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Rachel O. Gilbert
Rachel Gilbert is a partner with Gjerset & Lorenz, LLP. Ms. Gilbert specializes in counseling hospitals on compliance with federal and state regulations governing Medicaid participation and reimbursement. In addition, Ms. Gilbert has extensive experience advising both public and private hospital clients on transactional matters, financial strategies, Medicaid-related litigation, and policy initiatives related to Medicaid reimbursement.
Ms. Gilbert has:
- Developed and operated community-based and statewide programs designed to ensure sufficient availability of state and local financing for hospitals’ supplemental Medicaid payments.
- Assisted in the development, implementation, and operation of new Medicaid reimbursement programs in Texas, Nevada, South Carolina, and New Mexico, including Uncompensated Care (UC) programs, Delivery System Reform Incentive Payment (DSRIP) programs, managed care rate increase programs, and Upper Payment Limit (UPL) programs.
- Represented numerous hospitals in Medicaid Disproportionate Share Hospital (DSH) and Uncompensated Care (UC) programs in several states, managing the hospitals’ qualification, reporting requirements, funding entitlement, and audits.
- Prepared complex financial modeling of various federal and state laws or policies impacting Medicaid reimbursement, such as the Texas Health and Human Services’ decision to withhold $900 million in Disproportionate Share Hospital (DSH) and Uncompensated Care (UC) funds pending resolution of the Texas Children’s Hospital litigation, and assisted hospitals in developing corresponding advocacy and government relations strategies.
- Created comprehensive financial projections forecasting the impact of interrelated Medicaid supplemental payment programs on hospitals’ entitlements and reimbursements, enabling hospitals to develop informed business strategies and financial planning. The reimbursement programs Ms. Gilbert has significant experience analyzing include the Disproportionate Share Hospital (DSH) program, the Upper Payment Limit (UPL) program, Uncompensated Care programs, and various programs partnering hospitals and Medicaid managed care organizations.
- Represented hospitals in Medicaid-related litigation and administrative appeals, including issues related to financing Medicaid payments, Medicaid enrollment, Medicaid entitlement amounts, Medicaid managed care reimbursement, hospital licensure, and trauma-designation.
- Structured, negotiated, and drafted numerous lease agreements, professional services agreements, management agreements, joint ventures, letters of intent, and memoranda of understanding, as well performed due diligence for numerous hospital transactions.
- Negotiated with Medicaid managed care organizations to develop and implement statewide rate increases for hospitals.
- Assisted hospitals in structuring and operating non-profit organizations in several states, designed to increase and improve the availability of indigent care services in their local communities.
- Advised clients regarding Stark Law, Medicare cost-reporting principles, federal healthcare-related tax laws, and federal and state tax-exemption laws.
Prior to joining Gjerset & Lorenz, LLP, Ms. Gilbert worked as a healthcare attorney in North Carolina and assisted in litigating two federal class action lawsuits on behalf of Medicaid beneficiaries before the United States District Court for the Eastern District of North Carolina and the 4thCircuit Court of Appeals.
- University of Edinburgh School of Law, LLM in International Law, with Distinction, 2011
- Maclagan Prize Recipient, awarded for highest marks in Medical Jurisprudence
- University of Texas School of Law, J.D., 2011
- Executive Editor, Texas Journal of Women and the Law
- National Quarterfinalist, 2010 American Association for Justice Student Trial Advocacy Competition
- North Carolina State University, B.A., summa cum laude, 2006
- Phi Beta Kappa
Professional or Trade Affiliations
- Member, American Bar Association
- Member, Austin Young Lawyer’s Association