T. Mills Fleming

• IRS Determination Letter that a hospital foundation is a Type I supporting organization under Internal Revenue Code Section 509(a) (3) (November 30, 2010)
• U.S. Department of Justice – Business Review Letter, No. 09-1 (September 4, 2009) (approving a joint pricing collaboration between two competing health care systems) (Link 1 and Link 2)
• Certification of Compliance Agreement between the Office of Inspector General of the Department of Health and Human Services and a health system (February 11, 2008) (Link)
• IRS Private Letter Ruling, PLR 200211051, 2001 PLR Lexis 1971 (December 20, 2001) (approving a large health care system’s corporate restructuring) (Link)
• IRS Private Letter Ruling (April 30, 1998) (unpublished) (approving a tax-exempt entity’s physician compensation/gainsharing proposal)

Other Representative Engagements, Litigation and Transactions

• Appointed Special Assistant Attorney General to represent the Commissioner of the Georgia Department of Human Services in a class action lawsuit involving DHS’s alleged violations of various federal and state laws (S.C.G., et al. v. Candice Broce, in her official capacity as Commissioner of the Georgia Department of Human Services (U.S. District Court, Northern District of Georgia)).
• Appointed Special Assistant Attorney General to represent the Georgia Department of Family and Children’s Services in an appeal to the Georgia Court of Appeals regarding whether the State of Georgia is required to provide certain foster care benefits and other services to undocumented foreign national children. (In the Interest of K.A.V., a child, Georgia Court of Appeals.)
• Served as corporate and regulatory counsel for a nonprofit hospital in federal court litigation involving, among other things, the specific application of the Georgia Hospital Acquisition Act and the Georgia Hospital Authorities Law (U.S. District Court, Northern District of Georgia and the 11th Circuit Court of Appeals).
• Represented the Chapter 11 Trustee for a bankrupt hospital in the sale of the hospital and the hospital’s nursing home/skilled nursing facility (U.S. Bankruptcy Court, Northern District of Georgia). Subsequently appointed by the Bankruptcy Court as the Chapter 7 Trustee’s special counsel for health care matters when the case was converted.
• Represented a major health care system in criminal and civil fraud and abuse and tax fraud investigation by the USDOJ alleging violations of the federal Stark law and the federal Anti-Kickback Statute (U.S. District Court, Southern District of Georgia).
• Represented a health care executive in USDOJ investigation of federal False Claims Act violations (U.S. ex rel. Rogers v. Azmat, U.S. District Court, Southern District of Georgia) (Link).
• Represented a major health care system in USDOJ’s initial investigation of alleged federal Stark law, federal Anti-Kickback Statute, and federal False Claims Act violations relating to physician compensation, fair market value and commercial reasonableness issues (U.S. District Court, Southern District of Georgia).
• Represented a large health care system in USDOJ’s investigation of alleged federal Stark law, federal Anti-Kickback Statute, and federal False Claims Act violations relating to a cancer center joint venture (U.S. District Court, Northern District of Mississippi).
• Represented a large homebuilder in a federal Fair Housing Act lawsuit brought by a local fair housing council and the USDOJ under the Fair Housing Act, 42 U.S.C. §§ 3601-3619 (U.S. v. Genesis Designer Homes, LLC, et al. (CV407-139), U.S. District Court, Southern District of Georgia).
• Court appointed to represent (i) various criminal defendants who were indicted for an assortment of crimes including human trafficking, gun trafficking and drug trafficking and (ii) a black female in a Title VII action against her employer (U.S. District Court, Southern District of Georgia).
• Served as corporate counsel for laboratory services provider in defense of tortious interference claims in Georgia (U.S. District Court, Northern District of Georgia).
• Represented hospitals in medical malpractice defense litigation and various insurance companies in general defense litigation.
• Represented a major health care system in a managed care/revenue cycle dispute.
• Represented an international nurse recruiting company in its sale to a publicly traded entity.
• Obtained tax-exempt status for a cancer treatment and research nonprofit corporation.
• Negotiated an affiliation agreement between a major health care system and a university-based medical school.
• Negotiated sale of a large health system’s home health care services to a publicly traded entity.
• Obtained successful termination of provider agreement between the Centers for Medicare & Medicaid Services (CMS) and a health system under the provisions of 42 C.F.R. 489.52(b)(3).
• Negotiated the sale of a hospital-based outpatient surgery center to a hospital-physician joint venture ambulatory surgery center (ASC) and obtained the first-ever letter of non-reviewability for this type of transaction from the Georgia Department of Community Health.
• Served as health care system counsel for several $150+ million tax-exempt bond financings and refinancings.
• Served as a major health care system’s counsel for $50 million taxable and tax-exempt financing for the health system’s electronic medical record hardware and software purchase.
• Represented large health care system in the filing of federal Anti-Kickback Statute advisory opinion requests with DHHS’s Office of Inspector General.
• Negotiated a Shared Services Agreement between a major health system and multi-state health care provider.
• Negotiated the sale of a hospital-based air and ground ambulance service.
• Negotiated a bond insurer’s waiver of a major health care system’s rate covenant default.
• Served as health care system counsel for Community Needs Assessment and IRC Section 501(r)/Patient Protection and Affordable Care Act compliance.
• Represented a non-profit hospital in intergovernmental agreement negotiations with a county government and a county hospital authority for the provision of indigent care.
• Negotiated various telemedicine contracts between a major health system and numerous regional hospitals.
• Represented a major health care system in executive management agreement negotiations.
• Advised nonprofit hospital boards of directors and management on governance requirements, corporate bylaws, and compliance.

