FacultyFaculty/Author Profile

Adam Robison

King & Spalding LLP
Associate
Houston, TX, USA


Adam Robison is a partner in King & Spalding’s Houston Healthcare Practice Group. His practice focuses on representing health care providers, including public and private hospital systems, academic medical centers, medical schools, children’s hospitals, hospices, laboratories, physicians and suppliers. He represents clients in various regulatory and transactional matters. Specific aspects of his health care industry experience include: False Claims Act and Civil Monetary Penalty investigations; fraud and abuse; Anti-kickback and physician self-referral issues, including physician contracting; Medicare and Medicaid administrative overpayment appeals; Medicare and Medicaid self-disclosures and compliance with the 60 day overpayment rule; Medicaid supplemental payment and 1115 Waiver programs; and a variety of  transactional matters, including hospital joint operating company agreements,  merger  and acquisition agreements, and academic affiliation agreements.

Presentations 

  • Provider Transactions: Structures, Trends, and How to Minimize Health Regulatory Risk, Texas Hospital Association, co-presented with Gregory N. Etzel (October 10, 2016)
  • Provider Transactions: Structures, Trends, and How to Minimize Antitrust Risk, 2016 University of Texas System Legal Conference, Co-presented with John D. Carroll (September 29, 2016)
  • HIPAA, HITECH, and Texas Medical Records Privacy Act, Healthcare Financial Management Association, Texas Gulf Coast Chapter, Co-presented with Juliet McBride (August 2016)
  • Perilous World of Fraud and Abuse, Texas Society of CPAs (July 2016)
  • False Claims Act Enforcement and Government Investigations Update, Greater Houston Society for Healthcare Risk Management (June 2, 2016)
  • Administrative Law Update & The False Claims Act Enforcement and Investigations, Healthcare Financial Management Association, Louisiana Gulf Coast Chapter (May 2, 2016)
  • The False Claims Act Enforcement and Investigations, UT Health Law Conference, Co-presented with Scott McBride (April 2016)
  • The Perilous World of Fraud and Abuse: 2015 Year in Review, Healthcare Financial Management Association, Texas Gulf Coast Chapter (January 15, 2016)
  • Recent Medicaid Developments, Teaching Hospitals of Texas Conference, Co-presenter Monica Leo (Texas Health and Human Services Commission) (October 2015)
  • Hot-Button FMV & Compliance Issues Stemming from Recent Stark/AKS Developments, Houston Roundtable, Co-presented with Ben Ulrich (VMG) (November 13, 2015)
  • The Perilous World of Fraud and Abuse, Texas Society of CPAs (July 2015)
  • Healthcare Regulatory Update: Maintaining Compliance in 2014, Citizens Medical Center Continuing Medical Education (June 17, 2014)
  • The New Age of False Claims Act Enforcement and Investigations, UT Health Law Conference, Co-presented with Scott McBride (April 2014)
  • Going Down the Rabbit Hole: Stark Compliance After Tuomey and Halifax, King & Spalding Health Law & Policy Forum (March 17, 2014)
  • Moving Forward: Healthcare Reform in the President's Second Term, Healthcare Financial Management Association, Texas Gulf Coast Chapter, Co-presented with Gregory N. Etzel (January 2013)
  • Healthcare Executives Under Fire: The Government's Increasing Focus on Individual Liability, K&S Roundtable, Co-presented with Paul B. Murphy, Michael Paulhus, and Greg Sicilian (September 28, 2012 and November 9, 2012)
  • Recent Medicaid Developments Resulting From the Implementation of and the Supreme Court's Ruling on PPACA, Enforcement Activities, and Other Medicaid Reforms, K&S Roundtable, Co-presented with Allison Kassir, Kim Roeder, and Sara Kay Wheeler (August 24, 2012)
  • 340B Drug Program Overview, Southeast Healthcare Internal Auditors Event (December 2, 2011)
  • Taking Charge of Contractor Chaos, K&S Healthcare Roundtable, Co-presented with Rick Shackelford, Sara Kay Wheeler and Kate Stern (February 23, 2011)
  • Healthcare Reform Legislation, Part IV: Reform Driven Strategies and Tactics, K&S Healthcare Roundtable, Co-presented withRick Shackelford, Gary Eiland, and Michael Paulhus (May 21, 2010).

Awards & Recognition

  • Texas Super Lawyers, Super Lawyer (Healthcare) 2013 through Present 
  • Texas Super Lawyers, Rising Star (Healthcare) 2010, 2011, 2012

Publications:

  • “Universal Health Services v. Escobar: A win, loss, or stalemate for healthcare providers, the government, and qui tam relators,” August 2016
  • “The FCA and Fraudulent Opinions of Medical Necessity,” (Co-Author), American Bar Association GPSolo Magazine, April 2015
  • “False Claims Act Actions – The Developing Case Law Regarding If and When Opinions of Medical Necessity Can Be Fraudulent,” (Co- Author), American Bar Association Health Law Reporter, April 2015
  • “How Aggressive Will the Government Be in Pursuing Non-Compliance with the 60-Day Overpayment Rule?,” Reimbursement Advisor, November 2014
  • “Providers Brace for Significant Changes to Medicaid and Medicare in 2013,” (Co-Author) Healthcare Financial Management Association, Texas Gulf Coast Chapter, Gulf Coast Lines, January 2013
  • “Medicaid Expansion: Impact of the Supreme Court's Affordable Care Act Decision on Hospitals in States that Elect Not to Adopt Medicaid Expansion,” (Co-Author), Dennis Barry’s Reimbursement Advisor, February 2013
  • “Replacing Medicaid UPL Programs with 1115 Waivers: A Closer look at whether 1115 Waivers are viable replacements for traditional UPL program, (Co-Author) Dennis Barry’s Reimbursement Advisor, June 2012
  • “Physician and Practitioner Billing Privilege Denials and Revocations - Screening Excluded Provider Databases May No Longer Be Enough,” Dennis Barry’s Reimbursement Advisor, January 2010 
  • “Retail Clinics - Coming Soon to a Store Near You,” (Co-Author) Health Lawyers News, September 2008
  • “New Hospitals Face Financial Risk for Failure to Timely Enroll in Medicare Program,” (Co-Author) Dennis Barry’s Reimbursement Advisor, October 2008 
  • “OIG Guidance on ED On-Call Arrangements - Non-Compulsory Opinion Guidance on Structuring On-Call Arrangements to Comply with Federal Illegal Remunieration Statute (Co-Author) Dennis Barry’s Reimbursement Advisor, February 2008
  • “Assessing Provider MSP False Claims Act Liability - Governments and Whistleblowers Consider MSP Violations a Viable Source of FCA Liability, (Co-Author) Dennis Barry’s Reimbursement Advisor, July 2007  

MATTERS

Representative Experience: 

Litigation / Administrative Appeals

  •  Successfully represented large health care companyin obtainingan$18 millionarbitrationaward againstthesellers ofa hospice pursuant to claims for indemnification and fraud related to a self-disclosure audit that Adam also facilitated.
  • Successfully represented a drug testing laboratory in reducing a $31 Medicare overpayment resulting in more than a $29 million overpayment reduction.
  • Represented oncologist before the Administrative Law Judge in a Medicare overpayment case resulting in the full reversal of the multi- million alleged overpayment. 
  • Successfully represented coalition of children’s hospitals in connection with dispute involving cost settling certain Medicaid primary care case management payments resulting in multi-million settlements. 
  • Negotiated a $6 million settlement agreement for a children’s hospital in connection with a dispute involving cost settling certain Medicaid primary care case management payments.  

False Claims Act Matters and Settlements

  • Represented county owned hospital in approximate $21.75 million settlementof federalFalse ClaimsAct qui tamlawsuit involving allegations of Stark Law and Anti-Kickback statute violations without a Corporate Integrity Agreement. 
  • Represented nursing home chain in $4 million settlement of federal and state False Claims Act lawsuit and negotiation of Corporate Integrity Agreement related to ambulance arrangement allegations. 
  • Represented hospital district in favorable $3.3 settlement of federal and state False Claims Act lawsuit involving physician billing without a Corporate Integrity Agreement. 
  • Represented national hospice in negotiating approximate $25 million settlement and negotiated Corporate Integrity Agreement based on allegations of lack of medically necessary services. 
  • Represented county hospital district in negotiating approximate $15 million settlement and negotiated corporate compliance agreement related to allegations of lack of Medicare Secondary Payer issues and claims for prisoners. 

Transactions

  • Represented medical school in negotiating $100 plus million joint operating company and physician clinically integrated network agreements. 
  • Represented medical school in the annual negotiation of $220 plus million physician coverage and academic affiliation agreements. 
  • Representedastate university/academicmedical centerin thesuccessful negotiation of a $338 million agreement with the state’s department of criminal justice for the provision of correctional healthcare services to state inmates. 

Health Regulatory and Self-Disclosures

  • Represented state medical school in obtaining a favorable advisory opinion from the Office of Inspector General related to the medical school’s prenatal care programs. 
  • Represented academic medical center hospital in obtaining retroactive listing as a covered entity under the 340B drug discount program, resulting in $4.5 plus millions in drug savings. 
  • Represented multiple hospital systems and providers in self-disclosing overpayments to Medicare Administrative Contractors, the Office of Inspector General (self-disclosure protocol), and various state Medicaid agencies.
  • Represented various participants regarding the development and implementation of Medicaid supplemental payment/1115 Waiver programs to provide enhanced Medicaid payments to hospitals and other providers located in multiple counties in Texas. 
  • Reviewed and analyzed physician and referral arrangements on behalf of multiple financial institutions in connection with hospital public finance transactions to determine compliance with Anti-Kickback Statute and Stark Law. 
  • Represented multi-hospital system in voluntarily disclosing pursuant to the OIG through the OIG Self Disclosure Protocol its employment of individuals excluded from participation in federal health care programs.
Adam Robison is associated with the following items:
Web Segment  Web Segment Enforcement Trends in Health Care Law - Health Care Law Institute 2016: Emerging Challenges and Trends in Reimbursement, Enforcement, Compliance and other Hot Topics, Friday, December 16, 2016
MP3 Audio  MP3 Audio Enforcement Trends in Health Care Law - Enforcement Trends in Health Care Law , Friday, December 16, 2016
MP4 - Mobile Video Seg  MP4 - Mobile Video Seg Enforcement Trends in Health Care Law - Enforcement Trends in Health Care Law , Friday, December 16, 2016
On-Demand Web Programs  On-Demand Web Programs Health Care Law Institute 2016: Emerging Challenges and Trends in Reimbursement, Enforcement, Compliance and other Hot Topics, Tuesday, January 03, 2017, New York, NY
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