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Managed Care Liability Consultants

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Expert Witness in Hospice and Palliative Care
1058 7th Street
Santa Monica CA 90403
USA
phone: 661-916-3015
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Douglas Aberg Hospice Palliative Care Expert PhotoDouglas Aberg, RN BSN PHN CHPN, has 23 consecutive years of experience in Hospice and Palliative Care, combining eight years in the field and 15 years in Hospice Management, Administration, Operations, and Consultation.

Mr. Aberg currently has the responsibility of assuring consistent compliance and survey readiness for multiple hospice programs concurrently. He is accountable for the planning, implementation, direction, and overall management of hospice programs within the guidelines of Title 22, Medicare, JCAHO regulations, and applicable laws.

Mr. Aberg is also directly responsible for the creation and implementation of an overall Quality Assurance and Performance Improvement program. He has directed and participated in the hiring, orientation, on-going training, retention and supervision of appropriate and qualified staff, assumed and carries out the organizations purposes in a manner consistent with the goals, objectives and established policies.

Consulting Services - Mr. Aberg serves as a Consultant to Hospice and / or Palliative Care organizations who are newly starting and need assistance setting up the program, having financial issues (Pharmacy, DME, Medical Supplies, Overtime,) need support with Quality Assurance programs, need assistance ensuring state and/or federal compliance, help with marketing plans, review policies and procedures, and support in a variety of other areas.

Litigation Support Services - Douglas Aberg is also an Expert Witness in Hospice and Palliative Care. In this role, he reviews cases for law firms, insurance companies, and state and federal agencies that have claims requiring such services. Mr. Aberg is available to assist both plaintiff and defense attorneys.

Areas of Expertise:
  • Quality of Life
  • End of Life
  • Medications at End of Life
  • Hospice Nursing
  • Medicare Hospice Benefits
  • Assisted Suicide
  • The Rule of "Double Effect"
  • Terminally Ill Patients
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    Acute Care Consulting
    Georgia J. Persky, RN, MBA, PhD, CLNC
    Harrison New York USA
    phone: 914-552-2277
    fax: 914-921-6467
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    Georgia Persky Legal Nurse Consultant Expert PhotoGeorgia J. Persky RN, MBA, PhD, CLNC, is a seasoned nurse with over 40 years of broad Clinical Nursing experience and 25 years of Senior Leadership in Healthcare Organizations. She has expertise in the micro issues in direct patient care and the broad Management, Quality, and State, Federal, and Joint Commission regulatory issues in hospitals.

    Dr. Persky provides private consulting for entrepreneurs and hospitals that want to improve patient care quality and satisfaction. A national speaker and author, her services are in demand for engagements on healthcare issues

    Litigation Consulting Support - As a Certified Legal Nurse Consultant and Quality Reviewer, Dr. Persky has investigated hundreds of Malpractice and Injury cases as a quality reviewer and can assist in legal case review with chronologies, timelines, and evidence based reports. Dr. Persky's services are available to attorneys for plaintiff and defense seeking an expert in nursing and patient care with a strong understanding of how hospitals work.

    Facility Consulting Services:
    • Provide hospital and nursing leadership and support in turnaround or acute regulatory situations
    • Assess, plan, implement and evaluate Patient Care Services structure, processes and patient satisfaction initiatives
    • Mentor nursing leadership team or screen and recruit new leadership
    • Recommend strategies and tactics to improve efficiency or effectiveness in nursing and hospital operations
    • Assess Perioperative Services and improve volume and patient flow
    • Provide focused plan and implementation to address regulatory and accreditation issues and prepare leaders and staff for regulatory visits
    • Develop Nursing, Operational and Strategic plan for handoff to new leadership team
    Background Experience - Dr. Persky served as Vice-President of Nursing and Patient Care Services for New York Presbyterian Hospital at Columbia University Medical Center. For nine years, she was responsible for Risk and Quality Management and Patient Satisfaction for a 750 bed academic hospital. She directed a $200 million budget with 33 patient services units and Care Management, Respiratory Therapy, Social Work and Admitting Departments with 9 direct reports and 2,000 patient services FTEs.

