long-term-care pharmacies, laboratory companies, skilled nursing facility operators, behavioral health facilities, home health, hospice and palliative care providers, and durable medical equipment suppliers. 

Mike is actively involved in the community, serving on the Board of Directors of The Atlanta Opera.  

He served as a law clerk to the Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit.

Full Bio

Credentials

J.D., Washington and Lee University, summa cum laude, Order of the Coif

B.A., Boston College, summa cum laude, Phi Beta Kappa

District of Columbia

Georgia

Supreme Court of the United States

U.S. Court of Appeals for the Eleventh Circuit

U.S. Court of Appeals for the Second Circuit

U.S. Court of Appeals for the Seventh Circuit

U.S. District Court for the Central District of Illinois

U.S. District Court for the Middle District of Georgia

U.S. District Court for the Northern District of Georgia

Law Clerk, Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit

American Bar Association

American Health Law Association

Federal Bar Association

Georgia Academy of Healthcare Attorneys

Health Care Compliance Association

LEAD Atlanta, Class of 2012

Leadership Atlanta, Class of 2016

Order of the Coif, Washington & Lee University School of Law, 2002

Phi Beta Kappa, Boston College, 1999

"He goes above and beyond for his clients and is super responsive."


Chambers USA (2022)

Top Ranked Lawyer, Healthcare


Chambers USA, Georgia (2017-2022)

Healthcare: Georgia


Super Lawyers, 2017-2022

Healthcare Rising Star: Georgia


Super Lawyers, 2010–2016

MVP of Healthcare


Law360, 2014

Rising Star in Healthcare


Law360, 2013

40 Under 40 Georgia Attorneys On the Rise


The Daily Report, 2013

Outstanding Young Healthcare Lawyers


Nightingale’s Healthcare News, 2009

Close

Recognition

"He goes above and beyond for his clients and is super responsive."


Chambers USA (2022)

Top Ranked Lawyer, Healthcare


Chambers USA, Georgia (2017-2022)

Healthcare: Georgia


Super Lawyers, 2017-2022

Healthcare Rising Star: Georgia


Super Lawyers, 2010–2016

MVP of Healthcare


Law360, 2014

Rising Star in Healthcare


Law360, 2013

40 Under 40 Georgia Attorneys On the Rise


The Daily Report, 2013

Outstanding Young Healthcare Lawyers


Nightingale’s Healthcare News, 2009

Matters

State ex rel. Rapier v. SRCC Assocs., LLC, et al., Case No. BC 641254 (Cal. Super. Ct). Won a complete defense verdict on behalf of Prime Healthcare, a 45-hospital system, and its affiliate, Encino Hospital, against the California Department of Insurance (CDI) and a relator in a significant Insurance Frauds Prevention Act (IFPA) trial in Los Angeles County Superior Court. The Court rejected the CDI’s claims, finding no evidence of fraud and establishing a precedent-setting verdict for healthcare providers. This win was confirmed by the California Court of Appeals and Supreme Court.

Representing multiple healthcare providers and device manufacturers in various stages of government investigations as well as False Claims Act litigation with private relators and the U.S. Department of Justice.

Have secured numerous declinations to intervene by the DOJ and state Medicaid Fraud Control Units, followed by subsequent dismissal of complaints by the plaintiff/relator following an investigation in FCA qui tam suits.

See more

Close

Matters

State ex rel. Rapier v. SRCC Assocs., LLC, et al., Case No. BC 641254 (Cal. Super. Ct). Won a complete defense verdict on behalf of Prime Healthcare, a 45-hospital system, and its affiliate, Encino Hospital, against the California Department of Insurance (CDI) and a relator in a significant Insurance Frauds Prevention Act (IFPA) trial in Los Angeles County Superior Court. The Court rejected the CDI’s claims, finding no evidence of fraud and establishing a precedent-setting verdict for healthcare providers. This win was confirmed by the California Court of Appeals and Supreme Court.

