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B. Scott McBride

Scott McBride concentrates his practice on providing legal services to the healthcare industry, including representing and advising hospitals, academic medical centers, physician groups and other healthcare clients. He represents and advises clients in government and private payor investigations and reviews, including False Claims Act investigations and defense, as well as other regulatory enforcement proceedings, including matters related to Medicare and Medicaid billing compliance, Civil Monetary Penalties, Stark and anti-kickback laws, corporate oversight and exclusions from federal and state healthcare programs. He also counsels clients in comprehensive corporate compliance matters, including assisting and advising clients on internal investigations, self-disclosures and repayment matters.

Mr. McBride advises clients on Medicare, Medicaid and other government reimbursement and coverage matters. He represents clients in business transactions and financial arrangements, and also represents clients in healthcare matters before state and federal agencies and through administrative appeals, including claims appeals of Recovery Audit Contractors (RAC), Zone Program Integrity Contractors (ZPIC) and other Medicare and Medicaid contractors and payors. Mr. McBride also represents clients in payment disputes and recovery activities involving commercial payors.

Mr. McBride is listed in The Best Lawyers in America in healthcare law. Mr. McBride has also been named a “Super Lawyer” in 2010 and a “Texas Rising Star” each year from 2004 to 2010 by Law & Politics and the publishers of Texas Monthly. In addition, Mr. McBride was recognized as one of the Top 100 Super Lawyers in the Houston area for 2010. He has twice been named an “Outstanding Fraud and Compliance Lawyer” (2005 and 2009) and was named “Outstanding Young Healthcare Lawyer” in 2004 by Nightingale’s Healthcare News.

Representative Experience

• Representation of hospitals, physician groups, and other institutions in enforcement actions by the Department of Justice, the Office of Inspector General and state Attorney General’s Office in investigations related Medicare and Medicaid billing compliance, including DRG coding, E&M coding, prohibited referrals, cost reports, medical devices and other false claims allegations
• Representation of hospitals and physician groups in self-disclosures and repayment issues made to the Office of Inspector General and to Medicare and Medicaid carriers, intermediaries and payors
• Representation of healthcare providers in administrative appeal of overpayment demands from Program Safeguard Contractors and other Medicare contractors
• Representation of dental group providers before Medicaid agency and in administrative appeal related to overpayment allegations and demands
• Assisted various healthcare entities in the implementation and operation of corporate compliance plans, including risk assessments, internal reviews and voluntary disclosures and repayment matters
• Assisted in the representation of a group of hospitals in national Laboratory Unbundling initiative resulting in the government withdrawing the investigation in Texas
• Representation of hospital and physicians in payment disputes with commercial insurance payors related to underpayments to the provider, as well as overpayment demands from the payor
• Representation of 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 EMTALA
• Representation of physician groups and hospitals in transactional and financial arrangements, including joint ventures, residency programs, billing services, physician recruitment, professional services and other contracted services and reimbursement issues
• Representation of physician group in administrative appeal of overpayment demand related to teaching physician billing issues
• Representation of hospitals in administrative appeal related to residency programs, direct graduate medical education and indirect graduate medical education issues

Professional Membership and Activity

Mr. McBride is a member of the American Health Lawyers Association, the Healthcare Financial Management Association, the Health Care Compliance Association, the American Bar Association and the State Bar of Texas. Mr. McBride has served as the past President (2006-2007) for the Texas Gulf Coast Chapter of HFMA.

Some of Mr. McBride’s presentations include:

• “The Torture RAC: Managing Overpayment Issues and Disputes,” Texas Hospital Association, October 2009
• “Quality of Care, Performance Based Payments, and the False Claims Act: The Compliance Challenges that Lie Ahead,” HFMA Audio Conference, August 2009
• “We’re Here for the Money—Managing Medicare Overpayment Issues and Disputes,” Texas Medical Center, July 2009; HFMA Texas Gulf Coast, January 2009; Minnesota Hospital Association and HFMA Minnesota, October 2008
• “Fraud and Abuse,” Health Law and Policy Institute, University of Houston, July 2008
• “Investigation Aftermath: Taking Proper Remedial and Corrective Actions,” ACI, June 2008
• “Quality of Care, Payment and Compliance,” HCCA Upper North Central Region, May 2008
• “Auditing, Monitoring, Self-Disclosures and Paybacks,” HCCA Upper North Central Region, May 2008
• “Healthcare Fraud 101: The False Claims Act,” Beard Audio Conference, November 2007
• “Fraud and Abuse,” Health Law and Policy Institute, University of Houston, July 2007
• “OIG & Physician Recruiting Issues,” TAHFA, April 2007
• “Under the Magnifying Glass: Healthcare Compliance and Enforcement,” March 2007
• “Legal Implications of Transparency in Pricing,” World Research Group, January 2007
• “FCPA Internal Investigations: Controlling Costs & Directing the Investigation,” ACI, January 2007
• “Navigating Healthcare Investigations,” June 2006
• “Medicaid Fraud and Abuse,” Society of Medical-Dental Management Consultants, June 2006
• “Compliance Issues for Critical Access Hospitals,” HCCA Audio Conference, December 2005
• “False Claims Act, Disclosure, and Refunds,” December 2004
• “Hospital Charges and Discounts,” HFMA Texas Gulf Coast Chapter, April 2004
• “Navigating a Compliance Investigation,” HFMA Audio Conference, April 2003
• “Corporate Compliance: Integrating a Fraud Protection Program into a Human Services Organization,” Child Welfare League of America, March 2002
• “Preventing a Compliance Program from Becoming a Corporate Integrity Agreement,” Lorman Education Services, February 2002