    View Dr. Persky's Expert Witness Profile.
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    Paul M. Adler, DO, FACEP, MBA
    PO Box 6743
    Ventura CA 93006
    USA
    phone: 917-974-8073
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    Paul M. Adler, DO, FACEP, MBA, Medical Director for the Ventura County, California, Department of Corrections, has worked in Correctional / Jail/ Prison Medicine since 1995. He has overseen the care of inmates in Jails in California and New York, as well as Prison inmates who have been transferred to county facilities to serve their terms for years in county jails in California. He has also overseen Correctional health car in locked units in Hospitals .

    Dr. Adler is the President-Elect of The American Correctional Health Services Association of California / Nevada, which represents all clinicians and administrators in Jails/Prisons in California and Nevada. He previously oversaw a County Hospital, County Nursing Home and ran a County Health Department and oversaw Correctional healthcare for the Westchester, New York Jail.

    Litigation Support - Dr. Adler has defended Jails and Prisons in Southern California, Idaho, Texas, North Carolina, New York, Pennsylvania, etc. He has been involved in Plaintiff litigation in many states including against Rikers Island, NY and Cook County Jail.

    Dr. Adler still works as a full-time practicing physician and has helped attorneys and insurance companies in Emergency Medicine, Nursing Home Medicine, Public Health and Hospital Administration since 1985. Dr. Adler is available to review and consult on clinical Correctional/Jail/Prison cases for attorneys for both Plaintiff and Defense.

    Services:
    • Screen Cases for Merit
    • Review, Analyze and interpret Medical Records
    • Provide Basic or Comprehensive Written Reports
    • Interpret Standards of Care, Deviation and Adherences as they Relate to Correctional Health Care
    • Develop Chronological Time Lines
    • Policy and Procedure Development
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    Dr. John E. Schneider, PhD
    CEO & Founder
    26 Washington Street
    Floor 3
    Morristown NJ 07960
    USA
    phone: 862-260-9191 or (Cell) 319-331-2122
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    John Schneider John Schneider Health Care Economist Expert WitnessDr. John E. Schneider, PhD, CEO and Founder of Avalon Health Economics, is a Health Care Economist with over 25 years of experience. Dr. Schneider's expertise includes the Analysis of Medical Care Costs, Health Insurance and Managed Care, Regulation, Hospital Competition, Specialty Hospitals, Physician Ownership, Outcomes Research, Technology Assessment, Process Change, and Insurer / Provider Contracting. He serves as a Consultant to managed care organizations, state health departments, trade associations, medical device manufacturers, large pharmaceutical companies, and others.

    Dr. Schneider is an adjunct faculty in the Department of Economics at Drew University and Faculty Affiliate of the Petris Center on Health Care Markets at the University of California Berkeley. His previous positions include Senior Director at Oxford Outcomes, Ltd., Principal and Senior Health Economist of Health Economics Consulting Group, LLC (which merged with Oxford Outcomes in late 2009), and Director of Research at the California Association of Health Plans.

    Dr. Schneider’s research has been published in Health Affairs, Inquiry, Health Services Research, Medical Care Research and Review, International Journal of Health Care Financing and Economics, Review of Industrial Organization, International Journal of Technology Assessment in Health Care, Prevention Science, and Health Care Financing Review. He is often called upon for speaking engagements in his field of expertise. Dr. Schneider is also co-author of the book The Business of Health - The Role of Competition, Markets, and Regulation(AEI Press, 2006), in which he examines the influence of market competition and government regulation on hospitals, health insurance, managed care plans, and prescription drug advertising.

