Sherri Alexander has spent 30 years at the crossroads of medicine and law — in a career that has been both challenging and rewarding for developing practical healthcare litigation strategies.
As chair of Polsinelli’s Health Care Litigation practice, Alexander oversees some 70 attorneys nationwide, handling disputes that range from insurance reimbursement and government investigations to physician credentialing and peer review.
“We’ve really grown across the country,” she said, noting that Polsinelli added 27 healthcare litigators in the past two years, primarily to meet rising demand for managed care and government reimbursement work.
She said hospitals and other healthcare providers have relied on her firm to become “more aggressive” in recovering money for medical services. That’s because reimbursement rates have declined as private and government payors have started using AI tools and algorithms to deny or reduce claims.
“They are using it to deny claims when, under the law, you are really supposed to be using clinicians to deny the claims,” she said. “We are becoming much more aggressive in determining different ways to challenge either the way the payors are using AI or how the government agencies are using AI.”
She said her team has been asking payors and the federal government to explain how her clients’ medical claims have been denied.
“There is just a point at which they have to be more aggressive and file the arbitrations or file lawsuits to recoup the money in those situations.”
“They are having a very difficult time doing it because they are supposed to be based on clinical decision making,” she added. “But they are not doctors. It is just an AI tool.”
Her team’s four focus areas include managed care disputes, government reimbursement cases, False Claims Act investigations, and hospital peer review matters — the latter being Alexander’s personal specialty.
Her legal cases often unfold inside hospital conference rooms rather than courtrooms. She advises medical executive committees and other committees during sensitive hearings on whether physicians should retain their hospital privileges, which frequently involve allegations of impaired performance, professional misconduct, or declining cognitive ability.
She has helped mediate over 240 disputes between physicians and hospitals — mainly because Texas remains the only state that allows doctors to demand mediation before a hospital can revoke their privileges. The 1998 law, she said, has been “very effective” at resolving conflicts early and preventing the costly, time-consuming “mini-trial” hearings that could otherwise follow.
“Mediation gives both sides a fair way to resolve issues before it gets that far,” she said. “… Sometimes, ultimately, there is a decision to terminate the privileges of the doctor, and there is a mini-trial at the hospital where evidence is taken. And this is something that is required by federal law.”
Alexander said she’s handled about 70 “mini-trial” hearings, which she said are critical for protecting both patient safety and physician rights.
She has also helped hospitals adapt to new reporting laws passed in Texas after the notorious case of neurosurgeon Dr. Christopher Duntsch, whose botched surgeries prompted national scrutiny of medical oversight.
Under the revised Texas law, hospitals are now required to report physician suspensions to the Texas Medical Board after 14 days instead of 30 days.
Initially, medical executive committees were “reluctant to report a fellow doctor in half the time that they normally would,” she said.
However, reporting has improved. “We just had to help them get over that and understand the Medical Board really needed to be able to start looking,” she said.
After a physician suspension report has been filed, the Texas Medical Board opens an investigation and, after 14 days, subpoenas hospital peer review records. “I think that is fair to the doctor, and part of the give and take that needs to happen,” she said.
Alexander didn’t start out in healthcare. After graduating from SMU law school in 1983, she began her career as a commercial litigator — until she agreed to take on a hospital hearing under the newly enacted Health Care Quality Improvement Act of 1986. The law granted qualified immunity to those involved in peer review, protecting them from lawsuits filed by disciplined physicians.
“I thought it would be good practice,” Alexander recalled. “More experience examining and cross-examining witnesses.”
But that single hearing changed everything. “That was a huge turning point for me because I really loved it. I loved the medical nature of it,” she said. “And so, I slowly gravitated into that area.”
Another key point in her career came when she received a frantic phone call.
“One hospital called me on Christmas Eve and said: ‘We can’t find our attorney; will you handle this suspension?”’
She took the case.
“And that now has grown into my largest client,” she said. “I think we have about 45 hospitals.”
Alexander says her firm’s rapid growth reflected a broader trend: hospitals must litigate strategically. “We understand clients don’t always want to rush into court because litigation is expensive,” she said. “But there’s a point where they have to be aggressive to recover what they’re owed.”
Her team blends seasoned shareholders and associates to keep client costs manageable. “We try to be very careful as we are charging clients, that we have the best people on those matters, so it is cost-effective for the clients when they are trying to make those decisions.”
“We understand that clients do not necessarily want to rush into litigation,” she added. “It is very expensive. And so, we try very hard — and we know these areas of law well enough — that we can really sit down with these clients and talk through strategies with them and give them options on the best ways to go and let them think through it.”
While her healthcare litigation team challenges insurers’ use of AI, they have also begun experimenting with AI internally — using it to organize case documents and summarize evidence.
“The firm is taking, really from the top down, a position that AI is here to stay,” she said. “…We are going to use it in our cases so long as the clients approve it.”
Polsinelli’s collaborative structure has allowed attorneys to draw expertise from across its national offices, she said.
“We put the best people on these projects, really no matter where they are located,” she said. “…It has been great for us because we have so much depth in all of these areas.”
With more than two dozen offices, including Dallas, Fort Worth and Houston, Alexander said Polsinelli can also pair local counsel with attorneys who possess expertise in specific areas of law.
“A huge benefit is that with these local attorneys in all the different offices, they know the rules,” she said. “They know the judges. They can really advise the client on the local aspects of how things may be judged, even if maybe their deepest expertise is really in another office, with them collaborating.”
Alexander credits her success to strong mentors and a culture of inclusion. She named former Dallas attorney E. Russell Nunnally Jr. as pivotal to her development. “He was a phenomenal mentor — supportive of women attorneys, and a great litigator,” she said.
When recruiting, she said Polsinelli wants to ensure the new attorneys fit and bond well with other members of the firm.
We “want to make sure they get to know us,” she said. “And that they think it is the right fit for them because we have a great culture here.”
At Polsinelli, she has helped shape a structured integration program for new attorneys, pairing each with a sponsoring shareholder and arranging cross-office introductions.
“We assign every (incoming) shareholder a sponsoring shareholder that is really there to help them, to integrate them, and onboard them,” she said. “And I think it has been so effective for us. This is something we do throughout the law firm.”
Outside the office, Alexander’s interests are worldly and creative. She enjoys international travel — including upcoming trips to Italy and Malta — and sometimes travels with patrons from the Kimbell Art Museum in Fort Worth. She also loves musicals at the State Fair of Texas and dining at Al Biernat’s, one of her favorite Dallas restaurants.
She also likes the latest music. “I feel like if you get caught listening to songs in the past, you are getting old,” she said. “I would prefer to listen to current music, so I know what’s going on.”
Alexander has continued to find healthcare law engaging. “You are never going to get bored in healthcare litigation because the government is constantly changing the laws,” she said. “And we have to stay on top of the law. And that makes it very interesting.”
In advising young attorneys, she tells them to find a niche.
“I supervise quite a few here,” she said. “What I’ve told them is pick an area that you are enthusiastic with. You just need to find the niche you love, stay on top of it, and it’s great. And you end up making the clients happy, and they like you, and your business continues to expand.”