Kyle Gotchy

• Represented health systems, medical groups, clinical laboratories, and individual physicians in various stages of government investigation by the U.S. Department of Justice, state Medicaid Fraud Control Units, and other law enforcement agencies
• Counseled multinational technology company on a range of issues in connection with the development and implementation of a market leading telehealth service, including scope of practice, professional licensure, reimbursement, prescriptive practice, and patient engagement
• Represented multiple health systems on the establishment and expansion of multistate telemedicine programs
• Representing health system in administrative appeal of Medicare overpayment determination based on adverse findings in a HHS OIG hospital audit report, focused primarily on billing requirements for inpatient rehabilitation facility services
• Represented multiple health systems and other providers in investigating and self-disclosing potential overpayments to CMS under the Self-Referral Disclosure Protocol (SRDP)
• Represented multiple health systems and providers in responding to investigations by professional licensing boards
• Counseled health system on the development of a co-management arrangement with a behavioral health hospital for an eating disorder treatment program
• Advised private equity firms on the legal and business risks in connection with complex healthcare industry acquisitions
• Advised health system on issues raised under the federal anti-kickback statute and physician self-referral law in connection with a high-profile contract dispute with specialty group
• Counseled multiple manufacturers regarding compliance with reporting obligations under the federal Physician Payments Sunshine Act
• Counseled health system on the development of a cardiology co-management arrangement
• Represented academic medical center and physician in appealing proposed revocation of Medicare billing privileges
• Advised concierge medical practice on the development of a telemedicine service
• Represented coalition of clients in the development and submission of comments to CMS and HHS OIG in response to proposed rules amending the federal anti-kickback statute, the civil monetary penalties law, and the physician self-referral (Stark) law
• Counseled health systems and other providers on compliance with CARES Act and Provider Relief Fund requirements
• Advised multiple health systems on the development of a range of physician alignment models
• Counseled hospitals, medical groups, and clinical laboratories on collateral issues raised by the exclusion of practitioners from federal heath care programs
• Counseled multiple clinically integrated networks and accountable care organizations located across the country on structuring financial relationships consistently with federal and state fraud and abuse laws and related rules governing participation in Medicare value-based payment programs
• Counseled executive leadership and board of skilled nursing facility regarding resident rights and community engagement
• Represented health system in negotiations with academic medical center regarding staffing arrangement in support of air transport service

Kyle Gotchy works with leading hospitals, health systems, medical groups, technology companies, and related businesses in connection with regulatory matters, operational issues, complex contracting, investigations, and enforcement proceedings. He works closely with in-house counsel, leadership, and other business, clinical, and compliance stakeholders on matters related to the state and federal laws governing providers and suppliers, the physician self-referral (Stark) and anti-kickback laws, Medicare reimbursement, and the development of risk-  and value-based payment arrangements. Kyle also works with providers, retailers, and technology companies on the development, implementation, and operation of telemedicine services and other innovative digital health solutions. 

Kyle draws on the operational perspectives he gained while serving as Senior Counsel at Seattle Children’s Hospital and strives to help his clients develop practical legal approaches in furtherance of their key business objectives. His approach to client service is further informed by having completed extensive client secondments at one of the nation's largest health systems and later at a multinational technology company during the launch of its market-leading telehealth product. Prior to entering the legal profession, Kyle completed an internship at the EPA focused on children's environmental health and assisted with analytical and basic sciences research in leading academic and biopharmaceutical laboratories.