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He has represented clients in more than 65\u0026nbsp;high-stakes federal and state healthcare false claims and \u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;matters in courts and U.S. Attorney's Offices across the country.\u0026nbsp; Chambers USA recognizes\u0026nbsp;Mike nationally for False Claims Act defense work and as a Band 1 Healthcare attorney in Georgia, describing him as \"\u003cem\u003ea go-to attorney for providers facing external investigations and enforcement actions, as well as\u0026nbsp;False Claims Act suits\u003c/em\u003e.\"\u0026nbsp; Chambers reports clients\u0026nbsp;describe Mike as \"\u003cem\u003eextremely knowledgeable about the FCA and its intricacies\u003c/em\u003e\" and \"\u003cem\u003ean extremely high-quality lawyer and adviser\u003c/em\u003e.\u0026nbsp; \u003cem\u003eHe is efficient, effective and professional\u003c/em\u003e.\"\u0026nbsp; Mike is a national thought leader, speaking regularly and teaching a Healthcare Fraud \u0026amp; Abuse seminar at Georgia State University School of Law.\u0026nbsp; He also serves as a member of the Board of Directors of the American Health Law Association.\u0026nbsp;[[--readmore--]]\u003c/p\u003e\n\u003cp\u003eMike represents a wide range of healthcare and life sciences clients including\u0026nbsp;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 operators, behavioral health facilities, home health, hospice and palliative care providers, and durable medical equipment suppliers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsulting firm, BTI, named Mike a Client Service All-Star in 2024 and 2022 as one of the attorneys nationwide \u0026ldquo;who stand above all the others in delivering the absolute best in client service.\u0026rdquo;\u0026nbsp; 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\u0026rsquo;s 2019 Top California Verdicts and established key precedent for future litigants, establishing no right to a jury trial for California Insurance Fraud Prevention Act cases (i.e., state private insurance False Claims Act).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMike is actively involved in the community, serving on the\u0026nbsp;Board of Directors of The Atlanta Opera.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHe served as a law clerk to the Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit.\u003c/p\u003e","slug":"michael-paulhus","email":"mpaulhus@kslaw.com","phone":"+1 404 326 3637","matters":["\u003cp\u003e\u003cem\u003e\u003cstrong\u003eState ex rel. Rapier v. SRCC Assocs., LLC, et al.\u003c/strong\u003e\u003c/em\u003e, 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\u0026rsquo;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.\u003c/p\u003e","\u003cp\u003eRepresenting\u0026nbsp;\u003cstrong\u003emultiple healthcare providers\u003c/strong\u003e\u0026nbsp;and\u0026nbsp;\u003cstrong\u003edevice manufacturers\u003c/strong\u003e\u0026nbsp;in various stages of government investigations as well as False Claims Act litigation with private relators and the U.S. Department of Justice.\u003c/p\u003e","\u003cp\u003eHave 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\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;suits.\u003c/p\u003e","\u003cp\u003eWon three successive cases for long-term-care pharmacy\u0026nbsp;\u003cstrong\u003eOmnicare\u003c/strong\u003e\u0026nbsp;defending against FCA allegations by serial relator Fox Rx:\u003c/p\u003e","\u003cp\u003e\u003cstrong\u003eRepresented Regional hospital and corporate parent\u0026nbsp;\u003c/strong\u003ein 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\u0026rsquo;s opinion also included important holdings favorable to defendants on the scope of the Stark Law and Anti-Kickback Statute.\u003c/p\u003e","\u003cp\u003e\u003cstrong\u003eRepresented national hospice and palliative care provider\u003c/strong\u003e\u0026nbsp;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.\u003c/p\u003e","\u003cp\u003e\u003cstrong\u003eRepresented regional hospital and corporate parent\u003c/strong\u003e\u0026nbsp;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.\u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Fox Rx., Inc. v. Omnicare, Inc.\u003c/strong\u003e\u003c/em\u003e, 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\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;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\u0026rsquo;s attempt to proceed with purported nationwide claims on behalf of all Part D plans. See 2013 WL 2303768 (May 17, 2013).\u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Fox Rx., Inc. v. Omnicare, Inc.\u003c/strong\u003e\u003c/em\u003e, No. 1:12-cv-00275-DLC, 2014 WL 3928780 (S.D.N.Y. Aug. 12, 2014). Won motion to dismiss for Omnicare in FCA\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;litigation regarding generic drug substitution and National Drug Codes.\u003c/p\u003e\n\u003cp\u003e\u003cbr /\u003e \u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Fox Rx., Inc. v. Dr. Reddy\u0026rsquo;s Inc. et al.\u003c/strong\u003e\u003c/em\u003e, No. 1:13-cv-3779-DLC, 2014 WL 6750277 (S.D.N.Y. Dec. 1, 2014). Won motion to dismiss for Omnicare in FCA\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;litigation regarding Medicare Part D dispensing fees and Anti-Kickback Statute allegations regarding generic drug rebates.\u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Stephens v. Tissue Science Laboratories, Inc\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e, 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.\u003c/p\u003e","\u003cp\u003eRepresented 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.