Michael E.
Paulhus
(Mike)

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.