    View Expert Witness Profile.
    Robert Ohsfeldt, John Schneider
    The Business of Health examines the influence of market competition and government regulation on hospitals, health insurance, managed care plans, and prescription drug advertising. Reformers must determine which components of the system are suitable for market competition and which would benefit from more direct government control.
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    Aazaz Haq, MD
    Geriatric Psychiatry Expert
    640 W. California Ave., Suite 210
    Sunnyvale CA 94087
    USA
    phone: 408-663-1429
    fax: 408-769-6001
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    Aazaz Haq Geriatric Psychiatry Expert PhotoAazaz Haq, MD, is the founder and CEO of Bay Forensic Geropsychiatry, a consulting firm and educational resource center for Geriatric Psychiatry. He has subspecialty training in geriatric psychiatry and is certified by the American Board of Psychiatry and Neurology in both geriatric psychiatry and adult psychiatry.

    A practicing geriatric psychiatrist, Dr. Haq has expertise in all aspects of mental health issues pertaining to the elderly, particularly matters relating to dementia, cognitive impairment, impaired capacity, and vulnerability to undue influence.

    Dr. Haq is currently a full-time attending inpatient geriatric psychiatrist at the VA Palo Alto Hospital and an affiliated clinical Professor of Psychiatry and Behavioral Sciences at Stanford University, where he provides direct clinical mentorship and supervision to medical students, psychiatry residents, geriatric psychiatry fellows, and geriatric medicine fellows.

    Litigation Support - Dr. Haq provides expert psychiatric evaluations for medico-legal matters pertaining to the impact of mental and neurological illnesses on capacity and competency in the elderly. His services are available to attorneys representing plaintiff and defendant and include medical record review, written reports, deposition, and trial testimony as needed.

    Forensic Geropsychiatry Areas of Expertise:
    • Neuropsychiatry
    • Testamentary Capacity
    • Financial Capacity
    • Elder Abuse
    • Marital Capacity
    • Decision-making Capacity
    • Memory Loss
    • Undue Influence
    • Trusts and Estates
    • Conservatorships
  • Dementia
  • Mood Disorder
  • Psychotic Illnesses (Schizophrenia)
  • Delirium
  • Pharmacology
  • Anxiety Disorders (PTSD, OCD)
  • Neuromodulation Modalities
  • Effects of Medical and Neurological Conditions
  • Substance Abuse
  • Nursing Home Care
  • 9/12/2017 · Psychiatry
    Mr. B was a 75-year-old man who had made a will in 1995 naming his two sons as equal beneficiaries of his estate after his death. In 2004, he married Ms. M. On August 11, 2008, he was diagnosed with brain cancer, for the treatment of which he was hospitalized. On September 3, 2008, he signed a new will that Ms. M had procured for him, naming her the sole beneficiary of his estate after his death, to be subsequently given to his sons after the event of her death. Mr. B passed away on September 29, 2008. His sons subsequently sued Ms. M, alleging that Mr. B did not have testamentary capacity when he signed his new will. His attorney consulted me to review his medical records to assess Mr. B's mental state, testamentary capacity, and vulnerability to undue influence.

    8/22/2017 · Psychiatry
    Facts of the Case: Ms. P was a 91-year-old, widowed, Caucasian woman with a history of Parkinson's disease who was diagnosed with metastatic colon cancer after she was found down in her bedroom, where she had fallen and broken her arm. It was decided by her physicians that it was best to not pursue chemotherapy, radiation, or surgery. A colostomy bag was placed, and Ms. P was placed on home-based hospice care, with an emphasis on comfort care measures.

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    Yolanda Anderson, RN, BSN, CEN, CLNC
    Principal
    12081 W. Alameda Pkwy
    Suite 251
    Lakewood CO 80228
    USA
    phone: 720-308-7880
    fax: 303-988-3236
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    Yolanda Anderson, RN, BSN, CEN, CLNC is a Registered Nurse and has been working in the Emergency Department for more than 25 years. She began work in the Emergency Department of Los Angeles County, USC Medical Center, a level I Trauma Center. She then worked in the Emergency Department at Saint Anthony Hospital Central in Denver, Colorado, a level I Trauma Center where she helped initiate the Hyperbaric Medicine program. For 15 years, she was employed as a staff RN, Charge RN and Assistant Nurse Manager in the Emergency Department at Littleton Adventist Hospital - Littleton, Colorado, a level II Trauma Center. There, she helped with the expansion and reconstruction of the current Emergency Department facility.

