University of Tennessee, B.A., 1999, magna cum laude
Duke University School of Law, J.D., 2002
- District of Columbia
James F. Segroves is a partner resident in the Washington, DC office of Hooper, Lundy & Bookman, PC. He represents members of the health-care industry, trade associations, and public agencies in important, precedent-setting cases at the trial and appellate levels of court systems throughout the United States, as well as matters before administrative tribunals. These cases range from significant False Claims Act matters based on complicated regulatory theories, appeals from adverse jury verdicts in cases presenting legal questions of first impression, reimbursement disputes with payers involving hundreds of millions of dollars, substantive and procedural challenges of agency regulations, and matters before the Supreme Court of the United States with nationwide consequences.
In its 2014 rankings, Chambers USA noted James’s “very responsive” approach to client service, identifying him as an “up and coming” member of the health-law bar. Law360 echoed this assessment one year earlier by naming him among the nation’s top legal talent under 40. According to The Legal 500 United States, James goes “above and beyond the call” and is “extremely knowledgeable and very customer focused.”
A native of Knoxville, Tennessee, James received his law degree from the Duke University School of Law and his undergraduate degree from the University of Tennessee. Prior to joining HLB in 2014, James practiced law for over a decade in the Washington, DC office of Proskauer Rose LLP.
False Claims Act Investigations and Litigation
James, who is a member of HLB's Fraud & Abuse Practice Group, regularly advises members of the health-care industry in investigations and litigation brought under the False Claims Act (FCA) and similar state statutes. For example, in 2016, James helped convince the United States District Court for the Eastern District of Pennsylvania to dismiss all causes of action asserted against two hospitals named as defendants in a nationwide FCA case brought by a former official of the Centers for Medicare & Medicaid Services (CMS). The former CMS official alleged that the two hospitals had improperly classified Medicare beneficiaries as inpatients instead of as outpatients receiving observation services. In a published opinion, the district court ruled that even under the more lenient standard for pleading fraud with particularity established by circuit precedent, the former CMS official failed to adequately plead his claims against the two hospitals.
A few years earlier, James helped convince the United States District Court for the Southern District of New York to dismiss an FCA action brought against a major academic medical center and several of its former executives seeking penalties and treble damages exceeding $1.5 billion. In dismissing the case with prejudice, the district court’s published opinion agreed that federal Medicare regulations did not expressly prohibit the accounting practice in question. “The worst that can be said of [the defendant-hospital],” the district court concluded, “is that it took advantage of the uncertainty in the regulations to maximize its Medicare billings. This is not fraud.” The district court later denied the relator’s motion to reopen the case based on supposed “newly discovered” evidence. The United States Court of Appeals for the Second Circuit then affirmed the district court’s refusal to reopen the case in an appeal briefed and argued by James.
James regularly advises clients in federal and state appeals presenting significant questions of first impression. These cases include those in which clients are parties to the underlying case, as well as those in which clients seek to assist appellate courts in reaching correct answers to legal questions with broad consequences by filing friend-of-the-court briefs.
James has significant experience advising clients following adverse outcomes at the trial level, often collaborating with attorneys from other law firms who served as trial counsel. For example, he recently served as lead appellate counsel to a Colorado skilled nursing facility in its successful appeal of a jury verdict in a wrongful-death action. The appeal, which James briefed and argued, resulted in the award of a new trial after the Colorado Court of Appeals rejected the logic of a published decision it had issued decades earlier establishing a plaintiff-friendly causation standard for negligence actions. James then helped defeat the plaintiffs’ effort to have the new ruling reviewed by the Supreme Court of Colorado.
James also recently helped convince the Supreme Court of Illinois to grant discretionary review and issue a unanimous decision finding that the Federal Arbitration Act (FAA) preempts a state statute precluding the enforcement of certain health-care providers’ arbitration agreements. He later helped convince the same state court of last resort to grant discretionary review a second time following remand, resulting in a unanimous decision finding that the FAA preempts the imposition of unique mutuality requirements on arbitration agreements.
