Lore Brownson JD, BSN, CHC

Experience

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  Long Aldrige & Norman, LLP

  Apr 1998 - Jul 1999

  Associate, Healthcare Law
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  Kindred Healthcare

  Jan 1999 - Sept 2013

  Chief Counsel for contract rehabilitation therapy services division of Kindred Healthcare, Inc. (KND), RehabCare, with over 2000 healthcare clients providing services across the long-term care continuum. Managed complex internal investigations and investigations by federal and state governmental agencies. Advised on matters with the potential to implicate federal and state laws, to include the False Claims Act, anti-kickback laws, Stark, Elder Justice Act, and HIPAA. Advised on and kept division leadership and operators apprised of wide-ranging legal and compliance issues to detect, mitigate and resolve matters with the potential for legal ramifications and financial exposure. Provided targeted education and training on legal and compliance issues to division leadership and employees located nationwide. Advised operators on rehabilitation services arrangements to include the division’s rehab agency business development initiatives, federal and state licensure and certification requirements, and Medicare and other third-party payer reimbursement matters. Provided general commercial legal advice to include drafting, revising, and negotiating agreements. Notable Accomplishments: Key contributor in challenging post-acquisition integration to support compliance with federal and state regulations governing rehabilitation services delivery. Effectively prioritized and managed a high volume of complex legal and compliance matters in a fast-paced work environment. Adeptly managed outside counsel, based in numerous states, to ensure timely and cost-effective guidance on various legal matters. Show less Provided legal support to over 200 Nursing Center Division (NCD) skilled nursing centers, assisted living facilities, long-term acute care hospital sub-acute units, and the Peoplefirst Rehabilitation (PFR) division. Delivered legal support and advice on complex and time sensitive issues, such as withdrawal of life sustaining treatments, involuntary resident transfers and discharges, advance directives, inquiries from the Office for Civil Rights on matters of HIPAA privacy, and state nursing and therapist licensing board inquiries and investigations. Notable Accomplishments: Successfully averted a skilled nursing facility's decertification from the Medicare program through negotiations with a regional office of The Centers for Medicare and Medicaid Services (CMS) for authorization from CMS Baltimore for a fourth resurvey. Managed an unprecedented case involving efforts to close a KND owned skilled nursing facility, providing critical support in negotiating a 100% waiver of the $2.7 million sale penalty that was assessed subsequent to the State’s approval of the sale of the facility. Show less Collaborated with corporate compliance to investigate, mitigate and resolve matters with potential legal ramifications and financial exposure. Provided general commercial legal advice to include drafting, revising, and negotiating rehabilitation and other ancillary services agreements. Notable Accomplishments: Managed an Office of Inspector General (OIG) Finance Department Medicare Claims Audit involving a non-KND client. Claims denied resulted in exposure to extrapolated damages totaling $1.4+M. Greater than 95% of denied claims were successfully reversed on appeal, with PFR incurring zero indemnification expense. Negotiated a settlement agreement with a former PFR client that resulted in a lump sum payment of 100% of the outstanding balance owed, totaling $850k. Show less Provided counsel and guidance in the appropriate management of sensitive issues including involuntary resident transfers and discharges, withdrawal of life sustaining treatments, advance directives, healthcare guardianships and conservatorships, powers of attorney for healthcare and finances, medical record requests from residents, legal representatives, surrogates, family members, and state and federal agencies, and state licensing board inquiries and investigations involving licensed and certified clinicians. Notable Accomplishments: Produced a streamlined admission agreement that complied with federal laws and the laws of the states in which NCD operated, enabling admission coordinators to efficiently present the admission agreement to residents/families for timely execution. Delivered in-person training to large groups of multi-level NCD employees nationwide on the new admission process, materials and the state and federal laws governing the terms of the agreement. Show less Managed Medicare claims and appeals for the PFR division. Notable Accomplishments: Developed and implemented an electronic Medicare claims and denials tracking system that identified $1+M at risk for recoupment by Medicare, creating an efficient electronic tracking system to replace an onerous exclusively paper tracking process.Tracked and effectively managed Medicare claims under review and denied claims through the appeal process, resulting in more than 90% of Medicare denied claims being overturned. Show less

  • Vice President and Chief Counsel, RehabCare

    Jul 1999 - Sept 2013

  • Vice President, Nursing Center Division and Peoplefirst Rehabilitation Counsel

    Jan 2007 - Jan 2011

  • Senior Director, Operations Counsel

    Jan 2005 - Jan 2007

  • Director, Operations Counsel

    Jan 2001 - Jan 2005

  • National Director, Medicare Claims and Appeals

    Jan 1999 - Jan 2001
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  Brownson Legal and Compliance Consulting

  Mar 2014 - Oct 2014

  Legal and Compliance Consultant

  Expertise in providing counsel on wide-ranging legal and compliance matters involving federal and state laws and regulations that govern the provision of healthcare services across the post-acute care continuum. Advised on matters with the potential to implicate federal and state laws to avert or mitigate legal ramifications and financial exposure, to include without limitation, the False Claims Act, anti-kickback laws and HIPAA. Adept at effectively addressing inquiries from and investigations by federal and state governmental agencies, to include the Office of Inspector General, Office for Civil Rights, and state nursing and therapist licensing boards. Show less

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  New Perspective Senior Living

  Nov 2014 - now

  • Chief Clinical and Compliance Officer

    Jan 2023 - now

  • SVP, Quality Services and Chief Compliance Officer

    Nov 2014 - Mar 2023