Representing multiple healthcare providers and device manufacturers in various stages of government investigations as well as False Claims Act litigation with private relators and the U.S. Department of Justice.

Have secured numerous declinations to intervene by the DOJ and state Medicaid Fraud Control Units, followed by subsequent dismissal of complaints by the plaintiff/relator following an investigation in FCA qui tam suits.

Won three successive cases for long-term-care pharmacy Omnicare defending against FCA allegations by serial relator Fox Rx:

Represented Regional hospital and corporate parent in qui tam complaint alleging violations of the False Claims Act, Anti-Kickback Statute, Stark Law, and state Medicaid Fraud Act. The Relator alleged that a surgeon violated the Stark Law and Anti-Kickback Statute by requesting that the hospital purchase medical devices from a business owned by a family member. The Court dismissed all federal claims with prejudice for failure to state a claim upon which relief can be granted, separately holding that the corporate parent could not be held liable for the actions alleged in the complaint. The court’s opinion also included important holdings favorable to defendants on the scope of the Stark Law and Anti-Kickback Statute.

Represented national hospice and palliative care provider in an investigation and associated Civil Investigative Demand from the United States Department of Justice, requesting information on potential FCA violations involving allegations of improper medical director relationships. Engaged with the government and was successful in obtaining a declination and Notice of Voluntary Dismissal Without Prejudice of the action to which the Attorney General consented.

Represented regional hospital and corporate parent in qui tam complaint alleging violations of the FCA and Anti-Kickback Statute based on alleged improper admissions for geriatric psychiatric patients. Filed multiple rounds of motions to dismiss under Rules 9(b) and 12(b)(6). Court ultimately granted the motion to dismiss with prejudice.

United States ex rel. Fox Rx., Inc. v. Omnicare, Inc., No. 1:11-cv-962-WSD, 2014 WL 2158412 (N.D. Ga. May 23, 2014). Won complete summary judgment and award of costs (and preceding successive motions to dismiss) for Omnicare in FCA qui tam litigation regarding the scope of Medicare Part D drug coverage. In the first order, five of eight claims were dismissed with prejudice and three with leave to replead. See 2012 WL 8020674 (Aug. 29, 2012). In its second order, the Court dismissed two counts and significantly restricted the remaining theories, dismissing relator’s attempt to proceed with purported nationwide claims on behalf of all Part D plans. See 2013 WL 2303768 (May 17, 2013).

United States ex rel. Fox Rx., Inc. v. Omnicare, Inc., No. 1:12-cv-00275-DLC, 2014 WL 3928780 (S.D.N.Y. Aug. 12, 2014). Won motion to dismiss for Omnicare in FCA qui tam litigation regarding generic drug substitution and National Drug Codes.


United States ex rel. Fox Rx., Inc. v. Dr. Reddy’s Inc. et al., No. 1:13-cv-3779-DLC, 2014 WL 6750277 (S.D.N.Y. Dec. 1, 2014). Won motion to dismiss for Omnicare in FCA qui tam litigation regarding Medicare Part D dispensing fees and Anti-Kickback Statute allegations regarding generic drug rebates.

United States ex rel. Stephens v. Tissue Science Laboratories, Inc., 664 F. Supp. 2d 1310 (N.D. Ga. 2009). Won dismissal for medical device manufacturer in False Claims Act litigation regarding allegations of off-label promotion of hernia repair mesh. The decision created important precedent advancing the principle that Medicare DRG payments for inpatient services can preclude a finding of materiality under the FCA for products bundled within the DRG payment.

Represented leading pharmaceutical companies in investigations into physician interaction practices, off-label promotion, and safety of various prescription drugs by the DOJ, multiple state attorneys general and private litigants.