James often advises members of the health-care industry and leading trade associations in matters before the Supreme Court of the United States and other appellate courts raising a diverse range of legal issues. For example, he has filed numerous friend-of-the-court briefs successfully supporting petitions for discretionary review. Such cases have included disputes over the meaning of the FCA’s public-disclosure bar, the FAA’s preemptive effect, the limits of federal courts’ Article III jurisdiction, and the Fair Labor Standards Act’s compensation and overtime requirements. In that capacity, he has also filed merits briefing on issues such as what level of deference should be shown to agency statutory interpretations, as well as the constitutionality of federal legislation.
James has significant experience representing clients in litigation brought against federal agencies under the Administrative Procedure Act (APA). For example, James served as an outside deputy attorney general for the State of Alabama in its litigation challenging a nationwide “Dear State Health Official” letter issued by CMS that would have required States to pay CMS hundreds of millions of additional dollars stemming from Medicaid-related fraud recoveries. In 2011, the United States District Court for the Middle District of Alabama vacated CMS’s letter after finding that CMS violated the APA by failing to subject the letter to notice-and-comment rulemaking. CMS later dismissed its appeal before the United States Court of Appeals for the Eleventh Circuit.
James also represented the American Bar Association in its litigation challenging the Federal Trade Commission’s attempted application of identity-theft regulations to lawyers engaged in the practice of law. In 2009, the United States District Court for the District of Columbia awarded the American Bar Association summary judgment after finding that the Commission exceeded its statutory authority. In 2011, the United States Court of Appeals for the District of Columbia Circuit dismissed the Commission’s appeal on mootness grounds after Congress enacted legislation during a lame-duck session rejecting the Commission’s logic for applying identity-theft regulations to lawyers.
Legislative and Regulatory Advocacy
Finally, James has considerable experience advising clients with respect to legislative proposals pending before Congress on topics such as Medicare, Medicaid, the FCA, and arbitration. He also has significant experience advising clients regarding matters under consideration in the federal rulemaking process. For example, James has drafted regulatory comments that, on multiple occasions, have served as the basis for successful legal challenges to regulations promulgated by federal agencies.
- Supreme Court of the United States
- United States Court of Appeals for the Second Circuit
- United States Court of Appeals for the Third Circuit
- United States Court of Appeals for the Fourth Circuit
- United States Court of Appeals for the Sixth Circuit
- United States Court of Appeals for the Ninth Circuit
- United States Court of Appeals for the Tenth Circuit
- United States Court of Appeals for the Eleventh Circuit
- United States Court of Appeals for the District of Columbia Circuit
- United States Court of Appeals for the Federal Circuit
- United States District Court for the District of Columbia
- United States District Court for the District of Maryland
- United States Court of Federal Claims
- District of Columbia Court of Appeals
- Court of Appeals of Maryland
False Claims Act / Qui Tam Matters
- United States ex rel. Polansky v. Exec. Health Res., Inc., 196 F. Supp. 3d 477 (E.D. Pa. 2016) (discussed above);
- United States ex rel. Colucci v. Beth Israel Med. Ctr., 785 F. Supp. 2d 303 (S.D.N.Y. 2011), mot. to reopen denied, No. 1:06-cv-05033, 2012 WL 3577995 (S.D.N.Y. Aug. 16, 2012), aff’d, No. 12-3694-cv, 2013 WL 4516407 (2d Cir. Aug. 27, 2013) (discussed above);
- United States ex rel. Pervez v. Maimonides Med. Ctr., No. 1:06-cv-04989, 2010 WL 890236 (S.D.N.Y. Mar. 9, 2010) (represented an inpatient hospital and, over the objection of the qui tam relator, achieved the hospital’s dismissal based on the relator’s failure to timely serve the hospital with an unsealed complaint); and
- United States ex rel. Brockovich v. Promise Healthcare, Inc., No. 2:06-cv-04134, 2006 WL 5410366 (C.D. Cal. Oct. 24, 2006) (represented a national hospital corporation in litigation brought by Erin Brockovich in which she unsuccessfully sought to convert the Medicare Secondary Payer Act’s private cause of action into a qui tam cause of action).