\u003c/p\u003e"],"taggings":{"tags":[],"meta_tags":[]},"expertise":[{"id":81,"guid":"81.capabilities","index":0,"source":"capabilities"},{"id":103,"guid":"103.capabilities","index":1,"source":"capabilities"},{"id":24,"guid":"24.capabilities","index":2,"source":"capabilities"},{"id":952,"guid":"952.smart_tags","index":3,"source":"smartTags"},{"id":122,"guid":"122.capabilities","index":4,"source":"capabilities"}],"is_active":true,"last_name":"Paulhus","nick_name":"Mike","clerkships":[{"name":"Law Clerk, Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit","years_held":"2002-03"}],"first_name":"Michael","title_rank":9999,"updated_by":202,"law_schools":[],"middle_name":"E.","name_suffix":"","recognitions":[{"title":"\"He goes above and beyond for his clients and is super responsive.\" ","detail":"Chambers USA (2022)"},{"title":"Top Ranked Lawyer, Healthcare","detail":"Chambers USA, Georgia (2017-2022)"},{"title":"Healthcare: Georgia","detail":"Super Lawyers, 2017-2022"},{"title":"Healthcare Rising Star: Georgia","detail":"Super Lawyers, 2010–2016"},{"title":"MVP of Healthcare","detail":"Law360, 2014"},{"title":"Rising Star in Healthcare ","detail":"Law360, 2013"},{"title":"40 Under 40 Georgia Attorneys On the Rise","detail":"The Daily Report, 2013"},{"title":"Outstanding Young Healthcare Lawyers","detail":"Nightingale’s Healthcare News, 2009"}],"linked_in_url":"https://www.linkedin.com/in/michaelpaulhus/","seodescription":null,"primary_title_id":15,"translated_fields":{"en":{"bio":"\u003cp\u003eMike Paulhus is a litigation partner who\u0026nbsp;focuses his practice on defending healthcare and life sciences clients in mission critical civil and criminal government investigations.\u0026nbsp; He has represented clients in more than 65\u0026nbsp;high-stakes federal and state healthcare false claims and \u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;matters in courts and U.S. Attorney's Offices across the country.\u0026nbsp; Chambers USA recognizes\u0026nbsp;Mike nationally for False Claims Act defense work and as a Band 1 Healthcare attorney in Georgia, describing him as \"\u003cem\u003ea go-to attorney for providers facing external investigations and enforcement actions, as well as\u0026nbsp;False Claims Act suits\u003c/em\u003e.\"\u0026nbsp; Chambers reports clients\u0026nbsp;describe Mike as \"\u003cem\u003eextremely knowledgeable about the FCA and its intricacies\u003c/em\u003e\" and \"\u003cem\u003ean extremely high-quality lawyer and adviser\u003c/em\u003e.\u0026nbsp; \u003cem\u003eHe is efficient, effective and professional\u003c/em\u003e.\"\u0026nbsp; Mike is a national thought leader, speaking regularly and teaching a Healthcare Fraud \u0026amp; Abuse seminar at Georgia State University School of Law.\u0026nbsp; He also serves as a member of the Board of Directors of the American Health Law Association.\u0026nbsp;[[--readmore--]]\u003c/p\u003e\n\u003cp\u003eMike represents a wide range of healthcare and life sciences clients including\u0026nbsp;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 operators, behavioral health facilities, home health, hospice and palliative care providers, and durable medical equipment suppliers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsulting firm, BTI, named Mike a Client Service All-Star in 2024 and 2022 as one of the attorneys nationwide \u0026ldquo;who stand above all the others in delivering the absolute best in client service.\u0026rdquo;\u0026nbsp; 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\u0026rsquo;s 2019 Top California Verdicts and established key precedent for future litigants, establishing no right to a jury trial for California Insurance Fraud Prevention Act cases (i.e., state private insurance False Claims Act).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMike is actively involved in the community, serving on the\u0026nbsp;Board of Directors of The Atlanta Opera.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHe served as a law clerk to the Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit.\u003c/p\u003e","matters":["\u003cp\u003e\u003cem\u003e\u003cstrong\u003eState ex rel. Rapier v. SRCC Assocs., LLC, et al.\u003c/strong\u003e\u003c/em\u003e, 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\u0026rsquo;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.\u003c/p\u003e","\u003cp\u003eRepresenting\u0026nbsp;\u003cstrong\u003emultiple healthcare providers\u003c/strong\u003e\u0026nbsp;and\u0026nbsp;\u003cstrong\u003edevice manufacturers\u003c/strong\u003e\u0026nbsp;in various stages of government investigations as well as False Claims Act litigation with private relators and the U.S. Department of Justice.\u003c/p\u003e","\u003cp\u003eHave 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\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;suits.\u003c/p\u003e","\u003cp\u003eWon three successive cases for long-term-care pharmacy\u0026nbsp;\u003cstrong\u003eOmnicare\u003c/strong\u003e\u0026nbsp;defending against FCA allegations by serial relator Fox Rx:\u003c/p\u003e","\u003cp\u003e\u003cstrong\u003eRepresented Regional hospital and corporate parent\u0026nbsp;\u003c/strong\u003ein 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\u0026rsquo;s opinion also included important holdings favorable to defendants on the scope of the Stark Law and Anti-Kickback Statute.\u003c/p\u003e","\u003cp\u003e\u003cstrong\u003eRepresented national hospice and palliative care provider\u003c/strong\u003e\u0026nbsp;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.\u003c/p\u003e","\u003cp\u003e\u003cstrong\u003eRepresented regional hospital and corporate parent\u003c/strong\u003e\u0026nbsp;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.\u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Fox Rx., Inc. v. Omnicare, Inc.\u003c/strong\u003e\u003c/em\u003e, 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\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;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\u0026rsquo;s attempt to proceed with purported nationwide claims on behalf of all Part D plans. See 2013 WL 2303768 (May 17, 2013).