    A Certified Legal Nurse Consultant, Ms. Anderson is knowledgeable about all aspects of Hospital Care and Standards of Care for Physicians, Nurses and Ancillary Personnel. Her consulting services include:
    • Hospitals, Clinics, and Offices - Consult and organize for the development and expansion of a new facilities or offices and related care patterns
    • Personal - Consult with family members to organize health care history, needs, and medications and to help understand healthcare information and interpretation
    • Teaching - Emergency Nurse Pediatric Course Instructor, Triage Class instructor, Charge Nurse class instructor
    View Yolanda Anderson's Expert Witness Profile.
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    Constance Paine, CCRN, LNC
    4058 Hegg St.
    San Diego CA 92115
    USA
    phone: 619-997-8407
    fax: 619-255-9501
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    Constance J. Paine CCRN, LNC, is a Legal Nurse Consultant with over 40 years of nursing experience. Currently the Principal at CP LegalMed Consulting and a Staff Nurse in ICE at UC San Diego Health System, Ms. Paine specializes in Critical Care, Interventional Radiology, Medical Surgical, and Discharge Planning.

    In addition to her comprehensive services to the legal community, Ms Paine serves as an educator, mentoring new graduates and educating staff on special procedures. She also serves in hospital settings evaluating staff and reviewing and revising hospital policy and procedure. Ms. Paine's fields of expertise include:

    Acute and Critical Care in Hospital Setting:
    • Pre-operative Teaching
    • Post-operative Care and Instruction
    • Discharge Planning for Home or Extended Care
    • Infection Control for In-patients
    • Wound Care and Instruction
    • Intravenous Therapy
    • Coordination of Individualized Care Plans
    Interventional Radiology:
    • Pre-Procedure Instruction
    • Management of Conscious Sedation
    • Discharge Teaching
    Neonatal Intensive Care:
    • Care of Level 1 Neonates
    • Parental Teaching and Support
    View Constance Paine's Expert Witness Profile.
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    Dawn L. Cook, RN, LNCP-C, CLCP, CLNC
    1001 E Sunset Rd #97553
    Las Vegas NV 89131
    USA
    phone: 702-544-2159
    fax: 702-543-7133
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    Dawn L. Cook is a licensed Registered Nurse with certifications in life care planning. As well, Dawn Cook is certified as a Forensic Litigation Consultant. She has worked with serious and catastrophic illness and injury for over 30 years including clinical settings, home care and life care planning.

    Dawn Cook has prepared hundreds of expert reports and has testified at deposition or trial at state court or Federal Court.

    Ms. Cook prepares Life Care Plans, Critiques Life Care Plans, Future Medical Cost Projections and Past Medical Bill Reviews for plaintiff and defense.

    Dawn Cook's client list includes attorneys in Arizona, California, Georgia, Hawaii, Minnesota, Missouri, Mississippi, Nevada, New Mexico, Oklahoma, Utah and Washington state.

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    John H. Fullerton, MD, MRO, CMD, CFP, FACP, AGSF, FAAHPM
    Founder & President
    1700 California St.
    Suite #470
    San Francisco CA 94109
    USA
    phone: 415-460-5532
    fax: 415-376-5820
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    John FullertonJohn H. Fullerton, MD, MRO, CMD, CFP, FACP, AGSF, FAAHPM, FASAM specializes and is Board Certified in Internal Medicine, Geriatric Medicine, Addiction Medicine, and Hospice & Palliative Medicine.