• Served as hospital counsel for public access requests under Georgia’s Open Meetings and Open Records Act.
• Represented a major health care system in the sale of its inpatient rehabilitation service line to a for-profit joint venture with a national health care provider.
• Represented a large health care system against a municipality in negotiating payments for services rendered to inmates and prisoner detainees.
• Negotiated the sale of a hospital-based urgent care operation to a joint venture owned by a health care system and a regional health care provider.
• Represented a nonprofit hospital in intercompany service agreement negotiations.
• Represented a major health care system in an internal audit for tax-exempt bond compliance.
• Represented a nonprofit hospital, which had been destroyed by a tornado, in federal disaster relief negotiations with FEMA.
• Advised health systems on Patient Protection and Affordable Care Act, HIPAA and HITECH compliance.
• Represented a Finnish-based multi-national shipping engine manufacturer in immigration matters and compliance with the federal Export Administration Regulations.
• Represented a South African-based heavy equipment manufacturer, a Japanese-based food ingredient manufacturer, a Swedish-based biofuel manufacturer, a Turkish-based textile manufacturer, and a Finnish-based global chemicals company in immigration matters.
• Represented hospitals and physicians in “Interested Government Agency/Conrad State 30” and Appalachian Regional Commission J-1 visa waiver requests which require the review and approval of (1) the Georgia Department of Community Health/State Office of Rural Health, (2) the U.S. State Department and (3) the U.S. Citizenship and Immigration Services (USCIS).
• Advised multi-national companies on U.S. immigration policies and procedures and I-9 compliance.
• Represented U.S. manufacturers in USICE I-9 investigation.
• Served as immigration counsel for international music festival.
• Represented Nazi-era Holocaust survivor in child slave labor reparations claim against the Austrian company which aided and abetted in her being forced to work.
• Obtained I-512L Humanitarian Parole Authorization for a five-year-old child from Eritrea (an African country located on Ethiopia’s northern border) to enter the U.S. to receive a liver transplant.

Justice Robert Benham Award for Community Service: 2016
Mills Fleming was honored by the State Bar of Georgia and the Chief Justice’s Commission on Professionalism with the 17th Annual Justice Robert Benham Award for Community Service on February 23, 2016. The award recognizes judges and lawyers from the ten judicial districts across Georgia who have made outstanding contributions in the area of community service.