Insights

Article · Source: U.S. Chamber of Commerce Litigation Center Blog

October 13, 2022
Top False Claims Act Developments

Article · Source: Pratt’s Privacy & Cybersecurity Law Report

July 1, 2022
First False Claims Act Cases Since Justice Department Launched Its Cybersecurity Initiative Settle

View all

Matters

State ex rel. Rapier v. SRCC Assocs., LLC, et al., Case No. BC 641254 (Cal. Super. Ct). Won a complete defense verdict on behalf of Prime Healthcare, a 45-hospital system, and its affiliate, Encino Hospital, against the California Department of Insurance (CDI) and a relator in a significant Insurance Frauds Prevention Act (IFPA) trial in Los Angeles County Superior Court. The Court rejected the CDI’s claims, finding no evidence of fraud and establishing a precedent-setting verdict for healthcare providers. This win was confirmed by the California Court of Appeals and Supreme Court.

Representing multiple healthcare providers and device manufacturers in various stages of government investigations as well as False Claims Act litigation with private relators and the U.S. Department of Justice.

Have secured numerous declinations to intervene by the DOJ and state Medicaid Fraud Control Units, followed by subsequent dismissal of complaints by the plaintiff/relator following an investigation in FCA qui tam suits.

See more

Close

Matters

State ex rel. Rapier v. SRCC Assocs., LLC, et al., Case No. BC 641254 (Cal. Super. Ct). Won a complete defense verdict on behalf of Prime Healthcare, a 45-hospital system, and its affiliate, Encino Hospital, against the California Department of Insurance (CDI) and a relator in a significant Insurance Frauds Prevention Act (IFPA) trial in Los Angeles County Superior Court. The Court rejected the CDI’s claims, finding no evidence of fraud and establishing a precedent-setting verdict for healthcare providers. This win was confirmed by the California Court of Appeals and Supreme Court.

Representing multiple healthcare providers and device manufacturers in various stages of government investigations as well as False Claims Act litigation with private relators and the U.S. Department of Justice.

Have secured numerous declinations to intervene by the DOJ and state Medicaid Fraud Control Units, followed by subsequent dismissal of complaints by the plaintiff/relator following an investigation in FCA qui tam suits.

Won three successive cases for long-term-care pharmacy Omnicare defending against FCA allegations by serial relator Fox Rx:

Represented Regional hospital and corporate parent in qui tam complaint alleging violations of the False Claims Act, Anti-Kickback Statute, Stark Law, and state Medicaid Fraud Act. The Relator alleged that a surgeon violated the Stark Law and Anti-Kickback Statute by requesting that the hospital purchase medical devices from a business owned by a family member. The Court dismissed all federal claims with prejudice for failure to state a claim upon which relief can be granted, separately holding that the corporate parent could not be held liable for the actions alleged in the complaint. The court’s opinion also included important holdings favorable to defendants on the scope of the Stark Law and Anti-Kickback Statute.

Represented national hospice and palliative care provider in an investigation and associated Civil Investigative Demand from the United States Department of Justice, requesting information on potential FCA violations involving allegations of improper medical director relationships. Engaged with the government and was successful in obtaining a declination and Notice of Voluntary Dismissal Without Prejudice of the action to which the Attorney General consented.

Represented regional hospital and corporate parent in qui tam complaint alleging violations of the FCA and Anti-Kickback Statute based on alleged improper admissions for geriatric psychiatric patients. Filed multiple rounds of motions to dismiss under Rules 9(b) and 12(b)(6). Court ultimately granted the motion to dismiss with prejudice.

United States ex rel. Fox Rx., Inc. v. Omnicare, Inc., No. 1:11-cv-962-WSD, 2014 WL 2158412 (N.D. Ga. May 23, 2014). Won complete summary judgment and award of costs (and preceding successive motions to dismiss) for Omnicare in FCA qui tam litigation regarding the scope of Medicare Part D drug coverage. In the first order, five of eight claims were dismissed with prejudice and three with leave to replead. See 2012 WL 8020674 (Aug. 29, 2012). In its second order, the Court dismissed two counts and significantly restricted the remaining theories, dismissing relator’s attempt to proceed with purported nationwide claims on behalf of all Part D plans. See 2013 WL 2303768 (May 17, 2013).