\u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Fox Rx., Inc. v. Omnicare, Inc.\u003c/strong\u003e\u003c/em\u003e, No. 1:12-cv-00275-DLC, 2014 WL 3928780 (S.D.N.Y. Aug. 12, 2014). Won motion to dismiss for Omnicare in FCA\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;litigation regarding generic drug substitution and National Drug Codes.\u003c/p\u003e\n\u003cp\u003e\u003cbr /\u003e \u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Fox Rx., Inc. v. Dr. Reddy\u0026rsquo;s Inc. et al.\u003c/strong\u003e\u003c/em\u003e, No. 1:13-cv-3779-DLC, 2014 WL 6750277 (S.D.N.Y. Dec. 1, 2014). Won motion to dismiss for Omnicare in FCA\u0026nbsp;\u003cem\u003equi tam\u003c/em\u003e\u0026nbsp;litigation regarding Medicare Part D dispensing fees and Anti-Kickback Statute allegations regarding generic drug rebates.\u003c/p\u003e","\u003cp\u003e\u003cem\u003e\u003cstrong\u003eUnited States ex rel. Stephens v. Tissue Science Laboratories, Inc\u003c/strong\u003e\u003c/em\u003e\u003cem\u003e.\u003c/em\u003e, 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.\u003c/p\u003e","\u003cp\u003eRepresented 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.\u003c/p\u003e"],"recognitions":[{"title":"\"He goes above and beyond for his clients and is super responsive.\" ","detail":"Chambers USA (2022)"},{"title":"Top Ranked Lawyer, Healthcare","detail":"Chambers USA, Georgia (2017-2022)"},{"title":"Healthcare: Georgia","detail":"Super Lawyers, 2017-2022"},{"title":"Healthcare Rising Star: Georgia","detail":"Super Lawyers, 2010–2016"},{"title":"MVP of Healthcare","detail":"Law360, 2014"},{"title":"Rising Star in Healthcare ","detail":"Law360, 2013"},{"title":"40 Under 40 Georgia Attorneys On the Rise","detail":"The Daily Report, 2013"},{"title":"Outstanding Young Healthcare Lawyers","detail":"Nightingale’s Healthcare News, 2009"}]},"locales":["en"]},"secondary_title_id":null,"upload_assignments":{"headshot":[{"id":11061}]},"capability_group_id":2},"created_at":"2025-12-16T15:43:13.000Z","updated_at":"2025-12-16T15:43:13.000Z","searchable_text":"Paulhus{{ FIELD }}{:title=\u0026gt;\"\\\"He goes above and beyond for his clients and is super responsive.\\\" \", :detail=\u0026gt;\"Chambers USA (2022)\"}{{ FIELD }}{:title=\u0026gt;\"Top Ranked Lawyer, Healthcare\", :detail=\u0026gt;\"Chambers USA, Georgia (2017-2022)\"}{{ FIELD }}{:title=\u0026gt;\"Healthcare: Georgia\", :detail=\u0026gt;\"Super Lawyers, 2017-2022\"}{{ FIELD }}{:title=\u0026gt;\"Healthcare Rising Star: Georgia\", :detail=\u0026gt;\"Super Lawyers, 2010–2016\"}{{ FIELD }}{:title=\u0026gt;\"MVP of Healthcare\", :detail=\u0026gt;\"Law360, 2014\"}{{ FIELD }}{:title=\u0026gt;\"Rising Star in Healthcare \", :detail=\u0026gt;\"Law360, 2013\"}{{ FIELD }}{:title=\u0026gt;\"40 Under 40 Georgia Attorneys On the Rise\", :detail=\u0026gt;\"The Daily Report, 2013\"}{{ FIELD }}{:title=\u0026gt;\"Outstanding Young Healthcare Lawyers\", :detail=\u0026gt;\"Nightingale’s Healthcare News, 2009\"}{{ FIELD }}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.{{ FIELD }}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.{{ FIELD }}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.{{ FIELD }}Won three successive cases for long-term-care pharmacy Omnicare defending against FCA allegations by serial relator Fox Rx:{{ FIELD }}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.{{ FIELD }}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.{{ FIELD }}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.{{ FIELD }}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).{{ FIELD }}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.\n {{ FIELD }}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.{{ FIELD }}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.{{ FIELD }}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.{{ FIELD }}Mike Paulhus is a litigation partner who focuses his practice on defending healthcare and life sciences clients in mission critical civil and criminal government investigations.  He has represented clients in more than 65 high-stakes federal and state healthcare false claims and qui tam matters in courts and U.S. Attorney's Offices across the country.  Chambers USA recognizes Mike nationally for False Claims Act defense work and as a Band 1 Healthcare attorney in Georgia, describing him as \"a go-to attorney for providers facing external investigations and enforcement actions, as well as False Claims Act suits.\"  Chambers reports clients describe Mike as \"extremely knowledgeable about the FCA and its intricacies\" and \"an extremely high-quality lawyer and adviser.  He is efficient, effective and professional.\"  Mike is a national thought leader, speaking regularly and teaching a Healthcare Fraud \u0026amp; Abuse seminar at Georgia State University School of Law.  He also serves as a member of the Board of Directors of the American Health Law Association. \nMike 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 operators, behavioral health facilities, home health, hospice and palliative care providers, and durable medical equipment suppliers. \nConsulting firm, BTI, named Mike a Client Service All-Star in 2024 and 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, establishing no right to a jury trial for California Insurance Fraud Prevention Act cases (i.e., state private insurance False Claims Act). \nMike is actively involved in the community, serving on the Board of Directors of The Atlanta Opera.  \nHe served as a law clerk to the Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit. Partner \"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 Boston College Boston College Law School Washington and Lee University Washington and Lee University School of Law Supreme Court of the United States U.S. Court of Appeals for the Second Circuit U.S. Court of Appeals for the Seventh Circuit U.S. Court of Appeals for the Eleventh 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 District of Columbia Georgia American Bar Association Georgia Academy of Healthcare Attorneys Federal Bar Association American Health Law Association Health Care Compliance Association Leadership Atlanta, Class of 2016 LEAD Atlanta, Class of 2012 Order of the Coif, Washington \u0026amp; Lee University School of Law, 2002 Phi Beta Kappa, Boston College, 1999 Law Clerk, Honorable Kenneth F. Ripple, U.S. Court of Appeals for the Seventh Circuit 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.\n  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.","searchable_name":"Michael E. Paulhus (Mike)","is_active":true,"featured":null,"publish_date":null,"expiration_date":null,"blog_featured":null,"published_by":202,"capability_group_featured":null,"home_page_featured":null},{"id":447573,"version":1,"owner_type":"Person","owner_id":3360,"payload":{"bio":"\u003cp\u003eMark is a Partner in the firm\u0026rsquo;s Healthcare practice and Co-Chairs the firm\u0026rsquo;s Life Sciences and Healthcare Industry Group, which is comprised of more than 300 lawyers across the firm.\u0026nbsp; As the former HHS Deputy Associate General Counsel for Litigation for the Centers for Medicare \u0026amp; Medicaid Services, Mark has over 20\u0026nbsp;years of experience in Medicare reimbursement policy and Medicare fraud defense and represents numerous health care systems and hospitals in navigating the Medicare regulatory environment.\u0026nbsp; Mark has served as the lead litigator on numerous Medicare reimbursement litigation cases defending providers against government enforcement actions, and frequently advises clients on Medicare reimbursement strategy and regulatory and compliance requirements.[[--readmore--]]\u003c/p\u003e\n\u003cp\u003eFor more than 20 years, Mark has counseled clients in navigating through the complex realm of Medicare, a regulatory environment so intricate that the Supreme Court has described it as \u0026ldquo;unintelligible to the uninitiated.\u0026rdquo;\u0026nbsp; In that vein, Mark specializes in representing clients and litigating complicated Medicare reimbursement issues, including the successful challenge to Medicare\u0026rsquo;s so-called \u0026ldquo;Two Midnight\u0026rdquo; 0.2 percent rate cut.\u0026nbsp; As a former high-ranking litigator within the Department of Health and Human Services, Mark brings credibility and an insider\u0026rsquo;s knowledge when advocating before the Centers for Medicare \u0026amp; Medicaid Services and Congress on Medicare and Medicaid issues.\u003c/p\u003e\n\u003cp\u003eDrawing upon his experience as CMS\u0026rsquo;s\u0026nbsp;former chief litigation counsel, Mark represents hundreds of hospitals in Medicare reimbursement appeals.\u0026nbsp; His cases typically challenge national Medicare reimbursement policies, with hundreds of millions of dollars at stake.\u0026nbsp; On the defense side, Mark\u0026rsquo;s years of government fraud enforcement experience and Medicare knowledge translates to surgically effective representation of providers in Medicare fraud investigations.\u003c/p\u003e\n\u003cp\u003eMark is more than just a litigator.\u0026nbsp; According to Chambers USA, sources praise Mark\u0026rsquo;s ability to \u0026ldquo;distill issues carefully and thoughtfully,\u0026rdquo; while also praising his \u0026ldquo;very client service-oriented\u0026rdquo; approach.\u0026nbsp; Given Mark\u0026rsquo;s vast knowledge of the pitfalls and complexities woven throughout the regulatory and compliance labyrinth of Medicare and Medicaid, Mark is able to counsel and strategize with clients on diverse topics such as Graduate Medical Education reimbursement for teaching hospitals, Medicare\u0026rsquo;s \u0026ldquo;provider-based\u0026rdquo; rules, and Medicare coverage standards for inpatient services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHis extensive and lengthy experience in handling complex Medicare and Medicaid issues has led Mark to be deemed a nationally-recognized expert, particularly on matters related to Medicare reimbursement.\u0026nbsp; Mark is also a frequent speaker and a Faculty Member of the Institute on Medicare and Medicaid Payment, and participates annually in the Institute\u0026rsquo;s conference sponsored by the American Health Lawyers\u0026rsquo; Association.\u0026nbsp; Mark is also co-editor of the\u0026nbsp;\u003cem\u003eReimbursement Advisor\u003c/em\u003e, a leading publication within the healthcare finance community.\u003c/p\u003e","slug":"mark-polston","email":"mpolston@kslaw.com","phone":null,"matters":["\u003cp\u003e\"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals.\"\u003c/p\u003e","\u003cp\u003e\"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice.\"\u003c/p\u003e","\u003cp\u003e\"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program.\"\u003c/p\u003e","\u003cp\u003e\"Leading the Stark Reform Coalition, a consortium of hospitals seeking reform of the Stark Physician Self Referral Law.\"\u003c/p\u003e","\u003cp\u003e\"Representing an academic medical center in a False Claims Act investigation involving allegations of violations of the Medicare provider-based facility rule.\"\u003c/p\u003e","\u003cp\u003e\"Representing Community Health Systems in numerous cost report reimbursement appeals before the Provider Reimbursement Review Board and in federal court.\"\u003c/p\u003e","\u003cp\u003e\"Representing the Florida Hospital Association and several Florida hospitals in multi-million dollar group appeal challenge to CMS policy excluding Low Income Pool Section 1115 expansion waiver days from the Medicare DSH payment calculation.\"\u003c/p\u003e","\u003cp\u003e\"Counseled major Mid-Western hospital chain on reorganization of its Medicare Graduate Medical Education programs, including seeking rural re-designation of certain hospitals in order to maximize FTE 'cap space' and take advantage of relaxed rules for creation of 'new' medical education programs, all of which resulted in millions of dollars of additional Medicare reimbursement.