Chambers USA, America’s Leading Lawyers for Business: Health Care Law, 2014-2015
Chambers USA ranks the leading firms and lawyers in an extensive range of practice areas throughout America.

Martindale-Hubbell: AV Rated
The Martindale-Hubbell^® PEER REVIEW RATINGS™ are an objective indicator of a lawyer’s high ethical standards and professional ability, generated from evaluations of lawyers by other members of the bar and the judiciary in the United States and Canada.

Physician Contracts and Stark/Antikickback Statute Regulations
Presented at the AAPPR Annual Conference in Las Vegas, Nevada, on April 4-8, 2020.

The Rise of Foreign Nationals in the Healthcare Setting: Exploring Employment, Immigration & Medicare/Medicaid Laws, Rules and Requirements
Presented at the Georgia Hospital Association-Compliance Officers Roundtable on December 6, 2019.

Foreign National Physician Recruitment and Immigration
Presented at the SEPRA Annual Meeting in Atlanta, Georgia, on October 27-29, 2019.

The Rise of Foreign Nationals in the Healthcare Setting: Exploring Employment, Immigration, & Medicare/Medicaid Laws, Rules, and Requirements
Presented at the Georgia Hospital Association-Compliance Officer’s Retreat and Annual Meeting on September 4-6, 2019.

Refugees, Detainees, Asylees and More – Who’s Got the Power
Presented at the ASPR 2019 Annual Conference in Orlando, Florida, on August 26-28, 2019.

Physician Contracts – Stark and Anti-Kickback Regulations
Presented at the ASPR 2019 Annual Conference in Orlando, Florida, on April 8-10, 2019.

Federal False Claims Act and Qui Tam Relators
Presented for the Federal Bar Association, Southern District of Georgia Chapter, by Mills Fleming and the United States Attorney’s Office for the Southern District of Georgia on February 22, 2019.

Health Care Fraud and Abuse Enforcement – The Year in Review
Presented at the Georgia Hospital Association’s Compliance Officer’s Retreat in Greensboro, Georgia, on September 5-7, 2018. Mills’ lecture focused on the Stark Law and Anti-kickback Statute enforcement trends within the last two years, particularly in the 11th Circuit.

Travel Bans, Refugees and More – The Year in Immigration
Presented at the Georgia Hospital Association-Georgia Society for Healthcare Physician Services & Recruitment’s 2017 Annual Conference on July 23-25, 2018.

The Slippery Slope of Health Care Fraud Schemes between Hospitals and Physicians
Presented at the Georgia Hospital Association-Georgia Society for Healthcare Physician Services & Recruitment’s 2017 Annual Conference on July 23-25, 2018.

Physician Contracts – Stark and Anti-Kickback Regulations
Presented at the ASPR Annual Conference in Chicago, Illinois, on April 21-25, 2018.

Compliance Guidance Oversight for Health Care Governing Boards
Presented to a large health system’s senior management and board members on February 15, 2018.

Healthcare Supply Chain Contracts – What Every Health Care Materials Manager Needs to Know
Presented at the GSHMM 2017 Annual Conference on November 3, 2017.

Connecting the Dots: Measuring the Effectiveness of a Compliance Program
Presented at the 2017 Georgia Hospital Association-Compliance Officer’s Roundtable on September 7, 2017.

Stark, Anti-kickback Statute and False Claims Act Primer for Physician Recruiters
Presented at the Georgia Society for Healthcare Physician Services & Recruitment’s 2017 Annual Conference on August 16-18, 2017.

Visa Processing for Foreign National Physicians: The Trump Effect
Presented at the Georgia Society for Healthcare Physician Services & Recruitment’s 2017 Annual Conference on August 16-18, 2017.

What’s Next in Health Care? Challenges for Providers and Opportunities for Restructuring Professionals in an Ever-Changing Landscape
Mills Fleming presented this as an invited panelist for Healthcare Legal Matters at the American Bankruptcy Institute’s Annual Southeast Bankruptcy Conference in Hilton Head, South Carolina, on July 27-30, 2017.

