In 1998, Shauna Lorenz and Jim Gjerset formed the now national health care law firm of Gjerset & Lorenz, LLP in Austin, Texas. Ms. Lorenz’s practice focuses on advising health care providers on litigation, regulatory, operational and general business matters. Ms. Lorenz has extensive experience representing health care providers in complex contract disputes with governmental and non-governmental payors.

Representative Experience

Ms. Lorenz’s experience assisting health care providers with regulatory, transactional and operational issues includes:

• Development of numerous compliance plans related to fulfillment of charitable obligations and compliance with OMB-Circular requirements for government contracts. Ms Lorenz has assisted clients in implementing and auditing those plans.
• Development of operational policies and procedures related to EMTALA, patient transfers, discounting, fraud and abuse and reimbursement from managed care payors
• Advising health care providers regarding patient admission and discharge requirements
• Negotiation of managed care contracts for hospitals
• Advising on the licensure and regulation of insurance companies, HMOs, third-party administrators, utilization review agents, and insurance agents

Ms. Lorenz has litigated numerous complex payment and contract disputes on behalf of health care providers. Results obtained include:

• Collecting over $16 million, in payment of hundreds of claims from 14 hospitals, from an insurer that refused to pay for high cost pass through items
• Recovering $5.5 million of accounts receivables following a full judgment against a large managed care company that underpaid hundreds of claims
• $10 million settlement upon completion of the claimant’s case in chief. The managed care company had denied hundreds of claims arguing it was entitled to bundle services, resulting in underpaid stop loss claims and prompt payment penalties.
• $4 million full recoupment of underpaid claims from a managed care company that argued that its downstream risk bearing IPAs were responsible for the claims.
• $1.8 million payment in a successful counter claim against a managed care company that had sued our client for breach of contract alleging $2.5 million in damages because the hospital had increased its charges.
• $600,000 in a settlement with a managed care company over a single claim. The payor argued that the member was not eligible for the services he had received.

Education and Professional Qualifications

• University of Michigan, J.D., 1995
• Michigan State University, B.A., with Highest Honors, 1992
  
  
• Licensed to practice in Texas

Speeches

• Managed Care Disputes in Texas: A Retrospective, Concurrent and Prospective Approach to Pursuing Accounts Receivable – Managed Care Presentation at the October Health Law Meeting for the Dallas Bar Association – October 15, 2003
• HMO Managed Care Law: Health Care Arbitration in Texas - State Bar of Texas November 7-8, 2002

Activities and Professional Affiliations
Member: Administrative Law Section of the Austin Bar Association; the Administrative Law and Health Law Sections of the State Bar of Texas; the Administrative Law and Health Law Sections of the American Bar Association, and the Texas Young Lawyers Association.

Professional Background
Prior to forming Gjerset & Lorenz in 1998, Ms. Lorenz was a member of the Health Care and the Regulatory Industry Group at Haynes and Boone, L.L.P.