United States ex rel. Fox Rx., Inc. v. Omnicare, Inc., No. 1:12-cv-00275-DLC, 2014 WL 3928780 (S.D.N.Y. Aug. 12, 2014). Won motion to dismiss for Omnicare in FCA qui tam litigation regarding generic drug substitution and National Drug Codes.


United States ex rel. Fox Rx., Inc. v. Dr. Reddy’s Inc. et al., No. 1:13-cv-3779-DLC, 2014 WL 6750277 (S.D.N.Y. Dec. 1, 2014). Won motion to dismiss for Omnicare in FCA qui tam litigation regarding Medicare Part D dispensing fees and Anti-Kickback Statute allegations regarding generic drug rebates.

United States ex rel. Stephens v. Tissue Science Laboratories, Inc., 664 F. Supp. 2d 1310 (N.D. Ga. 2009). Won dismissal for medical device manufacturer in False Claims Act litigation regarding allegations of off-label promotion of hernia repair mesh. The decision created important precedent advancing the principle that Medicare DRG payments for inpatient services can preclude a finding of materiality under the FCA for products bundled within the DRG payment.

Represented leading pharmaceutical companies in investigations into physician interaction practices, off-label promotion, and safety of various prescription drugs by the DOJ, multiple state attorneys general and private litigants.

Insights

Article · Source: U.S. Chamber of Commerce Litigation Center Blog

October 13, 2022
Top False Claims Act Developments

Article · Source: Pratt’s Privacy & Cybersecurity Law Report

July 1, 2022
First False Claims Act Cases Since Justice Department Launched Its Cybersecurity Initiative Settle

View all

Credentials

J.D., Washington and Lee University, summa cum laude, Order of the Coif

B.A., Boston College, summa cum laude, Phi Beta Kappa

District of Columbia

Georgia

Supreme Court of the United States

U.S. Court of Appeals for the Eleventh Circuit

U.S. Court of Appeals for the Second Circuit

U.S. Court of Appeals for the Seventh Circuit

U.S. District Court for the Central District of Illinois

U.S. District Court for the Middle District of Georgia

U.S. District Court for the Northern District of Georgia

Law Clerk, Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit

American Bar Association

American Health Law Association

Federal Bar Association

Georgia Academy of Healthcare Attorneys

Health Care Compliance Association

LEAD Atlanta, Class of 2012

Leadership Atlanta, Class of 2016

Order of the Coif, Washington & Lee University School of Law, 2002

Phi Beta Kappa, Boston College, 1999

"He goes above and beyond for his clients and is super responsive."


Chambers USA (2022)

Top Ranked Lawyer, Healthcare


Chambers USA, Georgia (2017-2022)

Healthcare: Georgia


Super Lawyers, 2017-2022

Healthcare Rising Star: Georgia


Super Lawyers, 2010–2016

MVP of Healthcare


Law360, 2014

Rising Star in Healthcare


Law360, 2013

40 Under 40 Georgia Attorneys On the Rise


The Daily Report, 2013

Outstanding Young Healthcare Lawyers


Nightingale’s Healthcare News, 2009

Close

Recognition

"He goes above and beyond for his clients and is super responsive."


Chambers USA (2022)

Top Ranked Lawyer, Healthcare


Chambers USA, Georgia (2017-2022)

Healthcare: Georgia


Super Lawyers, 2017-2022

Healthcare Rising Star: Georgia


Super Lawyers, 2010–2016

MVP of Healthcare


Law360, 2014

Rising Star in Healthcare


Law360, 2013

40 Under 40 Georgia Attorneys On the Rise


The Daily Report, 2013

Outstanding Young Healthcare Lawyers


Nightingale’s Healthcare News, 2009