    Dr. Fullerton holds national certificates of added qualifications as a Certified Medical Director (CMD), a Certified Hospice Medical Director (AAHPM)and as a Home Care Physician (AAHCP). Dr. Fullerton is a Licensed Medical Review Officer (MRO) by the MROCC and is also Certified in Advanced Deep Wound Debridement.

    Dr. Fullerton holds active medical licenses in both California and Florida. His private practice Hampton Health, Ltd.™ is located with offices in both San Francisco and Marin County. We assist our patients in all stages of life at all levels of care including acute, rehabilitative, assisted and independent living facility care, home care, as well as palliative and hospice.

    Teaching and Lecture Experience: Dr. Fullerton has many years of clinical and teaching experience in internal medicine and geriatrics. He is credited with inventing the hospitalist business (and clinical) methods of care, submitting the first method patent for hospitalist care-"The Sub-Acute Solution: A Method for Hospital-Based Skilled Nursing Facility (SNF) Medical Care and Training."

    Dr. Fullerton served as the Education Director of Geriatrics and Palliative Medicine at St. Mary's Medical Center in San Francisco from 2009-2016 and is on the clinical faculty of UCSF, USC and Yale University Medical School(s)in their respective Department(s) of Medicine.

    Dr. Fullerton is a Fellow and Key National Lecturer for the AAHPM (American Academy of Hospice & Palliative Medicine) and was a 2013 Faculty member for the SEAK 22nd Annual National Expert Witness Conference held April 27-28 in Chicago where he presented How to Market and Grow Your Expert Witness Practice.

    Selected Honors & Awards:
    • “Dr. John Fullerton Day in San Francisco”: 12/14/94 - Awarded for his body of urban, under-served and hospital-based work in SF, including distinguished service in the areas of general internal medicine, geriatrics, HIV/AIDS, Rehabilitation/Addiction Medicine, Hospice, end-of-life (EOL) care, and transplant medicine
    • San Francisco Medical Society (SFMS) March 2013 Featured Member of the Month
    • Honorary Chairman, California Medicare Council 2003
    • International Organizational Heroes Award from the Berkeley School of Public Health
    • Congressional Award (NRCC)-"2003 California Physician of the Year"
    View Expert Witness Profile.
    2/3/2014 · Medical
    From the days of "Reefer Madness" until the timing of Proposition 19 with the "Legalization of Marijuana Initiative" on the ballot last November, the controversies swirling around not only the recreational use, but also the medical use of marijuana, particularly in frail, elderly geriatric patients with clinically significant weight loss (and cachexia), has been fraught with controversy. Even though the ballot initiative from 2010 went down in defeat on November 2, 2010, rumblings of some of the authors bringing another, more "targeted" CA initiative in 2012 are regaining momentum.

    A disturbing trend has emerged involving criminal charges being levied against family caregivers treating end-of-life (EOL) elders with dementia.

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    Dr. Paul Hofmann
    346 Rheem Blvd.
    Suite 101
    Moraga CA 94556
    USA
    phone: 925-247-9700
    fax: 925-247-9702
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    Expert Witness: Retained in Washington, D.C., and over 20 states as an expert in hospital administration who could render opinion after assessing medical records, hospital policies and procedures, medical staff bylaws and regulations, JCAHO standards, depositions, etc. Served as Expert Witness for Plaintiff and Defense.

    Consultant: Has assisted hospitals and health systems with accelerating their performance improvement efforts. Speaks, writes and consults on ethical issues in health care.

