Gabriel Scott is a partner in the firm's Research Triangle Park office and focuses his practice exclusively on health care regulatory and transactional matters. Gabe has extensive experience in government and health care operations—he previously served at the Centers for Medicare & Medicaid Services (CMS) and also spent several years in operational roles at one of the nation’s largest home health care providers. This unique combination of prior work experience in both government and health care 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 practice that focuses on resolving compliance, reimbursement, licensure, and Medicare/Medicaid enrollment issues for health care providers and non-provider entities involved in the health care 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 health care services (such as services associated with decentralized clinical trials).
This includes:
- Utilizing a “turnkey” approach in the preparation of thousands of health care regulatory filings, to increase the speed and efficiency of filing submissions.
- 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.
- 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.
- Counseling clients on complying with the increasingly complicated regulatory landscape of federal and state disclosure requirements related to certain health care transactions.
- Structuring business transactions and contractual arrangements in compliance with federal and state regulations, such as provider enrollment requirements, Medicare billing rules, the anti-kickback statute, and physician self-referral law (Stark Law).
- Identifying key health care regulatory changes that present potential opportunities or risks for clients and making strategic recommendations.
In addition to his regulatory practice, Gabe frequently represents health care entities in the regulatory aspects of health care transactions, including compliance, corporate structuring, changes of ownership, diligence, enrollment, licensure, and reimbursement. He maintains extensive contacts with state health care regulatory agencies across the country, and is knowledgeable of the many subregulatory policies and processes used by state licensure agencies.
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 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 health care 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
- 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)
- “Rural Hospital Support Act aims to offer additional financial assistance for rural hospitals and bolster health care access for rural communities,” Medical Economics, 27 April 2023
- CMS Makes Changes to MSSP in 2019 Physician Fee Schedule, JD Supra (December 5, 2018)
- CMS “Goes Fishing” on Stark Law’s Impediments to Value-Based, Coordinated Care, The National Law Review (June 21, 2018)
- Continuing Resolution Creates Significant Changes to Medicare and Medicaid Policies, The National Law Review (March 21, 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 (December 15, 2017)
- Newly-Announced 340B Payment Rule Presents Financial & Operational Challenges to All Covered Entities, The National Law Review (November 6, 2017)
- CMMI Requests Ideas to Spur Innovation and Reduce Burden, The National Law Review (October 10, 2017)
- Hospital Medicare Certification at Risk? CMS Clarifies Inpatient Volume Expectations, The National Law Review (September 26, 2017)
- Dealing with Disasters – Quality Payment Program Exception Available for MIPS-Participating Clinicians and Groups, The National Law Review (September 21, 2017)
- CMS Proposal Terminates and Revises Mandatory Bundled Payment Models, The National Law Review (August 18, 2017)
- MACRA: CMS Proposes Quality Payment Program Updates to Increase Flexibility and Reduce Burdens, American Health Lawyers Association Weekly (July 14, 2017)
- CMS Initiative For Hip And Knee Replacements Supports Quality And Care Improvements For Medicare Beneficiaries, Health Affairs (Nov 16, 2015)
