Judith A. Waltz is a partner and business lawyer with Foley & Lardner LLP. Her practice focuses on government investigations, false claims act, corporate integrity agreements (CIAs), bankruptcy and Medicare and Medicaid counseling. Judith works with clients in various areas of the health care industry. She is the co-chair of the firm’s Health Care Industry Team and former co-chair of the Life Sciences Industry Team. Judith is also a member of the Government Enforcement Defense & Investigations and Bankruptcy & Business Reorganizations Practices.
Fraud and Abuse, FCA and Health Care Fraud Investigations
Judith regularly advises clients who are the focus of government investigations and other enforcement actions, and has negotiated false claims act settlements with the U.S. Department of Justice as well as corporate integrity agreements (CIAs) with the Office of Inspector General. She then has worked closely with those clients to implement their CIAs, including ongoing advice in connection with IRO audits and reviews. At the state level, she has been involved with various Medi-Cal audits, payment suspensions and investigations, including a matter involving allegations of inflated drug pricing by a major pharmaceutical company. In 2004, she represented Gambro Healthcare, Inc., an entity with more than 500 sites, in CIA negotiations with the OIG, and subsequently was featured in the September 2005 cover story of Counsel to Counsel magazine for this work.
Medicare and Medicaid
Judith also provides ongoing compliance counseling and Medicare and Medicaid payment advice to clients, which include hospices, large physician practices, county health systems, hospitals, durable medical equipment suppliers, clinical laboratories, dialysis companies, skilled nursing facilities, ambulance companies, pharmacies, managed care providers and a variety of other health care entities. In 2013, she served as special Medicare counsel in the bankruptcy of San Diego Hospice, a large not-for-profit entity. Judith has advised clients (including physician practices, hospice and hospitals) undergoing ZPIC, RAC audits, other Medicare or Medicaid audits and pre-pay reviews. She is experienced in Medicare and Medi-Cal provider enrollment appeals and Medicare billing number deactivations and other enforcement actions.
Prior to joining the firm in 1998, Judith served as assistant regional counsel for the U.S. Department of Health and Human Services in San Francisco, primarily handling Medicare issues including survey and certification and various types of reimbursement disputes. In that position, she appeared frequently before the Ninth Circuit and other federal courts in matters primarily involving payment disputes (including PRRB appeals), bankruptcy issues and Medicare Secondary Payer disputes. She held collateral appointments as a special assistant United States attorney for the Eastern and Northern districts of California.
Health Care Litigation
As assistant regional counsel for the Department of Health and Human Services for 12 years, Judith represented the secretary in the Ninth Circuit and other federal courts in matters primarily relating to disputes regarding Medicare payments to providers and suppliers. These cases included several court appeals of Provider Reimbursement Review Board decisions involving Medicare cost reports. In the bankruptcy and district courts, she briefed and argued the government’s case in In re TLC Hospitals, Inc., later decided by the 9th Circuit in 224 F.3d 1008 (9th Cir. 2000), upholding Medicare’s ability to recoup pre-petition overpayments from post-petition overpayments. She also represented the government in various bankruptcy court actions involving the assumption of the Medicare provider agreement as an executory contract, a debtor’s challenge to a hospital decertification action taken post-petition and post-petition payment suspension actions. As an additional part of her government representation, she served as primary counsel in various proceedings involving the Medicare Secondary Payer (MSP) provisions. Since joining Foley in 1998, Judith has represented providers and suppliers who are under investigation relating to their participation in the Medicare and Medi-Cal programs, including negotiating settlements and corporate integrity agreements relating to issues including hospice admissions, clinical laboratory claims, partial hospitalization services, inpatient short stays, costs claimed on cost reports, oxygen (DME) billing and assorted allegations of upcoding. She also recently served as lead counsel in an administrative appeal of the imposition of a Medi-Cal civil money penalty. She has appeared in several administrative appeals before the federal HHS Departmental Appeals Board, including decertification actions taken under the Clinical Laboratory Improvement Act (CLIA), civil monetary penalties and adverse enrollment actions and in overpayment appeals heard by the Office of Medicare Hearings and Appeals. In addition, she has represented providers and suppliers in the OIG’s Self-Disclosure Protocol, and in CMS’s Self-Disclosure Referral Protocol.
Judith has advised on compliance and reimbursement issues relating to business structures for providing telemedicine, requirements of the Medicare Conditions of Participation for hospitals which are participating in telemedicine services, applicable Medicare and Medicaid enrollment issues for telemedicine providers and operational issues such as supervision of non-physician practitioners across sites. She has also worked extensively with the Clinical Laboratory Improvement Act (CLIA), payer and compliance requirements regarding laboratory verbal and electronic orders and results.
Judith is a frequent speaker and writer on health care and life science compliance issues, including overpayments, payment suspensions, corporate integrity agreements, off-label marketing, drug and device pricing and potential issues of personal liability for owners of entities who are the focus of government scrutiny.
Judith has been consistently ranked as one of the top health care attorneys in California by Chambers USA (2009 - 2020) where she is described as “the gold standard for issues with CMS” (2015) and “a leader in fraud and abuse” and “a masterful negotiator” (2014).
In 2019, Chambers USA commented:
Judith Waltz is ‘tremendously experienced’ in a broad range of healthcare matters, including Medicaid and Medicare issues, and government investigations. Clients note that ‘she conveys advice in a way that is friendly, calming and reassuring.’
In addition, Judith was previously recognized by The Legal 500 for her work in life sciences in 2017, and for her work in the area of health care – service providers in 2015.
Judith received her B.A., J.D. and M.P.A. degrees from Indiana University, where she was an associate instructor in the School of Business and a teaching assistant in the School of Public and Environmental Affairs (SPEA). As an undergraduate, she served as vice president of the Indiana University Student Association, the student government organization for the Bloomington campus. Judith currently serves on the Board of Visitors for Indiana University’s Maurer School of Law.
Admissions and Professional Affiliations
Judith is admitted to practice before the Ninth Circuit and all Federal District Courts for California. She was admitted to the California Bar in 1982.
Judith serves as a vice chair of the Regulation, Accreditation and Payment Practice Group of the American Health Lawyers Association (AHLA). Judith is a past chair of the Women’s Network Steering Committee at Foley. She is a member of the American Health Lawyers Association (serving as a vice chair for the Regulatory, Accreditation and Payment Practice Group), the Health Law Committee of the Business Law Section of the State Bar of California (serving as vice chair of education), the American Bar Association’s Health Law Section, the California Society for Healthcare Attorneys, the Healthcare Businesswomens' Association and the Health Care Compliance Association.
Selected Publications and Presentations