\"\u003c/p\u003e","\u003cp\u003e\"Successfully assisted academic medical center in seeking 'on-campus' status from CMS for provider-based facility located more than 250 yards from campus, resulting in millions of dollars of additional Medicare reimbursement.\"\u003c/p\u003e","\u003cp\u003e\"Counseled numerous providers on the 60-day overpayment rule, including advising a hospice provider in identifying and returning a $10 million overpayment refund to the Medicare program.\"\u003c/p\u003e","\u003cp\u003e\"Representing 30 hospitals in a multi-million dollar challenge to CMS regulation which arbitrarily penalizes teaching hospitals for training medical fellows above their 'FTE cap.'\"\u003c/p\u003e"],"taggings":{"tags":[],"meta_tags":[]},"expertise":[{"id":2,"guid":"2.capabilities","index":0,"source":"capabilities"},{"id":23,"guid":"23.capabilities","index":1,"source":"capabilities"},{"id":81,"guid":"81.capabilities","index":2,"source":"capabilities"},{"id":103,"guid":"103.capabilities","index":3,"source":"capabilities"},{"id":24,"guid":"24.capabilities","index":4,"source":"capabilities"},{"id":826,"guid":"826.smart_tags","index":5,"source":"smartTags"},{"id":952,"guid":"952.smart_tags","index":6,"source":"smartTags"},{"id":970,"guid":"970.smart_tags","index":7,"source":"smartTags"},{"id":109,"guid":"109.capabilities","index":8,"source":"capabilities"},{"id":1097,"guid":"1097.smart_tags","index":9,"source":"smartTags"},{"id":110,"guid":"110.capabilities","index":10,"source":"capabilities"},{"id":112,"guid":"112.capabilities","index":11,"source":"capabilities"},{"id":114,"guid":"114.capabilities","index":12,"source":"capabilities"},{"id":120,"guid":"120.capabilities","index":13,"source":"capabilities"},{"id":122,"guid":"122.capabilities","index":14,"source":"capabilities"},{"id":1202,"guid":"1202.smart_tags","index":15,"source":"smartTags"}],"is_active":true,"last_name":"Polston","nick_name":"Mark","clerkships":[{"name":"Law Clerk, Pierce Lively, U.S. Court of Appeals for the Sixth Circuit","years_held":"1988-1989"}],"first_name":"Mark","title_rank":9999,"updated_by":202,"law_schools":[{"id":824,"meta":{"degree":"J.D.","honors":"cum laude","is_law_school":"1","graduation_date":"1988-01-01 00:00:00"},"order":1,"pin_order":null,"pin_expiration":null}],"middle_name":"D.","name_suffix":"","recognitions":[{"title":"Source notes, “tremendous understanding of how enforcement agencies view and interpret the law...”","detail":"Chambers 2020 Healthcare"},{"title":"Sources praise his ability to “distill issues carefully and thoughtfully\"","detail":"Chambers 2017 Healthcare"},{"title":"Named a “Life Sciences Star”","detail":"LMG Life Sciences, 2016-2021"},{"title":"Ranked in the Healthcare: Service Providers category","detail":"The Legal 500, 2015"},{"title":"Received the Superior Achievement Award","detail":"HHS, Office of General Counsel"},{"title":"Received the Special Service Citation","detail":"CMS Administrator"}],"linked_in_url":null,"seodescription":null,"primary_title_id":15,"translated_fields":{"en":{"bio":"\u003cp\u003eMark is a Partner in the firm\u0026rsquo;s Healthcare practice and Co-Chairs the firm\u0026rsquo;s Life Sciences and Healthcare Industry Group, which is comprised of more than 300 lawyers across the firm.\u0026nbsp; As the former HHS Deputy Associate General Counsel for Litigation for the Centers for Medicare \u0026amp; Medicaid Services, Mark has over 20\u0026nbsp;years of experience in Medicare reimbursement policy and Medicare fraud defense and represents numerous health care systems and hospitals in navigating the Medicare regulatory environment.\u0026nbsp; Mark has served as the lead litigator on numerous Medicare reimbursement litigation cases defending providers against government enforcement actions, and frequently advises clients on Medicare reimbursement strategy and regulatory and compliance requirements.[[--readmore--]]\u003c/p\u003e\n\u003cp\u003eFor more than 20 years, Mark has counseled clients in navigating through the complex realm of Medicare, a regulatory environment so intricate that the Supreme Court has described it as \u0026ldquo;unintelligible to the uninitiated.\u0026rdquo;\u0026nbsp; In that vein, Mark specializes in representing clients and litigating complicated Medicare reimbursement issues, including the successful challenge to Medicare\u0026rsquo;s so-called \u0026ldquo;Two Midnight\u0026rdquo; 0.2 percent rate cut.\u0026nbsp; As a former high-ranking litigator within the Department of Health and Human Services, Mark brings credibility and an insider\u0026rsquo;s knowledge when advocating before the Centers for Medicare \u0026amp; Medicaid Services and Congress on Medicare and Medicaid issues.\u003c/p\u003e\n\u003cp\u003eDrawing upon his experience as CMS\u0026rsquo;s\u0026nbsp;former chief litigation counsel, Mark represents hundreds of hospitals in Medicare reimbursement appeals.\u0026nbsp; His cases typically challenge national Medicare reimbursement policies, with hundreds of millions of dollars at stake.\u0026nbsp; On the defense side, Mark\u0026rsquo;s years of government fraud enforcement experience and Medicare knowledge translates to surgically effective representation of providers in Medicare fraud investigations.\u003c/p\u003e\n\u003cp\u003eMark is more than just a litigator.\u0026nbsp; According to Chambers USA, sources praise Mark\u0026rsquo;s ability to \u0026ldquo;distill issues carefully and thoughtfully,\u0026rdquo; while also praising his \u0026ldquo;very client service-oriented\u0026rdquo; approach.