Robert B. Ramsey, III represents healthcare providers in a variety of regulatory, transactional and reimbursement matters. In the transactional area, Bob has represented clients in an array of innovative projects, including the formation of accountable care organizations (ACOs) and the structuring of bundled payment arrangements that qualify for payment under various CMS demonstration projects. He also has represented clients in the formation and operation of numerous joint ventures. In addition, Bob counsels clients regarding regulatory and compliance matters, including issues related to the Stark law, the Anti-Kickback Statue and the False Claims Act. His clients include health care systems, hospitals, post-acute providers, dialysis facilities and specialty pharmacies.
In the transactional arena, he has represented clients in various integration projects, including mergers and acquisitions, joint venture formation and creation of integrated delivery systems. In recent times, he has devoted considerable time to representing clients in the development and operation of ACOs and similar coordinated care arrangements. A partial list of his transactional experience includes the following:
- Created an ACO qualified to participate in the Medicare Shared Savings Program.
- Represented numerous clients in the development of arrangements designed to allow for participation in CMS' Model 2 and 3 Bundled Payment Care Initiatives.
- Developed an "ACO-like" arrangement for a major health insurer as an add-on to its basic participation agreement.
- Counseled several hospitals in the creation and operation of ambulatory surgical center joint ventures with physicians.
- Developed an "ESCO" for a national chain of dialysis facilities.
- Counseled a number of health care systems regarding compliance and regulatory due diligence related to potential mergers and acquisitions.
- Designed and negotiated co-management agreements between hospitals and physician groups.
In the regulatory and compliance arena, Bob advises clients on a host of federal and state issues, including the Stark law, the Medicare Civil Monetary Penalties law, the Anti-Kickback Statute and the False Claims Act. A representative sample of his work in this area includes:
- Prepared, submitted and resolved matters under the Stark self-disclosure protocol.
- Represented various hospitals and long-term care facilities in the settlement of qui tam cases brought under the False Claims Act.
- Obtained a dismissal without financial payment of a health system from an investigation regarding hospital outlier payments.
- Represented hospitals, long-term care providers, hospices and others in numerous self-disclosures to the OIG and/or Department of Justice, including matters related to pneumonia coding, modifier 25, the 72-hour rule, PATH audits, anesthesia direction and supervision, blood transfusion billing and E&M coding.
- Designed and implemented a corporate compliance programs for long-term care companies, ACOs, and other providers.
- Furnished advice to clients regarding the exclusion authority of the OIG, including the filing of numerous self-disclosures related to employment of excluded parties.
Bob also advises healthcare clients on a wide array of other issues and matters. These matters include Medicare reimbursement issues, managed care contracting, EMTALA and various contractual relationships. His experience in this area includes:
- Advised and counseled clients regarding a number of issues related to the federal 340B program, including qualification to participate in that program.
- Represented numerous clients regarding CMS' "meaningful use" payment program, including the self-disclosure and repayment of funds pursuant to that program.
- Negotiated numerous physician recruitment arrangements and employment agreements.
- Represented a specialty pharmacy company in negotiations of a managed care contract valued at more than $100 million.
- Advised clients regarding Medicare enrollment questions.
- Represented a number of hospitals in appeals before the Provider Reimbursement Review Board.
- Counseled health care providers on a variety of Medicare reimbursement matters, including provider-based status, incident-to billing, RAC audits, and national and local coverage determination.
Since 2012, Bob has been consecutively selected to the Pennsylvania Super Lawyers list in field of healthcare law. Additionally, he has been named to The Best Lawyers in America® list consistently since 2010 under the Health Care Law category. In 2022, Bob was named The Best Lawyers in America® Healthcare Law "Lawyer of the Year" in Pittsburgh. Recently, he was noted by Chambers USA as a "Leader in the Field" in healthcare law. Bob is a former adjunct professor at the University of Pittsburgh School of Law, where he taught a course in healthcare fraud and abuse.
Bob is a member of the firm's Board of Directors and Chair of the Promotions Committee.