Matters Before the Supreme Court of the United States
- Kindred Nursing Ctrs. Ltd. P’ship v. Clark, 137 S. Ct. 1421 (2017) (served as petition- and merits-stage counsel to the American Health Care Association and the Kentucky Association of Health Care Facilities as amici curiae arguing that the FAA preempts a rule of law created by the Supreme Court of Kentucky that required a power of attorney to expressly refer to arbitration agreements before the attorney-in-fact could bind her principal to an arbitration agreement);
- Universal Health Servs., Inc. v. United States ex rel. Escobar, 136 S. Ct. 1989 (2016) (served as merits-stage counsel to the American Health Care Association and the National Center for Assisted Living as amici curiae arguing that the Court should confine the use of the so-called “implied false certification” theory in FCA litigation);
- Integrity Staffing Solutions, Inc. v. Busk, 134 S. Ct. 1490 (2014) (served as petition-stage counsel to the Retail Litigation Center, the Chamber of Commerce of the United States of America, and other national trade associations as amici curiae arguing that the Court should grant discretionary review to decide whether time spent undergoing workplace security screenings is compensable under the Fair Labor Standards Act);
- United States v. Windsor, 133 S. Ct. 2675 (2013) (represented a former Central Intelligence Agency officer as an amicus curiae arguing that the Defense of Marriage Act hampers the Federal Government’s ability to attract and retain personnel with skill sets essential to the defense of national security);
- Vance v. Ball State Univ., 133 S. Ct. 2434 (2013) (served as merits-stage counsel to the Society for Human Resource Management and other trade associations arguing as amici curiae that the Court should not defer to enforcement guidance issued by the Equal Employment Opportunity Commission regarding who constitutes a “supervisor” capable of rendering an employer vicariously liable for the creation of a hostile work environment under Title VII of the Civil Rights Act of 1964);
- Genesis HealthCare Corp. v. Symczyk, 133 S. Ct. 1523 (2013) (served as petition- and merits-stage counsel to the Chamber of Commerce of the United States of America, the American Health Care Association, and other national trade associations as amici curiae arguing that putative collective actions under the Fair Labor Standards Act become moot, and thus beyond the judicial power of Article III, when a named plaintiff receives an offer from the defendants to satisfy all of the named plaintiff’s claims);
- Marmet Health Care Ctr., Inc. v. Brown, 132 S. Ct. 1201 (2012) (served as petition-stage counsel to a West Virginia skilled nursing facility operator as an amicus curiae arguing that the Court should summarily reverse a ruling of the Supreme Court of Appeals of West Virginia, which found that the FAA does not protect arbitration agreements covering claims of personal injury or wrongful death); and
- Graham Cnty. Soil & Water Conservation Dist. v. United States ex rel. Wilson, 559 U.S. 280 (2010) (served as petition- and merits-stage counsel to the Chamber of Commerce of the United States of America, the American Health Care Association, and several other national trade associations as amici curiae in helping convince the Court that public disclosures by state and local governments deprive courts of subject-matter jurisdiction over qui tam actions filed under the FCA prior to its amendment in 2010).
Appeals from Trial Court Rulings
- Sharon v. SSC Pueblo Belmont Operating Co., No. 14CA2006, 2016 WL 4720003 (Colo. App. Sept. 8, 2016) (served as lead appellate counsel to a skilled nursing facility operator and certain of its corporate affiliates, and achieved reversal of a jury verdict because the trial court erred by permitting the plaintiff to proceed on a joint-venture theory of liability), cert. denied, No. 16SC823 (Colo. Apr. 17, 2017);
- Elderberry of Weber City, LLC v. Living Ctrs.-Se., Inc., 794 F.3d 406 (4th Cir. 2015) (served as lead appellate counsel to the former tenant-operator of a skilled nursing facility and certain other entities, and successfully argued that the district court erred in entering a multimillion-dollar judgment against the tenant and its co-defendants because the district court erroneously ruled that the landlord’s termination of the lease did not preclude the award of future damages under Virginia common law);
- Polomski v. SavaSeniorCare, LLC, Nos. 311041 & 313727, 2014 WL 5018815 (Mich. Ct. App. Oct. 7, 2014) (served as lead appellate counsel to the corporate parent of a skilled nursing facility and succeeded in obtaining the reversal of a $500,000 attorney’s fee award after the appellate court rejected the logic of two previous decisions issued by previous panels of the same court that had affirmed such awards in similar cases under Michigan’s unique fee-shifting rule for cases involving claims of medical malpractice);
- Carter v. SSC Odin Operating Co., 927 N.E.2d 1207 (Ill. 2010), disc. appeal following remand, 976 N.E.2d 344 (Ill. 2012) (discussed above);
- Simon v. Harding Pharmacy, Inc., No. A-1234-11T4, 2012 WL 4896701 (N.J. Super. Ct. App. Div. Oct. 17, 2012) (served as appellate counsel to a wholesale pharmaceutical distributor and succeeded in obtaining the affirmance of summary judgment in favor of the distributor after the appellate court held that the distributor’s purported negligence was not a proximate cause of the plaintiff’s catastrophic injuries stemming from his illegal ingestion of medication stolen by an employee of the distributor’s customer-pharmacy);
- Bronx-Lebanon Hosp. Ctr. v. Daines, 956 N.Y.S.2d 660 (N.Y. App. Div. 2012) (served as lead appellate counsel to an inpatient hospital and succeeded in obtaining the reversal of a statute-of-limitations dismissal of the hospital’s Medicaid reimbursement challenge); and
- Reigel v. SavaSeniorCare, LLC, 292 P.3d 977 (Colo. App. 2011) (discussed above), cert. denied, No. 12SC134 (Colo. Nov. 19, 2012).