\u0026nbsp; Given Mark\u0026rsquo;s vast knowledge of the pitfalls and complexities woven throughout the regulatory and compliance labyrinth of Medicare and Medicaid, Mark is able to counsel and strategize with clients on diverse topics such as Graduate Medical Education reimbursement for teaching hospitals, Medicare\u0026rsquo;s \u0026ldquo;provider-based\u0026rdquo; rules, and Medicare coverage standards for inpatient services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHis extensive and lengthy experience in handling complex Medicare and Medicaid issues has led Mark to be deemed a nationally-recognized expert, particularly on matters related to Medicare reimbursement.\u0026nbsp; Mark is also a frequent speaker and a Faculty Member of the Institute on Medicare and Medicaid Payment, and participates annually in the Institute\u0026rsquo;s conference sponsored by the American Health Lawyers\u0026rsquo; Association.\u0026nbsp; Mark is also co-editor of the\u0026nbsp;\u003cem\u003eReimbursement Advisor\u003c/em\u003e, a leading publication within the healthcare finance community.\u003c/p\u003e","matters":["\u003cp\u003e\"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals.\"\u003c/p\u003e","\u003cp\u003e\"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice.\"\u003c/p\u003e","\u003cp\u003e\"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program.\"\u003c/p\u003e","\u003cp\u003e\"Leading the Stark Reform Coalition, a consortium of hospitals seeking reform of the Stark Physician Self Referral Law.\"\u003c/p\u003e","\u003cp\u003e\"Representing an academic medical center in a False Claims Act investigation involving allegations of violations of the Medicare provider-based facility rule.\"\u003c/p\u003e","\u003cp\u003e\"Representing Community Health Systems in numerous cost report reimbursement appeals before the Provider Reimbursement Review Board and in federal court.\"\u003c/p\u003e","\u003cp\u003e\"Representing the Florida Hospital Association and several Florida hospitals in multi-million dollar group appeal challenge to CMS policy excluding Low Income Pool Section 1115 expansion waiver days from the Medicare DSH payment calculation.\"\u003c/p\u003e","\u003cp\u003e\"Counseled major Mid-Western hospital chain on reorganization of its Medicare Graduate Medical Education programs, including seeking rural re-designation of certain hospitals in order to maximize FTE 'cap space' and take advantage of relaxed rules for creation of 'new' medical education programs, all of which resulted in millions of dollars of additional Medicare reimbursement.\"\u003c/p\u003e","\u003cp\u003e\"Successfully assisted academic medical center in seeking 'on-campus' status from CMS for provider-based facility located more than 250 yards from campus, resulting in millions of dollars of additional Medicare reimbursement.\"\u003c/p\u003e","\u003cp\u003e\"Counseled numerous providers on the 60-day overpayment rule, including advising a hospice provider in identifying and returning a $10 million overpayment refund to the Medicare program.\"\u003c/p\u003e","\u003cp\u003e\"Representing 30 hospitals in a multi-million dollar challenge to CMS regulation which arbitrarily penalizes teaching hospitals for training medical fellows above their 'FTE cap.'\"\u003c/p\u003e"],"recognitions":[{"title":"Source notes, “tremendous understanding of how enforcement agencies view and interpret the law...”","detail":"Chambers 2020 Healthcare"},{"title":"Sources praise his ability to “distill issues carefully and thoughtfully\"","detail":"Chambers 2017 Healthcare"},{"title":"Named a “Life Sciences Star”","detail":"LMG Life Sciences, 2016-2021"},{"title":"Ranked in the Healthcare: Service Providers category","detail":"The Legal 500, 2015"},{"title":"Received the Superior Achievement Award","detail":"HHS, Office of General Counsel"},{"title":"Received the Special Service Citation","detail":"CMS Administrator"}]},"locales":["en"]},"secondary_title_id":null,"upload_assignments":{"headshot":[{"id":11658}]},"capability_group_id":2},"created_at":"2026-04-15T20:55:41.000Z","updated_at":"2026-04-15T20:55:41.000Z","searchable_text":"Polston{{ FIELD }}{:title=\u0026gt;\"Source notes, “tremendous understanding of how enforcement agencies view and interpret the law...”\", :detail=\u0026gt;\"Chambers 2020 Healthcare\"}{{ FIELD }}{:title=\u0026gt;\"Sources praise his ability to “distill issues carefully and thoughtfully\\\"\", :detail=\u0026gt;\"Chambers 2017 Healthcare\"}{{ FIELD }}{:title=\u0026gt;\"Named a “Life Sciences Star”\", :detail=\u0026gt;\"LMG Life Sciences, 2016-2021\"}{{ FIELD }}{:title=\u0026gt;\"Ranked in the Healthcare: Service Providers category\", :detail=\u0026gt;\"The Legal 500, 2015\"}{{ FIELD }}{:title=\u0026gt;\"Received the Superior Achievement Award\", :detail=\u0026gt;\"HHS, Office of General Counsel\"}{{ FIELD }}{:title=\u0026gt;\"Received the Special Service Citation\", :detail=\u0026gt;\"CMS Administrator\"}{{ FIELD }}\"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals.\"{{ FIELD }}\"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice.\"{{ FIELD }}\"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program.\"{{ FIELD }}\"Leading the Stark Reform Coalition, a consortium of hospitals seeking reform of the Stark Physician Self Referral Law.\"{{ FIELD }}\"Representing an academic medical center in a False Claims Act investigation involving allegations of violations of the Medicare provider-based facility rule.\"{{ FIELD }}\"Representing Community Health Systems in numerous cost report reimbursement appeals before the Provider Reimbursement Review Board and in federal court.\"{{ FIELD }}\"Representing the Florida Hospital Association and several Florida hospitals in multi-million dollar group appeal challenge to CMS policy excluding Low Income Pool Section 1115 expansion waiver days from the Medicare DSH payment calculation.\"{{ FIELD }}\"Counseled major Mid-Western hospital chain on reorganization of its Medicare Graduate Medical Education programs, including seeking rural re-designation of certain hospitals in order to maximize FTE 'cap space' and take advantage of relaxed rules for creation of 'new' medical education programs, all of which resulted in millions of dollars of additional Medicare reimbursement.