Administrative and Commercial Litigation » Print This Page

Though our practice now focuses almost exclusively on regulatory and transactional work, Gjerset & Lorenz, LLP has a rich history in the fields of administrative and commercial litigation that informs our proactive philosophy today. We understand that, in order to best represent a healthcare provider, our advice must account for more than just the best strategy to recover damages, defend against an enforcement action or obtain an injunction.  Oftentimes, the right solution must also account for the continuing business relationship with the opposing party (e.g., Federal or state agency or third-party payor) or the long-term implications of the arguments necessary for success.  These considerations are especially important in the context of third-party payor disputes given the complex interrelationship between seemingly distinct payment programs. Our robust experience in healthcare and successful track record in dispute resolution empowers us to serve as subject matter consultants for our clients, supporting their litigation counsel to develop nuanced and highly technical legal arguments.

We use the breadth of our knowledge regarding healthcare reimbursement and provider operations to condense complex reimbursement disputes into a simple explanation and present them in an understandable format. 

We are proud to share our historical success in administrative and commercial litigation that serve as the foundation of our current client service model:

Administrative Litigation

• Successfully defending a state recoupment effort alleging overpayment of an aggregate $30 million from over 25 providers due to the inclusion of alleged unallowable costs;
• Representing investor-owned, non-profit and public hospitals in an investigation and deferral action of the Centers for Medicare and Medicaid Services related to Medicaid supplemental payments.
• Winning the appeal of a $5.5 million recoupment action initiated against several hospitals related to their receipt of funding under the Medicaid Disproportionate Share Hospital program;
• Providing advice to broad based hospital industry coalitions during an Office of Inspector General audit of $800 million in Medicaid supplemental payments.
• Representing a large non-profit hospital in a Medicaid supplemental reimbursement investigation, reducing its potential repayment liability by more than $250 million;
• Handling the administrative appeals and court injunction proceedings for 15 hospitals appealing a Medicaid rate setting methodology that violated agency rules.

Commercial Litigation

• A $16 million global resolution of a dispute over the contractual provisions governing high cost pass through reimbursement.
• A $10 million settlement upon completion of the provider’s case in chief in a case where the insurer had denied hundreds of claims arguing the hospital was required to bundle items and where the insurer had refused to pay for claims delegated to a defunct Independent Practice Association.
• A $16 million collection regarding hundreds of claims from 14 hospitals, from an insurer that refused to pay for high cost pass through items.