    Background Highlights:
    • Consultant, Executive Vice President and Chief Operating Officer of health system.
    • Executive Director of two academic medical centers: Emory University Hospital in Atlanta, Georgia, Stanford University Hospital and Clinics at Stanford.
    • Past chairman of the national advisory board for the University of Chicago’s Center for Clinical Medical Ethics.
    • An author of over 175 publications, he has written articles for USA Today, Health Management Quarterly, Trustee, Health Progress, the Journal of Health Administration Education, Frontiers of Health Services Management, Bioethics Forum, Modern Healthcare, the Cambridge Quarterly of Healthcare Ethics, Stanford Medicine, and Healthcare Executive among others.
    • Co-editor of Management Mistakes in Healthcare: Identification, Correction and Prevention, published by Cambridge University Press in 2005.
    • Co-editor of Managing Ethically: An Executive's Guide, published by Health Administration Press in 2001, and a second edition, Managing Healthcare Ethically: An Executive's Guide was published in 2010.
    • Fellow of the American College of Healthcare Executives, a past member of its Leadership Advisory Committee, and a consultant on health care management ethics since 1994.
    • Served as Distinguished Visiting Scholar at Stanford University’s Center for Biomedical Ethics.
    • Recipient of American Hospital Association's Award of Honor in 2009 and an Albert Schweitzer Leadership Award in 2012.
    • Faculty appointments held at Harvard, UCLA, Stanford, Emory, the University of California, and Seton Hall University.
    • Bachelor of Science, Master of Public Health, and Doctor of Public Health degrees are from the University of California, Berkeley.
    In 1989, I agreed for the first time to serve as an expert witness in a case brought by the family of a terminally ill pregnant patient who had a cesarean section performed against her will in a prominent university teaching hospital. Since then, whether retained as a plaintiff or defense expert, I have been surprised and disturbed by the number and types of cases in which hospitals and other health care facilities have been sued.

    Progress has been made on improving patient safety and reducing clinical mistakes, but errors happen and, in spite of everything, patients are still harmed.

    The belated but formal acknowledgement of medical errors and their impact has been well documented.1 Curiously, the topic of management or executive mistakes in healthcare is not raised in professional meetings nor, until recently, addressed by an article in health administration journals

    Paul Hofmann, MD, et. al (Editors)
    Ethical dilemmas are common in healthcare management. Although there is no handbook providing absolute solutions to ethics challenges, healthcare leaders can seek guidance and insight from others who have tackled similar issues. This book provides advice and inspiration from healthcare executives, ethicists, scholars, educators, and consultants. This collection of ethics columns from Healthcare Executive magazine will guide healthcare managers and executives in making personal and organizational decisions.
    Paul Hofmann (Editor), Frankie Perry (Editor)
    While increasing attention has been directed recently toward recognizing and reducing medical errors, healthcare organizations have yet to benefit from a similar scrutiny of management mistakes.
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    Dr. John C. Shershow
    240 Central Park South Suite 2H
    New York NY 10019
    USA
    phone: 800-388-9299
    Dr. John Shershow is a nationally known expert in all aspects of Hospital and Clinic Administration. In his nearly 20 years of experience as a Senior Hospital Executive and Healthcare Consultant, Dr. Shershow has surveyed or consulted to hundreds of hospitals, both as an accreditation surveyor for JCAHO and as a private consultant for hospitals nationwide.

    Dr. Shershow has been Medical Director of two prestigious hospitals and an Associate Dean of a nationally known medical school. He is Board Certified and was educated at Harvard, Yale and the University of Southern California.

    Areas Of Expertise Include:
  • Hospital Administration
  • Staffing
  • Quality of Care
  • JCAHO Accreditation
  • Medical Quality Assessment and Review
  • Medical Staff Affairs
  • Hospital And Ambulatory Standards of Care
  • Patient Rights
  • Health Care Risk Management
  • Medical Quality Assurance
  • Administrative Medicine
  • Peer Review
  • JCAHO Standards
  • Physician Credentialing & Privileging
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    Lynn M. Shaffer, RN, CLNC
    213 Thelma Road
    Central Square NY 13036
    USA
    phone: 315-676-2157
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    Lynn M. Shaffer, RN, CLNC®, is Registered Nurse with certification in Legal Nurse Consulting and the founder and managing member of Legal Nurse Consultants of CNY, LLC. Ms. Shaffer's 20 years of nursing experience includes clinical practice in hospitals, outpatient clinics and physician offices, and supervisory roles. She has specialized in Long Term Care / Rehabilitation for most of her nursing career.