\"{{ FIELD }}\"Successfully assisted academic medical center in seeking 'on-campus' status from CMS for provider-based facility located more than 250 yards from campus, resulting in millions of dollars of additional Medicare reimbursement.\"{{ FIELD }}\"Counseled numerous providers on the 60-day overpayment rule, including advising a hospice provider in identifying and returning a $10 million overpayment refund to the Medicare program.\"{{ FIELD }}\"Representing 30 hospitals in a multi-million dollar challenge to CMS regulation which arbitrarily penalizes teaching hospitals for training medical fellows above their 'FTE cap.'\"{{ FIELD }}Mark is a Partner in the firm’s Healthcare practice and Co-Chairs the firm’s Life Sciences and Healthcare Industry Group, which is comprised of more than 300 lawyers across the firm.  As the former HHS Deputy Associate General Counsel for Litigation for the Centers for Medicare \u0026amp; Medicaid Services, Mark has over 20 years of experience in Medicare reimbursement policy and Medicare fraud defense and represents numerous health care systems and hospitals in navigating the Medicare regulatory environment.  Mark has served as the lead litigator on numerous Medicare reimbursement litigation cases defending providers against government enforcement actions, and frequently advises clients on Medicare reimbursement strategy and regulatory and compliance requirements.\nFor more than 20 years, Mark has counseled clients in navigating through the complex realm of Medicare, a regulatory environment so intricate that the Supreme Court has described it as “unintelligible to the uninitiated.”  In that vein, Mark specializes in representing clients and litigating complicated Medicare reimbursement issues, including the successful challenge to Medicare’s so-called “Two Midnight” 0.2 percent rate cut.  As a former high-ranking litigator within the Department of Health and Human Services, Mark brings credibility and an insider’s knowledge when advocating before the Centers for Medicare \u0026amp; Medicaid Services and Congress on Medicare and Medicaid issues.\nDrawing upon his experience as CMS’s former chief litigation counsel, Mark represents hundreds of hospitals in Medicare reimbursement appeals.  His cases typically challenge national Medicare reimbursement policies, with hundreds of millions of dollars at stake.  On the defense side, Mark’s years of government fraud enforcement experience and Medicare knowledge translates to surgically effective representation of providers in Medicare fraud investigations.\nMark is more than just a litigator.  According to Chambers USA, sources praise Mark’s ability to “distill issues carefully and thoughtfully,” while also praising his “very client service-oriented” approach.  Given Mark’s vast knowledge of the pitfalls and complexities woven throughout the regulatory and compliance labyrinth of Medicare and Medicaid, Mark is able to counsel and strategize with clients on diverse topics such as Graduate Medical Education reimbursement for teaching hospitals, Medicare’s “provider-based” rules, and Medicare coverage standards for inpatient services. \nHis extensive and lengthy experience in handling complex Medicare and Medicaid issues has led Mark to be deemed a nationally-recognized expert, particularly on matters related to Medicare reimbursement.  Mark is also a frequent speaker and a Faculty Member of the Institute on Medicare and Medicaid Payment, and participates annually in the Institute’s conference sponsored by the American Health Lawyers’ Association.  Mark is also co-editor of the Reimbursement Advisor, a leading publication within the healthcare finance community. Partner Source notes, “tremendous understanding of how enforcement agencies view and interpret the law...” Chambers 2020 Healthcare Sources praise his ability to “distill issues carefully and thoughtfully\" Chambers 2017 Healthcare Named a “Life Sciences Star” LMG Life Sciences, 2016-2021 Ranked in the Healthcare: Service Providers category The Legal 500, 2015 Received the Superior Achievement Award HHS, Office of General Counsel Received the Special Service Citation CMS Administrator University of Dayton University of Dayton School of Law Harvard University Harvard Law School Supreme Court of the United States U.S. Court of Appeals for the Ninth Circuit U.S. Court of Appeals for the D.C. Circuit California District of Columbia Maryland Law Clerk, Pierce Lively, U.S. Court of Appeals for the Sixth Circuit \"Represented over 200 hospitals in a successful lawsuit challenging CMS's decision to cut inpatient Medicare hospital rates to offset the financial impact of the so-called Two Midnight rule, leading to a reversal of the policy by CMS and an influx of approximately $660 million in additional Medicare reimbursement to the nation's acute care hospitals.\" \"Won an $18 million arbitration award for a national healthcare company involving breach of contract and fraud claims against sellers of a Medicare-reimbursed hospice.\" \"Spearheaded the RAC Coalition, a group of the nation's leading hospitals which successfully lobbied for reform of the Medicare Recovery Audit Contractor program.\" \"Leading the Stark Reform Coalition, a consortium of hospitals seeking reform of the Stark Physician Self Referral Law.\" \"Representing an academic medical center in a False Claims Act investigation involving allegations of violations of the Medicare provider-based facility rule.\" \"Representing Community Health Systems in numerous cost report reimbursement appeals before the Provider Reimbursement Review Board and in federal court.