Academic Medical Centers

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King & Spalding has extensive experience working with medical and dental schools, teaching hospitals, faculty practice plans, and other components of academic medical centers (AMCs). Our attorneys have represented AMC clients on organizational, transactional and regulatory matters and in related litigation. This has included work on ACO development and other PPACA implementation matters; GME/IME payment issues; teaching physician billing and PATH audits; False Claims Act litigation; fraud and abuse compliance; clinical research compliance issues; advocacy before Congress and Congressional committees; HIPAA compliance; coverage and payment for investigational devices and other new services and technology; coding and reimbursement compliance; intellectual property issues; physician incentive programs; Medicare certification; Medicare organ acquisition issues; and obtaining favorable OIG advisory opinions for AMC clients.

The firm represents a number of universities in IP matters including: Stanford University, University of California, Emory University, Georgia Institute of Technology, University of Alabama, Vanderbilt University and the University of Georgia. We have performed a wide range of work including preparing and prosecuting patent applications, establishing IP policies and development strategies, conducting negotiations with inventors or investors, protecting trademark rights, preparing licenses covering all forms of intellectual property rights, and advising universities in commercializing technology.

Our attorneys’ projects for AMCs include:

  • Represented AMCs in obtaining favorable advisory opinions approving (i) donation of a medical office building from an affiliated teaching hospital to the medical school for use in supporting educational and research activities and (ii) contribution from an affiliated teaching hospital to the state university endowment organization for use by the school to support education and research

  • Represented AMCs in federal court and before the DOJ and OIG in federal FCA qui tam litigation concerning Medicare billing for cardiac medical devices subject to FDA investigational device exemptions

  • Represented an AMC in a qui tam case negotiating a settlement, only 20 percent greater than the approximately $10 million in single damages

  • Represented an AMC in negotiating a settlement of a medical education cost dispute with HHS resulting in increased payments to the AMC in excess of $20 million

  • Obtained Medicare Part B hearing decisions for two separate state university faculty practice plans reversing in their entirety multi-million dollar Medicare overpayment determinations

  • Represented AMCs in developing compensation models for faculty physicians and implementing time studies to support faculty physician compensation

  • Represented teaching hospitals in multiple Medicare PRRB appeals

  • Advised state and other governmental hospitals on Medicaid disproportionate share issues

  • Represented a children’s hospital AMC in preparation of ESRD composite rate exception request

  • Successfully represented public AMC in a suit regarding GME reimbursement to teaching hospitals under Texas Medicaid and enjoined HHSC from using any GME formula other than the statutory one

  • Successfully represented an AMC in a multi-year, multi-million dollar dispute regarding the AMC's available bed count and resident-to-bed ratio for purposes of IME payments.

  • Represented state universities and other AMCs and faculty practice plans in conducting internal investigations and disclosing billing errors to Medicare/Medicaid programs

  • Advised multiple AMCs on Medicare provider-based clinic issues

  • Provided ongoing advice to compliance officers of AMCs and faculty practice plans regarding coding and billing issues

  • Advised AMCs on resolving credit balance issues, including disclosure to Medicare contractors or in negotiating settlements with the OIG

  • Advised AMCs on structuring arrangements with faculty regarding freestanding facilities

  • Advised AMC clients in structuring various types of arrangements between AMC components and faculty physicians to comply with the Stark self referral law and anti-kickback statute

  • Advised AMCs regarding Medicare coverage and billing for clinical research activities and in establishing effective compliance plans regarding clinical trial billing

  • Represented AMCs in structuring affiliation models and preparing affiliation agreements

  • Represented dental schools, as well as AMCs, in drafting and negotiating GME agreements with respect to resident training in non-provider settings

  • Successfully represented two children’s hospital AMCs arguing that time spent in on-campus research rotations should be included in children’s hospital GME grant funding from HRSA

  • Represented AMC in making self disclosure to the National Institutes of Health concerning the use of incorrect, indirect cost rates on NIH grants over multiple years
Gary W Eiland 
T: +1 713 751 3207 HOUSTON