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Mr. Ramsey is a partner with Gjerset & Lorenz LLP. Mr. Ramsey has extensive experience representing public, non-profit, and investor-owned hospitals on a broad range of reimbursement issues. He has represented numerous hospitals on issues relating to Medicaid and Medicare compliance, rate analysis, and reimbursement appeal matters. In addition to his government reimbursement practice, Mr. Ramsey represents providers in disputes relating to payment from managed care, ERISA, FEHBA, and workers' compensation payors, and has successfully obtained arbitration awards, administrative decisions, judgments, and settlements exceeding $25 million.
Representative Experience
Mr. Ramsey's experience on government reimbursement issues includes:
Advising numerous hospitals on Medicaid Disproportionate Share Hospital (DSH) funding qualifications and funding compliance reporting and appeals
Handled over 150 Medicaid DSH appeals to ensure state Medicaid agencies accurately include hospital utilization data in making Medicaid DSH awards
Development of supplemental Medicaid programs for over 20 hospitals in 5 communities to obtain federal matching funds for services provided to Medicaid, uninsured, and indigent patients
Successfully resolved Medicare cost report adjustment challenges related to the classification of observation days that resulted in the hospital's avoidance of a $3.5 million audit adjustment
Represented hospitals in Pennsylvania, Texas and Florida in appeals related to Medicaid DSH hospital specific limits before state Medicaid agencies and the Centers for Medicare and Medicaid Services, resulting in over $100 million in reimbursement for the firm's clients
Advised numerous hospitals regarding the government program reimbursement impact of realigning multiple hospital licenses and provider-based status
Mr. Ramsey's litigation experience includes:
Recovering $4.5 million of accounts receivables following a full judgment against a large managed care company that underpaid hundreds of claims. Mr. Ramsey served as trial counsel
Successfully obtained $4.0 million arbitration award and judgment against a large IPA for underpayment of catastrophic stop loss claims
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
Obtaining a $1.3 million settlement with a managed care company that had attempted to pay emergency medical triage rates rather than room rates for certain patients. Mr. Ramsey served as trial counsel
Successfully challenging a worker's compensation carrier's refusal to pay for catastrophic stop loss claims, obtaining over $700,000 for a single stop loss claim
Obtaining an injunction against the enforcement of a state rule relating to Medicaid inpatient rate-setting methodology
Recovering $400,000 in arbitration from a managed care company that had refused to pay for trauma services at an enhanced reimbursement rate pursuant to the parties' agreement
Education and Professional Qualifications
University of Texas School of Law, J.D., with honors, 1996
Associate Editor of The Review of Litigation
Dean's Achievement Award for Academic Excellence in Employment Discrimination
University of North Texas, B.A., 1992
Licensed to practice in Texas and Tennessee, as well as the United States District Courts for the South and West Districts of Texas, and the Middle District of Tennessee.
Speeches
HMO Managed Care Law: Health Care Arbitration in Texas - State Bar of Texas - November 7-8, 2002
Professional Affiliations
Member: Austin Bar Association, the American Bar Association, and the Austin Young Lawyers Association
Professional Background
Prior to joining Gjerset & Lorenz, Mr. Ramsey served as a law clerk for the Honorable Harry Lee Hudspeth, Chief Judge for the United States District Court for the Western District of Texas, and later as an associate attorney with law firms with national commercial practices.
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