Physician Contracts – Stark and Anti-Kickback Regulations
Presented at the ASPR Annual Conference in San Diego, California, on April 29-May 3, 2017.

The Changing Landscape of Immigration Law: A Panel Discussion of Recent Changes in Immigration Policy
Mills Fleming participated in this panel discussion at Georgia Southern University in Statesboro, Georgia, on April 4, 2017.

Visa Processing and the Conrad 30 Program for Foreign National Physicians
Presented to the Georgia Hospital Association’s in-house legal counsel group on November 4, 2016, in Atlanta, Georgia.

Visa Processing and the Conrad 30 Program for Foreign National Physicians
Co-presented by Mills Fleming and the Georgia Department of Community Health’s State Office of Rural Health at the Georgia Society for Healthcare Physician Services & Recruitment’s 2016 Annual Conference on July 22, 2016, at the Ritz-Carlton/Reynolds Plantation, Lake Oconee, Georgia.

Navigating the Bermuda Triangle of Stark, the Anti-kickback Statute and the False Claims Act
Presented at the Georgia Society for Healthcare Physician Services & Recruitment’s 2016 Annual Conference on July 22, 2016, at the Ritz-Carlton/Reynolds Plantation, Lake Oconee, Georgia.

Physician Contracts – Stark and Anti-Kickback Regulations
Presented at the 2016 ASPR Annual Conference in New Orleans, Louisiana, on May 15, 2016.

Immigration Law
Presented at the SEALA 2016 Annual Seminar on May 13, 2016.

Health Care, Immigration and Physicians
Presented at the Annual Meeting of the American College of Osteopathic Internists on May 7, 2016.

Hospital Contracts and Stark Law Implications
Presented at the Medical Group Management Association’s Annual Meeting on May 3, 2016.

How a Case Involving Unlawful Presence Became a Topic of Interest for the U.S. Supreme Court: U.S. v. Texas and the Balance of Power Between the Executive and Legislative Branches of Government
Presented at South University in Savannah, Georgia, on April 20, 2016.

Physician Contracts – Stark and Anti-Kickback Statute Regulations
Presented at the 2015 ASPR Annual Conference in Orlando, Florida, on May 16-20, 2015.

Fraud and Abuse Primer for Physician Recruiters – Anti-Kickback Statute/Stark/False Claims Act
Presented as an ASPR webinar on March 25, 2015.

Hospital-Physician Compensation Relationships: Community Need, Fair Market Value and Commercial Reasonableness Considerations
Presented to major health system’s board of directors in 2014.

Health Law Update
Presented at the Georgia Society of Healthcare Materials Management Annual Meeting in 2010.

Hospital and Health Care Compliance: New Rules We Need to Know
Presented to a health system’s board of directors in 2010.

Whistleblowers, Form 990 and Tax-Exempt Bond Compliance
Presented to major health system’s board of directors in 2009.

Employed Physician Fair Market Value Compensation Opinion Summary and Analysis
Presented to major health system’s board of directors in 2009.

Form 990, Tax Exempt Bonds and a Stark Reality: New Rules We Need to Know
Presented to major health system’s board of directors in 2008.

A Stark Reality: New Rules We Need to Know – Stark III and Beyond
Presented to the Atlanta Chapter of the Association of Healthcare Internal Auditors in Atlanta, Georgia, in 2008.

Health Law Update and Contract Boilerplates: Are You Getting What You Deserve or What You Negotiate?
Presented at the Georgia Society of Healthcare Materials Management Annual Meeting in 2008.

New Frontiers for Stark: Fair Market Value and Commercial Reasonableness for Physician Employees
Presented at the Georgia Academy of Healthcare Attorneys-Health Law Update and Annual Meeting in Atlanta, Georgia, in 2008.

