Kristen L. Gentry, Partner

Biography

Kristen Gentry is a partner in the firm’s Health Law Practice Group, who focuses her practice in the area of Medicaid and Medicare program reimbursement, providing specialized legal and consulting services to all providers, state agencies, lenders, and contractors. Kristen has a vast array and depth of experience in all areas related to Medicaid and Medicare reimbursement, including the following representative experience:

  • design and implementation of, and or general representation of entities participating in, Medicaid Supplemental Payment (upper payment limit [UPL]) programs, Medicaid disproportionate share (DSH) programs, and Medicaid administrative claiming (MAC) programs in the States of Indiana, Illinois, Idaho, Michigan, Utah and Wyoming (see below for more);
  • representation of providers in front of State and Federal agencies, and their third party contractors (included managed care entities), state professional licensing and facility licensing boards, state Medicaid agencies (and managed care contractors), Medicaid Fraud Control Units (MFCU), state attorney general offices, the Centers for Medicare and Medicaid Services (CMS) and their Medicare Administrative Contractors (MACs), the Provider Reimbursement Review Board (PRRB), the Departmental Appeals Board (DAB);
  • representation of manufacturers in front of State and Federal agencies, including Pharmacy Boards, Medicare contractors, the Healthcare Common Procedure Coding System (HCPCS), and American Medical Association (AMA), CPT Code Editorial Panel;
  • analysis and evaluation of complex business relationships of providers for purposes of determining compliance under the various state and federal fraud and abuse laws, including the False Claims Act, Anti-Kickback Statute, Physician Self-Referral Law (Stark), Exclusion Authorities and Civil Monetary Penalties Law, and assisting providers with obtaining favorable Office of Inspector General opinions;
  • experience in 340B pricing for manufacturers, covered entities, and contractors; and
  • general health care representation of healthcare providers and their contractors, including physician groups, hospitals, dentists, dental clinics, ambulatory surgery centers, DME and drug manufacturers, pharmacies, managed care plans, third party administrators, pharmacy benefit managers, etc.

Additional information concerning Kristen's experience with Medicaid Supplemental Payment Programs:

Medicaid Supplemental Payment Programs. Kristen is known throughout the country for her experience in the very specialized area of Medicaid supplemental payment (also known as Medicaid upper payment limit [UPL]) programs. She has worked in a number of states, including Indiana, Illinois, Michigan, Texas, Utah, Oklahoma, Wyoming, Montana and Idaho, having worked with providers and State Medicaid agencies to create and implement these programs. Kristen has worked with a variety of health care provider-types in the creation and implementation of these programs including hospitals, physicians, nursing facilities, dental clinics, and ambulance services. With respect to nursing facility Medicaid supplemental payment programs, Kristen has worked with county and city hospitals and managers of the facilities and has advised lenders who work with the hospitals and managers. She is one of, if not the most, knowledgeable and experienced individuals in the country in this area.

Representative Medicaid Supplemental Payment Program experience includes:

  • the Indiana, Utah, and, most recently, Wyoming Medicaid non-state governmental nursing facility programs;
  • the Michigan Community Dental Clinics Medicaid non-state governmental dental clinic program;
  • the Indiana and Michigan Medicaid physician supplemental payment programs;
  • the Indiana hospital inpatient and outpatient hospital supplemental payment programs; and
  • the Indiana Medicaid ambulance supplemental payment program.

Legal Services

Education and Honors

  • Indiana University – Robert H. McKinney School of Law (J.D., 2002)
  • Indiana University (B.S., with distinction, 1998)

Bar Admissions

  • Indiana

Court Admissions

  • U.S. District Court, Northern District of Indiana
  • U.S. District Court, Southern District of Indiana

Professional and Civic Activities

  • American Bar Association (Member)
  • American Health Lawyers Association (Member)
  • Indianapolis Bar Association (Member)
  • Executive Women in Health Care (Vice President of the Board)
  • Indiana Benefits Conference (Member)
  • Executive Women in Healthcare (Ex officious President and Board Member)
  • American Heart Association, Go Red for Women (Executive Leadership Team)

Professional Recognition

  • Selected for inclusion in the Indiana Super Lawyers®–Rising Stars 2013-2016 Editions