B. Scott McBride

Scott also counsels clients in comprehensive corporate compliance matters, including assisting and advising clients on internal investigations, self-disclosures, and repayment matters.

Additionally, Scott advises clients on government reimbursement and coverage matters including Medicare and Medicaid. He also represents clients in healthcare matters before state and federal agencies and through administrative appeals, including claims appeals of recovery audit contractors, zone program integrity contractors, and other Medicare and Medicaid contractors and payors. Scott regularly represents clients in payment disputes and recovery activities involving commercial payors and other business transactions and financial arrangements.

False Claims Acts and Government Investigations

• Represented an academic medical center in FCA litigation involving allegations related to federal research grants and retaliation, resulting in dismissal of all claims in district court clarifying state agency liability under the False Claims Act and affirmed by Fifth Circuit Court of Appeals.
• Represented a university hospital and a large national healthcare system in national FCA litigation involving allegations related to implantable cardioverter defibrillator services and violations of Medicare national coverage determination, resulting in resolution of litigation for clients.
• Represented a university faculty physician in FCA litigation involving allegations of improper billing, scope of practice, and retaliation, resulting in dismissal of all claims in district court.
• 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 on motion to dismiss and resolution of remaining issues.
• Represented an academic medical center in an FCA investigation related to allegations of improper physician coding and billing.
• Represented a hospital in an FCA investigation related to allegations of kickbacks in a joint venture arrangement.
• Represented a long-term acute care hospital in an FCA investigation related to allegations of medical necessity.
• Represented an academic medical center in an FCA investigation related to allegations of improper charging to 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.
• Assisted in the representation of a group of hospitals in a national Laboratory Unbundling Initiative, resulting in the government’s withdrawing the investigation in Texas.
• Represented hospitals, physician groups, and other institutions in enforcement actions by the US Department of Justice, the Office of Inspector General, and the state attorney general’s office in investigations related to Medicare and Medicaid billing compliance, including diagnosis-related group coding, evaluation and management coding, prohibited referrals, cost reports, medical devices, and other false claims allegations.

Provider Appeals

• Represented an academic medical center in a HIPAA breach investigation by the US Department of Health and Human Services (HHS) Office of Civil Rights and the appeal of the proposed civil monetary penalty.
• 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 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 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 hospital in a PRRB appeal related to cost report reimbursement claims.
• 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 healthcare providers in an administrative appeal of overpayment demands from Zone Program Integrity Contractors and other Medicare contractors.
• 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 a physician group in the negotiation of a billing services agreement.
• Represented a physician group in drafting and 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 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 providers regarding Medicare and Medicaid reimbursement and regulatory guidance.
• Advised providers on compliance programs and corporate oversight.
• Advised an academic medical center regarding Clery Act compliance.

Internal Investigations and Self-Disclosures

• Represented a physician group 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.
• 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.
• Assisted various healthcare entities in the implementation and operation of corporate compliance plans, including risk assessments, internal reviews and voluntary disclosures, and repayment matters.

Commercial Payor Payment Disputes

• Represented a hospital in an overpayment investigation by 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.