James A. Robertson

Professional Memberships

Healthcare Financial Management Association New Jersey Chapter: Chair, Communications Committee; Editor, Garden State FOCUS Magazine

American Health Law Association: Hospitals and Health Systems Practice Group

Work Highlights

Represented a New Jersey healthcare system and its Chair of Surgery in litigation brought by a trauma surgeon challenging a summary suspension of medical staff privileges. Following reinstatement through internal proceedings, the firm continued to defend the client in this $2.4 million action, which settled before trial.

Representing 170 hospitals nationwide before the Medicare PRRB in challenges to CMS’ historical calculation of IPPS rates dating to federal fiscal year 1986. The matter, valued in the hundreds of millions of dollars, seeks correction of longstanding reimbursement underpayments and remains pending before the PRRB.

Representing over 300 hospitals nationwide in Medicare PRRB and federal court litigation challenging CMS’ application of the rural floor budget neutrality factor affecting federal fiscal year 2024 wage indices. The firm’s team secured expedited judicial review and filed suit in the U.S. District Court for the District of Columbia seeking declaratory relief and damages.

Representing 173 hospitals nationwide in Medicare PRRB proceedings challenging CMS’ exclusion of Section 401 hospital wage data from rural floor reimbursement calculations. This Medicare reimbursement matter, valued in the hundreds of millions of dollars, remains pending before the PRRB.

Representing a New Jersey healthcare system and its leadership in litigation arising from termination of a surgeon’s staff privileges, defending claims for alleged wrongful suspension and lost income.

Advised a medical practice in a Chapter 11 bankruptcy proceeding involving competing claims from a private equity sponsor, an acquisition lender, and the practice’s physician owners. The matter addressed disputes arising from the dissolution of the practice, restrictive covenant issues, and claims exceeding $35 million. The firm guided the parties to a global settlement and confirmation of a Chapter 11 plan of liquidation, resolving all claims.

Represented a New Jersey healthcare system in defense of antitrust and tort claims brought by a pediatric surgeon following revocation of privileges, securing a negotiated resolution.

Represented a New Jersey healthcare system in defense of fraud, breach of contract, age discrimination, and CEPA retaliation claims brought by three physicians and their surgical group seeking more than $9 million.

Represented a leading senior care provider in dozens of guardianship proceedings for residents lacking family decision-makers, coordinating with the New Jersey Office of the Public Guardian to secure medical authority and Medicaid eligibility.

Represented a real estate company as healthcare and regulatory counsel in developing assisted living facilities in Scotch Plains, East Brunswick, and Old Tappan in transactions exceeding $10 million.

Representing two New Jersey health systems in high-stakes litigation against multiple Medicare Advantage plans seeking recovery of approximately $5 million in underpaid 340B drug reimbursements, following a U.S. Supreme Court decision invalidating CMS' reimbursement reductions; matters are proceeding toward mediation and arbitration.

Advising a local government agency on the formation of a compliant “friendly P.C.” structure for the operation of New Jersey’s largest psychiatric hospital, including drafting and negotiating all transactional and governance documents.

Advising an ABA therapy organization in responding to a New Jersey MFD audit. This matter includes counseling the client on the MFD interview process, assisting in providing relevant documentation responsive to the audit, and advising the client on compliance with follow-up requests from the MFD in anticipation of an eventual resolution of the audit, including any repayment demands.

Represented a client in a New Jersey Appellate Division appeal arising from Medicaid reimbursement and eligibility determinations, authoring the appellate brief and securing affirmance of the agency’s decision.

Represented a defendant in a New Jersey Superior Court matter, securing dismissal of claims based on the Entire Controversy Doctrine in a published Law Division decision.

In Rahway Hospital v. Horizon Blue Cross Blue Shield (2005), argued on behalf of amicus curiae New Jersey Hospital Association before the New Jersey Appellate Division, supporting reversal of an administrative ruling concerning healthcare reimbursement, resulting in a published decision overturning the agency’s interpretation.

In United States ex rel. Quinn v. Omnicare, Inc. (2004), represented Omnicare in a False Claims Act qui tam action in the U.S. Court of Appeals for the Third Circuit alleging fraudulent billing and reimbursement practices, securing affirmance of summary judgment and dismissal of all claims.

Career

Jim advises healthcare entities on a broad range of regulatory, transactional, reimbursement, compliance, and operational matters affecting the healthcare industry.

He regularly represents hospital systems and providers in Medicare, Medicaid, charity care subsidy, disproportionate share hospital (DSH), and graduate medical education (GME) matters before state agencies and the federal Provider Reimbursement Review Board (PRRB). Jim also negotiates Medicare Advantage and Managed Medicaid risk-sharing arrangements and advises on provider-payer relationships.

His transactional practice includes representation in mergers, acquisitions, joint ventures, divestitures, and the establishment and sale of healthcare businesses and facilities. Jim represents hospital systems, academic medical centers, pharmaceutical companies, integrated delivery networks (IDNs), physician practices, and healthcare private equity funds. He also advises on the formation and operation of Clinically Integrated Networks (CINs), Accountable Care Organizations (ACOs), Multiple Employer Welfare Arrangements (MEWAs), ambulatory surgery centers, nursing homes, assisted living facilities, and physician practices.

Jim counsels clients on healthcare regulatory compliance matters, including Stark Law, the federal Anti-Kickback Statute (AKS), the Codey Law, HIPAA, HITECH, the ACA, Emergency Medical Treatment and Labor Act (EMTALA), and Corporate Practice of Medicine (CPOM) issues. He assists clients with corporate compliance programs, audits, government investigations, voluntary self-disclosures, advisory opinions, Certificates of Need, and approvals required by the New Jersey Department of Health, the Attorney General, and the Community Healthcare Asset Protection Act (CHAPA).

He also advises on medical staff matters, including bylaws, fair hearing requirements, and privileging issues, and represents healthcare entities in litigation involving provider-payor disputes, restrictive covenants, and medical staff proceedings.

Education

Awards