Matters Presenting Issues Under the Administrative Procedure Act
- Se. Ala. Med. Ctr. v. Sebelius, 572 F.3d 912 (D.C. Cir. 2009) (represented 113 inpatient hospitals in their appeal of a district court decision upholding the Secretary of Health and Human Services’ methodology for calculating Medicare payments, which resulted in a unanimous decision rejecting the Secretary’s defense of her 25-year practice of including certain costs in her “wage index” calculation);
- Shands Jacksonville Med. Ctr. v. Burwell, 139 F. Supp. 3d 240 (D.D.C. 2015) (represented dozens of inpatient hospitals in companion cases in which the district court held that the Secretary of Health and Human Services violated the APA’s notice-and-comment requirements when she implemented a $220 million Medicare payment cut);
- Alabama v. Ctrs. for Medicare & Medicaid Servs., 780 F. Supp. 2d 1219 (M.D. Ala. 2011) (discussed above);
- Peak Med. of Okla. No. 5, Inc. v. Sebelius, No. 4:10-cv-00597, 2010 WL 4809319 (N.D. Okla. Nov. 18, 2010) (represented a skilled nursing facility in its successful effort to obtain interim relief under the APA pending the outcome of its administrative appeal of CMS’s decision to terminate the facility’s Medicare participation); and
- Am. Bar Ass’n v. FTC, 671 F. Supp. 2d 64 (D.D.C. 2009) (discussed above).
- American Health Care Association, Legal Committee
- American Health Lawyers Association
- Supreme Court Historical Society
Honors & Awards
- Up and Coming Lawyer, Healthcare, District of Columbia, Chambers USA (2014, 2015)
- Rising Star, Health, Law360 (2013)
- Healthcare Service Providers, The Legal 500 United States (2013)
- Outstanding Healthcare Litigator, Nightingale’s Healthcare News (2009)
Presentations & Speaking Engagements
- LTC Risk Legal Forum Summit 2015, Alternative Dispute Resolution Best Practices, March 5, 2015 (Las Vegas, Nevada)
- Hooper, Lundy & Bookman, Dueling Circuits and the Future of the ACA Webinar, August 13, 2014
- American Health Lawyers Association, Long-Term Care and the Law Conference, 2014 (Las Vegas, Nevada)
- American Health Lawyers Association, Long-Term Care and the Law Conference, 2011 (San Diego, California)
- American Health Lawyers Association, Long-Term Care and the Law Conference, 2010 (Las Vegas, Nevada)
- September 21, 2017
- October 15, 2015Health Law Perspectives
- July 7, 2015
- June 25, 2015
- May 20, 2015
- April 1, 2015
- U.S. Supreme Court Determines that Providers Cannot Challenge Medicaid Rates under 42 U.S.C. Section 1396a(a)(30)(A)April 1, 2015
- April 1, 2015
- Courts Issue Opposing Opinions Regarding Federal Tax Credits in States with Federal Health Benefits ExchangesJuly 23, 2014
- May 23, 2014
- April 28, 2014
- April 2, 2014
Health Law Perspectives
- HLB Attorney James Segroves Provides Perspective on the Court's OpinionMarch 12, 2015
- HLB Attorney James Segroves Discusses Likely Impacts of the Court's OpinionMarch 9, 2015