B. Scott McBride

Partner

Houston
T +1.713.646.1390
F +1.713.751.1717

"Scott McBride handles a range of investigations and reviews for healthcare providers, and is held in high regard by peers for his impressive expertise in this area."

— Chambers USA 2013

Overview

Scott McBride concentrates his practice on providing legal services to the healthcare industry with an emphasis on compliance and enforcement issues, including representing and advising hospitals, academic medical centers, physician groups, and other healthcare clients. He represents and advises clients in overpayment disputes, False Claims Act litigation, internal and external investigations, and regulatory enforcement proceedings, including matters related to Medicare and Medicaid billing compliance, civil monetary penalties, Stark Law and the Anti-Kickback Statute, 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.

Scott advises clients on Medicare, Medicaid and other government reimbursement and coverage matters. He represents clients in certain 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, Zone Program Integrity Contractors and other Medicare and Medicaid contractors and payors. Scott also represents clients in payment disputes and recovery activities involving commercial payors.

Select Experience

False Claims Acts and Government Investigations
  • Representation of academic medical center in False Claims Act 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.

  • Representation of university hospital and of large national healthcare system in national False Claims Act litigation involving allegations related to implantable cardioverter defibrillator services and violations of Medicare National Coverage Determination, resulting in resolution of litigation for clients.

Provider Appeals
  • Representation of academic medical center in HIPAA breach investigation by HHS Office of Civil Rights and appeal of proposed Civil Monetary Penalty.

  • Representation of cancer hospital in federal court litigation appealing Provider Reimbursement Review Board (PRRB) decision related to claims for case mix adjustments and related costs.

AMC Affiliations and Other Agreements
  • Representation of academic medical center in negotiation of multi-year academic affiliation agreement with hospital teaching partner.

  • Representation of large physician group in negotiation of orthopedic services agreement under an ACO.

Medicare, Medicaid and Regulatory Compliance
  • Advise providers regarding Medicare and Medicaid reimbursement and regulatory guidance.

  • Advise providers on compliance programs and corporate oversight.

Internal Investigations and Self-Disclosures
  • Representation of physician group in reviewing, evaluating, and refunding claims related to evaluation and management services.

  • Representation of ambulance provider in internal review of regulatory guidelines and self-disclosure and refund to Medicaid of services.

Commercial Payor Payment Disputes
  • Representation of hospital in overpayment investigation by commercial payor Special Investigation Unit, resulting in withdrawal of overpayment demand of more than $2 million.

  • Representation of physician groups in overpayment demand from commercial payors and allegations of improper payments.

More »

Experience

False Claims Acts and Government Investigations
  • Representation of academic medical center in False Claims Act 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.

  • Representation of university hospital and of large national healthcare system in national False Claims Act litigation involving allegations related to implantable cardioverter defibrillator services and violations of Medicare National Coverage Determination, resulting in resolution of litigation for clients.

  • Representation of university faculty physician in False Claims Act litigation involving allegations of improper billing, scope of practice and retaliation, resulting in dismissal of all claims in district court.

  • Representation of large physician group in False Claims Act litigation involving allegations of improper coding and billing related to evaluation and management services and chiropractic services, resulting in dismissal of majority of claims on Motion to Dismiss and resolution of remaining issues.

  • Representation of academic medical center in False Claims Act investigation related to allegations of improper physician coding and billing.

  • Representation of hospital in False Claims Act investigation related to allegations of kickbacks in joint venture arrangement.

  • Representation of long-term acute care hospital in False Claims Act investigation related to allegations of medical necessity.

  • Representation of academic medical center in False Claims Act investigation related to allegations of improper charging to research grants.

  • Representation of multiple Medicaid dental providers in fraud investigations by state Office of Inspector General alleging overpayments of more than $100 million, resulting in the return of payment hold funds and resolutions for clients.

  • Representation of dental group in Medicaid Fraud Control Unit investigation related to allegation of improper coding and billing, resulting in closing of investigation.

  • Assisted in the representation of a group of hospitals in a national Laboratory Unbundling Initiative, resulting in the government withdrawing the investigation in Texas.

  • Representation of hospitals, physician groups and other institutions in enforcement actions by the 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
  • Representation of academic medical center in HIPAA breach investigation by HHS Office of Civil Rights and appeal of proposed Civil Monetary Penalty.

  • Representation of cancer hospital in federal court litigation appealing Provider Reimbursement Review Board (PRRB) decision related to claims for case mix adjustments and related costs.