    Litigation Support - Ms. Shaffer provides consulting and expert witness services for attorneys’ cases including criminal, disability, personal liability, toxic tort, and medical malpractice (specializing in long term care). As a Certified Legal Nurse Consultant, she assists insurance companies and attorneys with screening cases for merit, locating medical and nursing experts, and analyzing and interpreting medical records for both plaintiff and defense.

    Ms. Shaffer's CLNC® services also include: development of reports, timelines and chronologies to highlight the significant medical events, identify adherences to and deviations from applicable standards of care, and assess injuries and identify causation issues and pre-existing contributing factors. She also attends and reports on Independent Medical Exams in the Central New York areas.

    Areas of Expertise:
    • Geriatrics Independent Medical Examinations
    • Long Term Care / Rehabilitation
    • Managed Care Medical Malpractice
    • Medical Records Review
    • Nursing Home Malpractice
    • Nursing Home Medical Malpractice
    • Nursing Home Safety
  • Nursing Home Staffing / Training
  • Nursing Homes Standards of Care
  • Nursing Malpractice
  • Nursing Policy & Procedures
  • Personal Injury
  • Disability
  • Wrongful Death
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    Mary Wickens, JD, CFE
    2237 Raby Road
    East Lansing MI 48823
    USA
    phone: 248-770-4906
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    M.K. Wickens, PLLC, is a Health Care Fraud and Compliance company. Principal, Mary Wickens, JD, CFE has over 35 years experience in the Healthcare Insurance, Managed Care, and Compliance Industry. Her experience includes advising and counseling health care providers, insurers, government contractors, and others in compliance, ethics, fraud and abuse, Medicare, Medicaid and Federal Employees Plan, managed care, and other matters.

    Consulting Services:
    • Internal Investigations - As a highly experienced investigator, Mary Wickens is available to provide swift and thorough review of potential compliance and ethics issues. She is seasoned at handling potential whistleblower concerns, C-suite investigations, and reporting for self-disclosures. She provides comprehensive, understandable reports and recommendations to executives, audit committees, and auditors.
    • Compliance Consulting - Ms. Wickens is experienced in providing site reviews, red team reviews, and independent compliance reviews. She has in-depth knowledge developing and implementing effective corrective action plans and extensive experience in responding to government and commercial audits and investigations.
    Background Experience - Ms. Wickens is a former compliance officer for a major health insurer and former legal and compliance specialist for a CMS Medicare Program Safeguard Contractor. Also a former operations director for government programs (Medicare Part C, Medi-gap, and FEHBP) for a major HMO, she is experienced with government audits and investigations, commercial audits, as well as self-reporting and internal investigations.

    Ms. Wickens has decades of experience as in house counsel to HMOs and health insurers. She has drafted, developed, negotiated, and implemented numerous healthcare provider-payor contracts, and developed and implemented codes of conduct, ethics programs, compliance programs and numerous corrective action plans. Ms. Wickens has authored numerous professional publications and presentations on health care fraud and compliance, government and commercial audits, compliance programs, and healthcare contracting.

    View Mary Wickens' Expert Witness Profile.
    4/12/2017 · Healthcare
    Health care fraud and abuse cases are often won or lost on the effective use of expert witnesses. As health care fraud cases have become more complex and technical, the scope and use of expert testimony has proliferated, and the successful use of experts is one of the lawyer's most important jobs. False Claims Act, Anti-Kickback Statute, and Stark Law cases all demand various types of experts to assist the trier of fact in understanding the nature of the case, the morass of rules at play, the evidence, and a variety of billing, valuation, contractual, technical, and compliance concepts. Increasingly, expert reports and testimony play a pivotal role in motions for summary judgment, as well as at trial. Experts also are used in "conference room litigation," such as mediations or negotiations between defense counsel and enforcement agencies. This article is the result of interviews with health care fraud litigators and expert witnesses in the field who identified their best practices to produce optimum outcomes for their clients.

