An overview of litigation in the healthcare industry for managers, consultants and legal support staff: types of disputes, the litigation process, medical malpractice, regulatory and government litigation, contract and business disputes, employment matters, antitrust, class actions, evidence and records, experts, risk management and dispute resolution. Eighteen lessons.
Modules
The Litigation Landscape
Lessons
Medical Malpractice
Lessons
Government and Regulatory Litigation
Lessons
Business and Commercial Disputes
Lessons
Employment Antitrust and Class Actions
Lessons
Evidence Experts and Resolution
Lessons
Other Lessons
Module 4 Review
Module review: key terms, activity and quiz.
Lesson 1.1: Why Healthcare Is a High-Litigation Industry
Healthcare organizations face an unusually dense web of legal exposure because they sit at the intersection of clinical risk, heavy regulation, and large public and private payment flows. A single patient encounter can c
Lesson 5.1: HHS OIG and CMS Enforcement Tools
The HHS Office of Inspector General has broad authority to audit, investigate, and impose administrative sanctions on healthcare providers and entities that participate in federal healthcare programs. Its primary tools i
Lesson 1.2: Where Healthcare Disputes Are Resolved
Most healthcare litigation is resolved in one of three settings: state civil courts, federal civil courts, or administrative forums run by an agency. Malpractice claims and most contract and employment disputes are filed
Lesson 5.2: DOJ and State Attorney General Enforcement
The Department of Justice pursues healthcare fraud through both its Civil Division, primarily using the False Claims Act, and its Criminal Division and U.S. Attorneys’ Offices, which can bring criminal charges under stat
Lesson 1.3: Key Players in Healthcare Litigation
Plaintiffs in healthcare litigation include patients and families (malpractice, informed consent, wrongful death), employees and physicians (employment discrimination, wage and hour, peer review due process), competitors
Lesson 5.3: Settlements, Corporate Integrity Agreements, and Collateral Consequences
Many healthcare enforcement matters resolve through settlement rather than trial, often paired with a Corporate Integrity Agreement (CIA) with OIG when the underlying organization remains in federal healthcare programs.
Module 1 Review
Module review: key terms, activity and quiz.
Module 5 Review
Module review: key terms, activity and quiz.
Lesson 2.1: The Elements of a Malpractice Claim
A medical malpractice claim is a type of negligence claim, and like any negligence claim it generally requires the plaintiff to prove four elements: duty, breach, causation, and damages. Duty means the healthcare provide
Lesson 6.1: Documentation and the Medical and Business Record
The medical record is the single most influential piece of evidence in most healthcare litigation, and its quality is determined largely by habits formed long before any dispute exists. Contemporaneous, specific, objecti
Lesson 2.2: From Adverse Event to Claim
The path from an adverse clinical event to a filed lawsuit typically runs through several stages that create distinct obligations for the organization. Immediately after an event, clinical staff document the care given a
Lesson 6.2: Privilege and Protected Communications
Attorney-client privilege protects confidential communications made for the purpose of obtaining or providing legal advice, and the work product doctrine protects materials prepared in anticipation of litigation, but bot
Lesson 2.3: Institutional and Corporate Liability
Beyond claims against individual practitioners, healthcare organizations face direct institutional liability theories, including corporate negligence (failure to maintain safe facilities, properly credential staff, or ma
Lesson 6.3: Building an Organizational Litigation Response Protocol
A well-designed litigation response protocol identifies, in advance, who is notified when a claim, subpoena, investigator visit, or serious incident occurs, what the first 24 to 72 hours of response should look like, and
Module 2 Review
Module review: key terms, activity and quiz.
Module 6 Review
Module review: key terms, activity and quiz.
Lesson 3.1: The False Claims Act
The federal False Claims Act (31 U.S.C. 3729 et seq.) prohibits knowingly submitting, or causing to be submitted, a false or fraudulent claim for payment to the federal government, including claims submitted to Medicare
Lesson 3.2: The Anti-Kickback Statute and Stark Law
The Anti-Kickback Statute (42 U.S.C. 1320a-7b) is a criminal statute that prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce or reward referrals of items or services reimb
Lesson 3.3: Responding to a Government Investigation
Government investigations often begin quietly: a civil investigative demand (CID) from DOJ, a subpoena from OIG or a state Medicaid Fraud Control Unit, or an unannounced audit request from a Medicare Administrative Contr
Module 3 Review
Module review: key terms, activity and quiz.
Lesson 4.1: Common Employment Claims in Healthcare Organizations
Healthcare employers face the same core categories of employment litigation as other industries, but with some sector-specific patterns. Wage and hour claims under the Fair Labor Standards Act and state law are common be
Lesson 4.2: Physician Employment and Restrictive Covenants
Physician employment agreements raise distinct issues beyond ordinary employment law, including compensation models tied to productivity (such as work relative value units) that must be structured to comply with Stark La
Lesson 4.3: Peer Review and Credentialing Disputes
Peer review is the process by which a hospital’s medical staff evaluates the clinical competence and conduct of practitioners seeking or holding privileges, and it operates under a distinct legal framework from ordinary