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Scott Carroll has spent his entire legal career representing physicians, medical groups, hospitals, health plans, specialty service organizations and pharmaceutical manufacturers. Scott’s experience includes counseling clients on health care corporate finance; managed care and insurance regulation; intellectual property and information technology; public policy and government advocacy; government investigations and fraud and abuse; antitrust law and health care litigation, and health care bankruptcies and reorganizations.
Partner
Tel: 716.853.5100
Fax: 716.853.5199
Email: scarroll@lippes.com
Representative Matters
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Outside General Counsel to specialty health benefit management company focused on muscular skeletal conditions.
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Health care corporate development and investment activities
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Preferred equity investment by health plan in disease management company
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Strategic planning and corporate development for regional BlueCross BlueShield Plan, including evaluation of conversion to investor owned status and negotiations with multiple parties for potential mergers and acquisitions
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Acquisition of Florida network and formation Strategic Alliance with sellers covering other products and markets.
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Restructuring of Medicare Part B and DMERC regional contractor subsidiary and operations.
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Specialty benefit agreements and single service agreements for pharmaceuticals (including injectables), behavioral medicine, laboratory, diagnostic imaging, implants, chiropractic, physical therapy and spine care.
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Joint Development and License Agreement with Research Triangle clinical decision support application developer.
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Pharmaceutical and device research, development, alliance and manufacturing agreements.
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Defended RICO matter for regional BlueCross BlueShield plan against self-funded plan.
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Litigated bankruptcy matter in the Eastern District of Pennsylvania on behalf of health plan seeking recoveries of amounts covered by capitation payments from an insolvent IPA.
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Antitrust litigation including successful antitrust plaintiff action alleging physician group boycott, antitrust arbitration against physician IPA and regulatory challenge to merger of competing health plans.
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Coordinated response to New York State Insurance Department investigation of non-profit health plan’s termination of Chief Executive Officer and related governance matters.
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Advised regional health plan on New York State Office of Attorney General investigation of broker compensation practices.
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OIG audits of plan cost reports and premium submissions.
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Insurance market-conduct examinations.
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Fraud and abuse counseling related to routine and novel transactions.
Past Professional Experience
- Executive Vice President, General Counsel and Corporate Secretary, Palladian Health, LLC
- Assistant General Counsel, HealthNow New York Inc. d/b/a BlueCross BlueShield of Western New York
- Gnessin & Waldman, PC, Washington, DC
- Office of Risk Management and Legal Affairs, George Washington University Medical Center
Education
- Juris Doctor, 1994 Catholic University of America, Columbus School of Law,
Washington, D.C.
- Executive Editor, Journal of Contemporary Health Law and Policy
- B.A., Philosophy, 1991 - Catholic University of America, Washington, D.C., cum laude
Publications/Presentations
Guest Lecturer, State University of New York at Buffalo, School of Law, Introduction to Health Law, Legal Issues in Managed Health Law (April 2006).
Panelist, The Right to Appeal: Providers Battle On, Healthcare Association of New York State (HANYS), (May 2004).
Panelist, Third Party Payor Risk Areas, Physicians Survival: Critical Care for Physicians and their Lawyers (Erie County Bar Association & Erie County Medical Society, March 2002).
Moderator, Nuts and Bolts of E-Commerce Negotiations, BlueCross BlueShield Association Annual Lawyers Conference (BlueCross BlueShield Association, May 2001).
Speaker, Medicare Managed Care and Provider Networks: Tapping an Exploding Market, 1998 Congress On Health Care Management (American College of Health Care Executives, March 1998).
Co-authored, Recent Regulations Clarify the Application of Medicare Fraud and Abuse Legislation to Managed Care Relationships, 9 Medical Interface No.5, p. 110 (May 1996).
Lee v. Weisman, Amateur Psychology or an Accurate Representation of Adolescent Development, How Should Courts Evaluate Psychological Evidence? 10 J. Cont. Health L. & Policy 513 (1994).
Honors
Who’s Who in Law 2005 and 2006, Buffalo Business First
Bar Admissions
- Maryland
- District of Columbia
- New York
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