  • Representation of hospital in federal court litigation appealing PRRB decision related to claims for depreciation losses.

  • Representation of hospital in appeal of CMS denial of provider-based status, resulting in approval of provider-based determination.

  • Representation of laboratory in appeal through Medicare appeals process for an overpayment demand related to medical necessity.

  • Representation of hospitals in appeal through Medicare appeals process for denial of inpatient rehabilitation admissions.

  • Representation of cardiology medical group in appeal through 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 medical group.

  • Representation of hospital in PRRB appeal related to cost report reimbursement claims.

  • Representation of a physician group in an administrative appeal of an overpayment demand related to teaching physician billing issues.

  • Representation of hospitals in an administrative appeal related to residency program, direct graduate medical education and indirect graduate medical education issues.

  • Representation of healthcare providers in an administrative appeal of overpayment demands from Zone Program Integrity Contractors and other Medicare contractors.

  • 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 the Emergency Medical Treatment and Labor Act.

AMC Affiliations and Other Agreements
  • Representation of academic medical center in negotiation of multi-year academic affiliation agreement with hospital teaching partner.

  • Representation of large physician group in negotiation of orthopedic services agreement under an ACO.

  • Representation of academic medical center physician group in negotiation of long-term services and affiliation agreement.

  • Representation of physician group in negotiation of billing services agreement.

  • Representation of physician group in drafting and negotiating population health agreement with hospital partner.

  • Representation of academic medical center in joint venture ambulatory surgery center.

  • Representation of physician groups and hospitals in certain arrangements, including joint ventures, residency programs, billing services, physician recruitment, professional and other contracted services, and reimbursement issues.

Medicare, Medicaid and Regulatory Compliance
  • Advise providers regarding Medicare and Medicaid reimbursement and regulatory guidance.

  • Advise providers on compliance programs and corporate oversight.

  • Advise academic medical center regarding Clery Act compliance.

Internal Investigations and Self-Disclosures
  • Representation of physician group in reviewing, evaluating, and refunding claims related to evaluation and management services.

  • Representation of ambulance provider in internal review of regulatory guidelines and self-disclosure and refund to Medicaid of services.

  • Representation of hospital in internal review, assessment, disclosure and refunds related to short inpatient stays and inpatient level-of-care reviews.

  • Representation of hospital in internal review related to compliance with charges to federal grants.

  • Representation of hospital in internal review and reporting related to allegations of research misconduct.

  • Representation of hospitals and physician groups in self-disclosures and repayment issues made to the Office of Inspector General, Medicare and Medicaid contractors, and payers.

  • 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
  • Representation of hospital in overpayment investigation by commercial payor Special Investigation Unit, resulting in withdrawal of overpayment demand of more than $2 million.

  • Representation of physician groups in overpayment demand from commercial payors and allegations of improper payments.

  • Representation of hospital in dispute with commercial payor for breach of contract and failure to properly pay the hospital.

  • Representation of physician group in bringing breach of contract claim against payor for underpayments.

Recognitions and Memberships

Recognitions

  • Chambers USA: Healthcare in Texas (2013 to 2017)
  • The Best Lawyers in America© (2008 to 2018)
    • Houston: Healthcare Law
      • Best Lawyers® 2015 "Lawyer of the Year"
  • Texas "Super Lawyer" (2010 to 2017)
    • Top 100 Super Lawyers in Texas (2013) 
    • Top 100 Super Lawyers in Houston (2010, 2012 to 2015)
    • Texas Super Lawyers "Rising Star" (2004 to 2010)
  • Nightingale's Healthcare News "Outstanding Fraud and Compliance Lawyer" (2005 and 2009)

Memberships

  • American Bar Association
  • State Bar of Texas
  • Health Care Compliance Association
  • American Health Lawyers Association: Member
  • Healthcare Financial Management Association: Member
    • Texas Gulf Coast Chapter: Past President (2006 to 2007)

Industries

Admissions

  • U.S. Supreme Court
  • U.S. Court of Appeals, First Circuit
  • U.S. Court of Appeals, Fifth Circuit
  • U.S. District Court, District of Colorado
  • U.S. District Court, Northern District of Texas
  • U.S. District Court, Southern District of Texas
  • U.S. District Court, Western District of Texas
  • Texas, 1997

Education

  • J.D., Brigham Young University J. Reuben Clark Law School, 1997; magna cum laude; Order of the Coif; Managing Editor, Brigham Young University Law Review
  • B.S., Brigham Young University, 1994, cum laude