\" \"Representing the Florida Hospital Association and several Florida hospitals in multi-million dollar group appeal challenge to CMS policy excluding Low Income Pool Section 1115 expansion waiver days from the Medicare DSH payment calculation.\" \"Counseled major Mid-Western hospital chain on reorganization of its Medicare Graduate Medical Education programs, including seeking rural re-designation of certain hospitals in order to maximize FTE 'cap space' and take advantage of relaxed rules for creation of 'new' medical education programs, all of which resulted in millions of dollars of additional Medicare reimbursement.\" \"Successfully assisted academic medical center in seeking 'on-campus' status from CMS for provider-based facility located more than 250 yards from campus, resulting in millions of dollars of additional Medicare reimbursement.\" \"Counseled numerous providers on the 60-day overpayment rule, including advising a hospice provider in identifying and returning a $10 million overpayment refund to the Medicare program.\" \"Representing 30 hospitals in a multi-million dollar challenge to CMS regulation which arbitrarily penalizes teaching hospitals for training medical fellows above their 'FTE cap.'\"","searchable_name":"Mark D. Polston","is_active":true,"featured":null,"publish_date":null,"expiration_date":null,"blog_featured":null,"published_by":202,"capability_group_featured":null,"home_page_featured":null},{"id":434202,"version":1,"owner_type":"Person","owner_id":4087,"payload":{"bio":"\u003cp\u003eAlek Pivec is an associate in the Washington, D.C. office of King \u0026amp; Spalding and a member of the firm\u0026rsquo;s Healthcare practice.\u0026nbsp; Alek specializes in representing hospitals and other healthcare providers in reimbursement controversies involving government payors such as Medicare and Medicaid.\u0026nbsp;[[--readmore--]]\u003c/p\u003e\n\u003cp\u003eHis practice focuses primarily on Medicare reimbursement litigation before the Provider Reimbursement Review Board and strategic reimbursement counseling.\u0026nbsp; Alek has represented hospitals, academic medical centers and other providers in Medicare reimbursement matters involving graduate medical education, nursing and allied health education, and disproportionate share hospital payments.\u0026nbsp; He has also advised clients on enrollment and compliance issues related to the 340B Drug Pricing Program and on False Claims Act investigations and litigation.\u0026nbsp;\u003c/p\u003e","slug":"alek-pivec","email":"apivec@kslaw.com","phone":null,"matters":null,"taggings":{"tags":[],"meta_tags":[]},"expertise":[{"id":81,"guid":"81.capabilities","index":0,"source":"capabilities"},{"id":24,"guid":"24.capabilities","index":1,"source":"capabilities"},{"id":103,"guid":"103.capabilities","index":2,"source":"capabilities"}],"is_active":true,"last_name":"Pivec","nick_name":"Alek","clerkships":[],"first_name":"Alek","title_rank":9999,"updated_by":202,"law_schools":[{"id":755,"meta":{"degree":"J.D.","honors":"","is_law_school":"1","graduation_date":"2015-01-01 00:00:00"},"order":0,"pin_order":null,"pin_expiration":null}],"middle_name":" ","name_suffix":"","recognitions":[{"title":"Associates to watch: Healthcare","detail":"Chambers and Partners (2025)"}],"linked_in_url":null,"seodescription":null,"primary_title_id":75,"translated_fields":{"en":{"bio":"\u003cp\u003eAlek Pivec is an associate in the Washington, D.C. office of King \u0026amp; Spalding and a member of the firm\u0026rsquo;s Healthcare practice.\u0026nbsp; Alek specializes in representing hospitals and other healthcare providers in reimbursement controversies involving government payors such as Medicare and Medicaid.\u0026nbsp;[[--readmore--]]\u003c/p\u003e\n\u003cp\u003eHis practice focuses primarily on Medicare reimbursement litigation before the Provider Reimbursement Review Board and strategic reimbursement counseling.\u0026nbsp; Alek has represented hospitals, academic medical centers and other providers in Medicare reimbursement matters involving graduate medical education, nursing and allied health education, and disproportionate share hospital payments.\u0026nbsp; He has also advised clients on enrollment and compliance issues related to the 340B Drug Pricing Program and on False Claims Act investigations and litigation.\u0026nbsp;\u003c/p\u003e","recognitions":[{"title":"Associates to watch: Healthcare","detail":"Chambers and Partners (2025)"}]},"locales":["en"]},"secondary_title_id":null,"upload_assignments":{"headshot":[{"id":12358}]},"capability_group_id":2},"created_at":"2025-08-11T17:19:17.000Z","updated_at":"2025-08-11T17:19:17.000Z","searchable_text":"Pivec{{ FIELD }}{:title=\u0026gt;\"Associates to watch: Healthcare\", :detail=\u0026gt;\"Chambers and Partners (2025)\"}{{ FIELD }}Alek Pivec is an associate in the Washington, D.C. office of King \u0026amp; Spalding and a member of the firm’s Healthcare practice.  Alek specializes in representing hospitals and other healthcare providers in reimbursement controversies involving government payors such as Medicare and Medicaid. \nHis practice focuses primarily on Medicare reimbursement litigation before the Provider Reimbursement Review Board and strategic reimbursement counseling.  Alek has represented hospitals, academic medical centers and other providers in Medicare reimbursement matters involving graduate medical education, nursing and allied health education, and disproportionate share hospital payments.  He has also advised clients on enrollment and compliance issues related to the 340B Drug Pricing Program and on False Claims Act investigations and litigation.  Senior Associate Associates to watch: Healthcare Chambers and Partners (2025) Georgetown University Georgetown University Law Center District of Columbia Virginia","searchable_name":"Alek Pivec","is_active":true,"featured":null,"publish_date":null,"expiration_date":null,"blog_featured":null,"published_by":202,"capability_group_featured":null,"home_page_featured":null}]}}