B. Scott McBride

Scott counsels clients in comprehensive corporate compliance matters, including assisting and advising clients on internal investigations, self-disclosures, and repayment matters. His work spans a variety of matters related to Medicare and Medicaid billing compliance, grants and contracts compliance, civil monetary penalties, Stark Law and the Anti-Kickback Statute, corporate oversight, and exclusions from federal and state healthcare programs. He also represents clients in healthcare matters before state and federal agencies and through administrative appeals, including claims appeals of recovery audit contractors, integrity contractors, and other Medicare and Medicaid contractors and payors.

Additionally, Scott advises clients in certain strategic arrangements and alignments, such as academic or other affiliation agreements, joint ventures, service line agreements, management agreements, and governance matters. These arrangements may cover issues related to reimbursement, fraud and abuse, physician recruitment, teaching issues, residency programs, research support, clinical care strategies, and population health.

False Claims Acts and Government Investigations

• Represented a hospital in FCA litigation involving allegations of improper participation by foreign physicians in medical services, resulting in dismissal of claims in district court and granting of summary judgment
• Represented a hospital in FCA litigation involving allegation of patient boarding and improper inpatient care, resulting in dismissal of claims in district court and affirmed on appeal
• Represented an academic medical center in FCA litigation involving allegations of noncompliance and improper payments related to Medicare transplant programs, resulting the dismissal of investigation and litigation
• Represented a healthcare provider group accepting full risk in FCA investigation related to Medicare Managed Care and allegations of kickbacks and improper relationships with patient brokers, resulting in the dismissal of investigation and litigation
• Represented an academic medical center in FCA litigation involving allegations of misconduct and conflicts related to National Institutes of Health (NIH) research grants and retaliation, resulting in the dismissal of all claims in district court clarifying state agency liability under the FCA and affirmed by the US Court of Appeals for the Fifth Circuit
• Represented a device company in FCA litigation related to allegations of kickbacks to physicians and other providers through speaker programs and service agreements, resulting in a voluntary dismissal by relator prior to trial
• Represented a hospital in FCA litigation related to allegations of medically unnecessary services, upcoding, patient steering, provider-based issues, and Stark Law and kickback violations regarding physician recruitment and employment arrangements, resulting in dismissal of all claims
• Represented a physician group in FCA investigation related to allegations of increasing risk adjustment scores under managed care full-risk sharing arrangements and allegations of improper diagnosis coding
• Represented a hospital on compliance issues related to artificial intelligence (AI) in healthcare and enforcement investigation from state attorney general office
• Represented a university in federal enforcement matter related to grant compliance and alleged foreign influence
• Represented a rehabilitation hospital in FCA investigation related to allegations of inappropriate admissions
• Represented a physician group in FCA litigation related to allegations of improper provider donations and supplemental payments
• Represented a university hospital and a large national healthcare system in FCA litigation involving allegations related to implantable cardioverter defibrillator services and violations of Medicare national coverage determination
• Represented a university faculty physician in FCA litigation involving allegations of improper billing and violations of scope of practice, resulting in dismissal of all claims in district court
• Represented a military physician in an FCA investigation related to allegations of kickbacks from pharmaceutical company for off-label use
• Represented a medical school in FCA litigation alleging hospital support payments to faculty physicians were above fair market value and violated the Anti-kickback Statute and Stark Law.
• Represented a large physician group in FCA litigation involving allegations of improper coding and billing related to evaluation and management services and chiropractic services, resulting in dismissal of the majority of claims and favorable resolution of remaining issues
• Represented a hospital in an FCA investigation related to allegations of kickbacks through a joint venture arrangement
• Represented a spinal device company in an FCA investigation related to allegations of improper and sham agreements with physicians and kickbacks
• Represented a long-term acute care hospital in an FCA investigation related to allegations of medical necessity and improper admissions
• Represented an academic medical center in an FCA investigation related to allegations of improper charging to NIH research grants
• Represented multiple Medicaid dental providers in fraud investigations by a state Office of Inspector General alleging overpayments of more than $100 million, resulting in the return of payment hold funds and resolutions for clients
• Represented a dental group in a Medicaid Fraud Control Unit investigation related to allegations of improper coding and billing, resulting in the closing of the investigation

