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Shauna L. Lorenz
Shauna Lorenz and Jim Gjerset founded the now national healthcare law firm of Gjerset & Lorenz, LLP in 1998. Ms. Lorenz’s legal practice focuses on advising healthcare providers in reimbursement, regulatory, legislative, and operational business matters. She also represents large hospital systems in numerous complex payment and contract disputes.
In the Reimbursement area, Shauna:
- Designed and operated numerous Medicaid supplemental reimbursement programs for hospitals under federal supplemental payments, including programs financed by intergovernmental transfers, certified public expenditures, and provider assessments.
- Assessed opportunities to enhance Medicaid payments to hospitals and physicians in collaboration with Medicaid managed care plans.
- Advised non-profit, investor-owned and public hospitals regarding economic incentives under 1115 Waiver.
- Assisted academic health science center in designing transformation projects and meeting 1115 Waiver requirements to access opportunities for incremental reimbursement.
- Designed aggregate cap demonstration models to assist Medicaid State Agency with Medicaid State Plan Amendment on behalf of hospital clients.
In the Legislative and Regulatory area, Shauna:
- Worked with State Medicaid Agencies to develop comprehensive strategies for transitioning Medicaid patients to managed care options without disrupting Medicaid supplemental reimbursement funds.
- Advised hospital clients and state hospital associations regarding the effects of legislative proposals that impact Medicaid reimbursement.
- Worked with coalitions of public, non-profit and investor-owned hospitals to develop legislative and regulatory strategies that maximize Medicaid reimbursement opportunities.
- Drafted regulatory rule language for hospital and physician clients related to implementation of 1115 Waiver.
In the Operations and Compliance area, Shauna:
- Created tax-exempt entity to employ physician groups to assist public hospital authority in collaboration with private hospitals.
- Assisted public hospital on supplemental payment compliance issues for employed physicians.
- Developed self-pay and charity care policy and procedures for national hospital system to comply with federal and various state legal requirements.
- Helped clients implement and audit compliance plans, including plans for fulfillment of charitable obligations and compliance with OMB-Circular requirements for government contracts.
- Developed operational policies and procedures addressing EMTALA, patient transfers, discounting, fraud and abuse, and reimbursement from managed care payors.
- Advised healthcare providers on patient admission and discharge requirements.
- Analyzed licensing and regulation of insurance companies, HMOs, third-party administrators, utilization review agents, and insurance agents.
In the Managed Care area, Shauna:
- Negotiated managed care contracts and payment terms, including prompt pay obligations for hospitals in several states.
- Handled numerous managed care contracting disputes resulting in more than $40 million in monetary damages plus improved prospective contract terms.
- University of Michigan, J.D., 1995
- Michigan State University, B.A. with Highest Honors, 1992
- Member, Administrative Law Section of the Austin Bar Association
- Member, Administrative Law and Health Law Sections of the State Bar of Texas
- Member, Administrative Law and Health Law Sections of the American Bar Association
- 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