Community Based Care and Other Health Care Providers
Community based providers cover a range of social and medical services for people with chronic illnesses or physical or cognitive disabilities that are underfunded by the government and that do not fit neatly into non-cost based reimbursement formulas. Gjerset & Lorenz provides a wide range of transactional, operational, business and reimbursement advice to substance abuse, assisted living, mental health, home health, foster homes, physical therapy and long-term care providers. Over the past ten years, Gjerset & Lorenz attorneys have developed creative approaches to overcome the unique challenges, special responsibilities and specific risks associated with owning and operating theses types of facilities.

These providers are faced with operational, reimbursement, regulatory and private litigant issues that differ significantly from other health care providers. Our attorneys are uniquely qualified to address these issues due to the many years of experience we have representing clients in these industries. Gjerset & Lorenz has been most active on behalf of these clients in fending off governmental funding cuts and licensure revocation actions.

Our attorneys provide advice to these providers from reimbursement to licensing and work with our clients to respond to statements of deficiencies, develop plans of correction and defend against governmental administrative sanction actions.

Representative projects for these providers include:

• Successful defense of a state recoupment effort alleging overpayment of an aggregate $30 million due to the inclusion of alleged unallowable costs.
• General licensure and certification advice including development of policies and procedures required for compliance conditions of participation.
• Successful defense of over 100 license revocation, decertification and administrative penalty actions by state and federal regulatory agencies.
• Recoupment of over $20 million in withheld state funding.
• Consummating the divestiture and closure of over 50 home health agencies.
• Negotiating managed care contracts.
• Development of partnership, directorship, management, research and employment contracts.
• Successful defense of individual owners of cost based providers from personal liability for over $5 million in governmental overpayments due upon cost report reconciliation.