Provider Appeals

• Represented MD Anderson Cancer Center in a HIPAA enforcement action brought by the US Department of Health and Human Services (HHS) Office for Civil Rights and the first-of-its-kind appeal of a proposed civil monetary penalty (CMP), resulting in the Fifth Circuit Court of Appeals vacating the $4.3 million CMP
• Represented a nursing home in a HIPAA enforcement action brought by OCR alleging regulatory violations related to a lack of encryption, inadequate risk assessments, and disclosure, resulting in withdrawal of proposed CMP
• Represented dialysis company in appealing numerous payment denials through the Medicare appeals process related to alleged documentation deficiencies and medical necessity, and defending payments for such
• Represented a cancer hospital in federal court litigation appealing a Provider Reimbursement Review Board (PRRB) decision related to claims for case mix adjustments and related costs
• Represented a hospital in federal court litigation appealing a PRRB decision related to claims for depreciation losses
• Represented a hospital in the appeal of a Centers for Medicare and Medicaid Services (CMS) denial of provider-based status, resulting in approval of the provider-based determination
• Represented a laboratory in an appeal through the Medicare claims appeals process for an overpayment demand related to medical necessity
• Represented hospitals in an appeal through the Medicare appeals process for denial of inpatient rehabilitation admissions
• Represented a cardiology medical group in an appeal through the Medicare claims appeals process of alleged overpayment and extrapolation of more than $1 million related to medical necessity and coverage criteria, resulting in a return of all monies to the medical group
• Represented a physician group in an administrative appeal of an overpayment demand related to teaching physician billing issues
• Represented hospitals in an administrative appeal related to residency program, direct graduate medical education, and indirect graduate medical education issues
• Represented Hospitals, physician groups, and other providers in administrative appeals on issues related to disproportionate share payments, licensing, teaching physician billing, graduate medical education, clinical laboratory rules, and the Emergency Medical Treatment and Labor Act

Academic Medical Center Affiliations and Other Agreements

• Represented an academic medical center in the negotiation of a multiyear academic affiliation agreement with a hospital teaching partner
• Represented a large physician group in the negotiation of an orthopedic services agreement under an accountable care organization (ACO)
• Represented an academic medical center physician group in the negotiation of a long-term services and affiliation agreement
• Represented an academic medical center in negotiation of Infusion Services Management Agreement and strategic joint venture
• Represented a physician group in the negotiation of a strategic billing services agreement
• Represented a physician group in negotiating a population health agreement with a hospital partner
• Represented an academic medical center in a joint venture to operate an ambulatory surgery center (ASC)
• Represented hospitals in negotiating training agreements and support agreements with residency programs
• Represented physician groups and hospitals in certain arrangements regarding joint ventures, residency programs, billing services, physician recruitment, professional and other contracted services, and reimbursement issues

Medicare, Medicaid, and Regulatory Compliance

• Advised healthcare clients on compliance issues and considerations related to the use and monitoring of artificial intelligence (AI) in healthcare
• Advised healthcare clients on regulatory compliance issues related to research and grants, including federal and state contracting requirements and considerations
• Advised providers regarding Medicare and Medicaid reimbursement and regulatory guidance
• Advised hospitals regarding provider-based rules, requirements, and internal assessments
• Advised device company regarding regulatory licensure and Medicare participation requirements
• Advised university hospital regarding regulatory requirements under the Clery Act
• Advised various healthcare entities in the implementation and operation of corporate compliance plans, including risk assessments, internal reviews and voluntary disclosures, and repayment matters

Internal Investigations and Self-Disclosures

• Represented clients in internal investigations related to grant and research compliance, including conflicts of interest, foreign influence, research misconduct, time and effort, charges for services and items, charge downs, service centers, and reimbursement matters
• Represented client in internal investigation related to transplant program compliance, including matters related to patient care, wait lists, testing, UNOS, and reimbursement
• Represented physicians and physician groups in reviewing, evaluating, and refunding claims related to evaluation and management services
• Represented an ambulance provider in the internal review of regulatory guidelines and self-disclosure and refund to Medicaid of services
• Represented a hospital in an internal review, assessment, and disclosure and refunds related to short inpatient stays and inpatient level-of-care reviews
• Represented a hospital in an internal review related to compliance with charges to federal grants and NIH compliance
• Represented a hospital in an internal review and reporting related to allegations of research misconduct
• Represented hospitals and physician groups in self-disclosures and repayment issues made to the Office of Inspector General, Medicare and Medicaid contractors, and payors

Commercial Payor Payment Disputes

• Represented a hospital in an overpayment investigation by a commercial payor special investigation unit, resulting in the withdrawal of an overpayment demand of more than $2 million
• Represented physician groups in an overpayment demand from commercial payors and allegations of improper payments
• Represented a hospital in dispute with a commercial payor for breach of contract and failure to properly pay the hospital
• Represented a physician group in bringing a breach of contract claim against a payor for underpayments