Legal Update: Stark II-Phase III, Section 409A, ERISA Plan Fiduciaries and Other Current Topics for Healthcare Internal Auditors
Presented to the Atlanta Chapter of the Association of Healthcare Internal Auditors in Atlanta, Georgia, in 2008.

Fair Market Value for Physician Practice Acquisitions and Physician Employment: A View from the Rear View Mirror
Presented at the Georgia Academy of Healthcare Attorneys-Health Law Update and Annual Meeting in Atlanta, Georgia, in 2008.

Post-Issuance Compliance for Tax-Exempt Bonds
Presented to major health system’s board of directors in 2008.

Recent Stark Law Developments
Presented at the Physician’s Viewpoint Network’s Annual Meeting in 2007.

Form I-9 Verification and Compliance
Presented to major health system’s board of directors in 2007.

Immigration Law Update
Presented at the Savannah Bar Association’s Hot Topics Seminar in 2007.

Contract Boilerplates: Are You Getting What You Deserve or What You Negotiate?
Presented at the Georgia Hospital Association’s Society of Healthcare Materials Management Annual Meeting in 2007.

Nonprofit Hospital Reorganizations
Presented at a Georgia Hospital Association webinar in 2006.

Healthcare Price Transparency
Presented at the Georgia Society of Healthcare Materials Management Annual Meeting in 2006.

Immigration Consequences of Criminal Activity
Presented at the Savannah Bar Association’s Hot Topics Seminar in 2006.

Purchasing Rules for Healthcare Material Managers: Rebates, GPOs and Other Incentives
Presented at the Georgia Hospital Association’s Society for Healthcare Materials Management Annual Meeting in 2005.

The Future of Health Care
Mills Fleming participated in this panel discussion at the Georgia Association of Health Underwriters – Annual Convention on July 22-24, 2005.

Georgia Rules and Regulations for Corporate Governance
Presented at the Georgia Academy of Healthcare Attorneys-Health Law Update and Annual Meeting in Atlanta, Georgia, in 2004.

Fraud and Abuse Developments: Stark II, Phase II
Presented to major health system’s board of directors in 2004.

Immigration in a Post 9/11 World
Presented at the SEALA Conference and Annual Meeting in 2004.

Overview of U.S. Immigration Law
Presented to Global Shipping Engine Manufacturer in Annapolis, Maryland, in 2003.

Undocumented Aliens: Finding a Place to Stand After September 11
Presented at the ICJE Annual Seminar in St. Simons Island, Georgia, in 2002.

Nuts and Bolts of Immigration Law
Presented at the East Georgia College Foundation, Georgia Rural Economic Development Center in 2001.

Immigration Basics: What Every Health Care Provider Needs to Know
Presented at the Georgia Academy of Healthcare Attorneys 2001 Healthcare Law Update and Annual Meeting in Atlanta, Georgia, on May 4, 2001.

When Worlds Collide: Ethical Considerations in Law and Medicine – A Patient’s Right to Choose?
Presented at the Meadows Regional Medical Center’s Hot Topics in the Practice of Medicine Multispecialty Symposium in Vidalia, Georgia, on April 21, 2001.

Undocumented Alien Claims: Finding a Place to Stand
Presented at the ICLE Workers’ Compensation Judges Annual Seminar in Jekyll Island, Georgia, on April 2, 2001.

Physician Contracting: Knowing the Nuts and Bolts to Keep You from Getting Nailed
Presented to the University of Florida College of Medicine’s Department of Anesthesiology in Gainesville, Florida, on February 6, 2001.

Changing Relationships with Competitors: To Be or Not to Be Competitive
Presented to the Georgia Society of Healthcare Planning and Marketing in Atlanta, Georgia, on March 2, 1995.

Whose Right Is It Anyway: A Physician’s Guide to Georgia Law on Living Wills, Do Not Resuscitate Orders and Durable Power of Attorney for Health Care
Presented at the Memorial Health University Medical Center Research Day Competition in Savannah, Georgia, on May 5, 1993.