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    William C. Mohlenbrock, MD, FACS
    816 C Avenue
    Coronado CA 92118
    USA
    phone: 858-354-0415
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    William (Bill) C. Mohlenbrock, MD, FACS, is a nationally recognized expert in the assessment of hospital quality having developed systems to quantify the major metrics of hospital quality. The defense of a hospital involved with an allegation of malpractice might find it very useful to have three years of risk-adjusted data, encompassing all the major metrics of quality, as an adjunct to the defense against the allegation. He provides consulting services to hospitals including:
    • Hospital Quality of Care
    • Mortality Rates
    • Risk-adjusted Clinical Information System for Monitoring and Improving Quality and Cost-efficient Inpatient Care
    To address Medicare's Prospective Payment System in 1983, Dr. Mohlenbrock founded a technology and consulting company, Verras, and developed the Acuity Index Method, a risk-adjusted clinical information system for monitoring and improving quality and cost-efficient inpatient care. Verras received the American Hospital Association’s exclusive endorsement in 2015. His experience in the area of pay-for-performance led to the creation of Verras’ Medical Value Index (MVI), which is a patented, objective means to quantify value of hospitals’ outcomes and assist providers with the distribution of hospitals’ and physicians’ payments for Global and bundled-payment models.

    Comprehensive Quality Data used to Defend Hospitals for Med Mal


    Dr. Mohlenbrock has practiced General Orthopedics and Trauma Care, including total joint and arthroscopy surgeries and sports medicine and related injuries for many years at Scripps Memorial Hospital in La Jolla, California. He is senior physician in a group of 8 orthopedic surgeons and 2 Physician Assistants.

    Dr. Mohlenbrock is a noted lecturer and has published numerous articles on measuring and improving the quality and cost efficiency of medical care. His extensive teaching in these areas has made him comfortable conveying complex problems in public forums, including Fox News.

    View Dr. Mohlenbrock's Expert Witness Profile.
    The legal strategies for defending hospitals against medical legal liabilities are certainly many and varied. An additional consideration to augment every defense strategy might be contained in each hospital’s own store of big data. Heretofore these data have been underutilized for medical legal purposes...

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    Michael Arrigo
    620 Newport Center Drive
    Suite 1100
    Newport Beach CA 92662
    USA
    phone: 949-335-5580 x101
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    Michael Arrigo - Managing Partner, Health care Practice works with health systems, health IT companies, and health plans.

    He has in-depth experience in HIPAA mandates, the HITECH Act and Patient Protection and Affordable Care Act (PPACA) and is a published author and regular speaker. He consults to clients including Health IT investors, Health IT companies, and health plans and hospital systems in matters regarding:
    • HIPAA 5010
    • ICD-10
    • Revenue Cycle Management
    • Meaningful Use of Electronic Health Care Records
    • Quality Measures for Medicare Advantage Hospital Value Based Purchasing
    • Medicare Advantage HEDIS 5-Star Ratings for Health Plans
    Mr. Arrigo was recently quoted in the Wall Street Journal Venture Capital Dispatch regarding medical coding standards and Wall Street Journal Health Blog regarding venture-backed information-technology companies that serve hospitals and health insurers. He provided a macroeconomic analysis of the reimbursement risk of the transition to ICD-10 CM and ICD-10 PCS on the U.S. health care economy in comparison to the impact of the mortgage backed securities devaluation and diligence work for a premier venture capital firm in the U.S on their investment in medical analytics, a health plan, physician group, and accountable care organization solutions.

    View Michael Arrigo's Expert Witness Profile. Degree from University of Southern California in Business Administration, UC Irvine Economics and Computer Science, Stanford Medical School biomedical informatics, Harvard Law School bioethics. Rule 26 disclosure includes over 35 cases, two recent trial appearances, arbitration. Recent Department of Justice retention resulted in $155 million settlement.
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