Gabriel Scott is a partner in the firm’s Healthcare and FDA practice group and focuses his practice exclusively on healthcare matters. Gabe has extensive experience in government and healthcare operations—he previously served at the Centers for Medicare & Medicaid Services (CMS) and spent several years in operational roles at one of the nation's largest home health providers. This combination of prior work experience in both government and healthcare delivery informs his assistance to clients, which is rooted in identifying practical legal solutions to complex regulatory matters in a manner that gives attention to both business objectives and compliance.
Gabe maintains a national healthcare regulatory and transactional practice that centers on resolving compliance, reimbursement, licensure, and Medicare/Medicaid enrollment issues for healthcare providers and non-provider entities involved in the healthcare industry. He has experience assisting institutional acute and post-acute providers (such as health systems, hospitals, home health agencies, hospices, and skilled nursing facilities), ancillary providers (such as diagnostic testing facilities, durable medical equipment suppliers, laboratories, pharmacies, and sleep centers), physician groups, therapy practices, telemedicine providers, and companies furnishing specialty healthcare services (such as services associated with decentralized clinical trials).
On the transactional side, Gabe frequently represents healthcare entities in the regulatory aspects of healthcare transactions, including provider compliance, transaction structuring, corporate practice of medicine, changes of ownership, diligence, enrollment, licensure, and reimbursement. He maintains extensive contacts with state healthcare regulatory agencies across the country, and is knowledgeable of the many subregulatory policies and processes used by state licensure agencies.
The types of matters on which Gabe regularly assists clients include:
- Preparing healthcare regulatory filings related to healthcare provider operations, such as facility licensure, laboratory certificates, controlled substances registrations, pharmacy permits, radioactive materials licenses, telemedicine practice registrations, and notices to state medical boards.
- Counseling clients on complying with the increasingly complicated regulatory landscape of federal and state disclosure requirements related to certain healthcare transactions, such as material change transaction notice filings to the Office of Health Care Affordability (OHCA) in California and health care market oversight submissions to the Oregon Health Authority (OHA) in Oregon.
- Establishing national and regional PC/MSO structures and corresponding management and professional services arrangements in compliance with federal and state laws, including restrictions on the corporate practice of medicine (CPOM).
- Structuring business transactions and contractual arrangements in compliance with federal and state regulations, such as provider enrollment and payor requirements, Medicare billing rules, 36-month rule for hospices and home health agencies, the anti-kickback statute (AKS), civil monetary penalties law, Eliminating Kickbacks in Recovery Act (EKRA),physician self-referral law (Stark Law),
- Advising providers on technical reimbursement matters, including incident to billing, anti-markup rule, 70/30 laboratory rule, value-based payment structures, and other complex payment issues.
- Guiding clients through the Medicare overpayments process, including submissions to the Self-Referral Disclosure Protocol (SRDP) to resolve Stark Law compliance and corresponding settlement negotiations with CMS.
- Representing providers in licensure and enrollment compliance matters before federal and state regulators and state professional boards, including CMS, state laboratory agencies, and state pharmacy boards.
- Identifying key healthcare regulatory changes that present potential opportunities or risks for clients and making strategic recommendations.
Prior to entering private practice, Gabe worked at the Centers for Medicare & Medicaid Services (CMS)—first in the Center for Medicare & Medicaid Innovation (CMMI), where his work focused on the development of value-based payment models, and later at the CMS Division of Technical Payment Policy (DTPP), which administers the physician self-referral law (Stark Law) for CMS. His experience at CMS included analyses of Stark Law self-referral disclosures submitted through the CMS Self-Referral Disclosure Protocol (SRDP), leading multi-disciplinary teams through proposed and final rulemaking processes, and collaborating with the HHS Office of Inspector General (OIG) in the design of fraud and abuse waivers for CMS alternative payment models.
Prior to his tenure at CMS, Gabe spent several years in compliance- and operations-focused management roles at a national home healthcare provider. He has significant “on-the-ground” experience with more than a dozen unannounced surveys conducted by state survey agencies or The Joint Commission.
- North Carolina Pro Bono Honor Society, 2020, 2021, 2022
- Centers for Medicare & Medicaid Services, Administrator’s Achievement Award, 2017
- Centers for Medicare & Medicaid Services, Administrator’s Special Awards in Teamwork, 2015
- Centers for Medicare & Medicaid Services, Administrator’s Special Citation Award, 2014
- American Bar Association
- American Health Lawyers Association
- North Carolina Society of Health Care Attorneys
- North Carolina Bar Association
- Tenth Judicial District Bar Association
- Speaker, “Health Care Transactions: Regulatory Considerations for Structuring Deals, Minimizing Reimbursement Delays, and Maintaining Provider/Supplier Enrollments,” Tennessee Bar Association, 36th Annual Health Law Forum, 18 October 2024
- Panelist, "Hunting Pandemic Fraud: Audits and FCA Litigation Resulting From the PHE," American Bar Association, Physicians Legal Issues: Healthcare Delivery & Innovation Conference, 7 September 2023
- Speaker, "Sharing of Innovative Bundled Payments for Joint Replacement: Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement," Health Care Payment Learning & Action Network, 17 August 2015
- Speaker, "Medicare Bundled Payments for Care Improvement Initiative: Experiences on the Front Lines of Alternative Payment," American Health Lawyers Association, 13 May 2015
- CMS Value-Based Care Toolkit, American Health Law Association, 31 May 2024
- “Rural Hospital Support Act aims to offer additional financial assistance for rural hospitals and bolster healthcare access for rural communities,” Medical Economics, 27 April 2023
- CMS Makes Changes to MSSP in 2019 Physician Fee Schedule, JD Supra, 5 December 2018
- CMS “Goes Fishing” on Stark Law’s Impediments to Value-Based, Coordinated Care, The National Law Review, 21 June 2018
- Continuing Resolution Creates Significant Changes to Medicare and Medicaid Policies, The National Law Review, 21 March 2018
- Gainsharing Guidance: Clarification on Cost-Savings Arrangements Between Hospitals and Physicians, Austin Medical Times, March 2018
- CMS Terminates and Scales Back Mandatory Bundled Payment Models. JD Supra, 15 December 2017
- Newly-Announced 340B Payment Rule Presents Financial & Operational Challenges to All Covered Entities, The National Law Review, 6 November 2017
- CMMI Requests Ideas to Spur Innovation and Reduce Burden, The National Law Review, 10 October 2017
- Hospital Medicare Certification at Risk? CMS Clarifies Inpatient Volume Expectations, The National Law Review, 26 September 2017
- Dealing with Disasters – Quality Payment Program Exception Available for MIPS-Participating Clinicians and Groups, The National Law Review, 21 September 2017
- CMS Proposal Terminates and Revises Mandatory Bundled Payment Models, The National Law Review, 18 August 2017
- MACRA: CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens, American Health Lawyers Association Weekly, 14 July 2017
- CMS Initiative For Hip And Knee Replacements Supports Quality And Care Improvements For Medicare Beneficiaries, Health Affairs, 16 November 2015
