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HMO - Managed Care
There are 3 expert witnesses in this category

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Peter F. George
Principal

P.O. Box 833
Petersham MA 01366
USA
phone: 978-724-0299
Peter F.
Healthcare Litigation Support is a team of experts - physicians, healthcare administrators, reimbursement specialists, health organization experts, health insurance experts, and other healthcare personnel - with broad, extensive experience and expertise in medical and administrative malpractice issues, physician practice operations, hospital management, health insurance and TPA issues, Medicare and Medicaid, medical billing and collections, fraud and abuse, managed care and other areas.

Healthcare Litigation Support is a team of experienced healthcare experts who consult on litigation issues and testify as needed. In addition to the four Principals, there is a larger group of Associates, individuals with specific expertise and areas of knowledge, we include in order to fully serve the needs of the legal community.

Areas of Expertise:
  • Audit
  • Medical Standards of Care
  • Dental Standards of Care
  • Geriatrics and Nursing Home Care Standards
  • Long Term Care Standards
  • Health Insurance
  • Health Insurer-Provider Relations
  • Managed Healthcare (HMO, PPO)
  • TPA (Third Party Administrator
  • National Accreditation Guidelines
  • Medicare / Medicaid
  • Federal Employees Health Benefits Program
  • CDH (Consumer Driven Health Plans)
  • ERISA, COBRA, EMTALA, HIPAA
  • Physician / Hospital Joint Ventures
  • Qui Tam and False Claims Act


  • Representing Both Plaintiff and Defense, Our Services Include:
  • Review Case for Merit
  • Analyze Medical and Administrative Events
  • Identify Causation
  • Address Standards of Care
  • Research Relevant Literature
  • Interpret Contracts in Light of Industry Standards
  • Evaluate Case Strengths and Weaknesses
  • Develop Deposition Strategy
  • Prepare a Defensible Report
  • Articulate Complex Issues to Triers of Fact
  • Check for SynapsUs
    Robert Dobson
    Principal, Consulting Actuary
    3000 Bayport Drive, Suite 1050
    Tampa FL 33607
    USA
    phone: 813-282-9262
    fax: 813-282-8276
    Milliman’s Tampa Office provides Health Insurance, Health Care and Employee Benefit Consulting to law firms, insurance companies, hospitals, HMO’s, Blue Cross/Blue Shield plans, employers and government agencies. Our staff is experienced with medical, dental, long-term care, Medicare supplement & critical illness.

    We assist clients nationwide with forensic actuarial work, rate filings, regulatory compliance, reserve projections, valuations, employee benefit analysis and design, mergers and acquisitions, demutualizations, claim cost analysis, and utilization management programs.

    These health care services are used in litigation relating to:
  • Pricing & Underwriting
  • Senior Services
  • Contract Development and Negotiations
  • New Plan Design
  • Check for SynapsUs
    Reed Tinsley
    Owner
    21175 Tomball Parkway, #194
    Houston TX 77070
    USA
    phone: 281-379-5988
    fax: 801-912-1197
    Reed
    Reed Tinsley, CPA has provided consulting services to physicians and physician related entities and their legal counsel for more than 20 years. A sampling of his services to physicians include all aspects of physician practice management and economics, managed care contract review / negotiation, profit growth strategies, strategic planning, practice merger facilitation, physician contract reviews, physician buy-ins/buy-outs, regulatory compliance, and litigation support.

    Mr. Tinsley's litigation support specific services have included billing and collection reviews, medical practice or healthcare entity business valuation, lost profits analysis, covenant not to compete valuation, wrongful termination damage analysis, and overhead allocation reviews. He has also been engaged as a court appointed Special Master and Receiver.

    Areas of Expertise:
  • Practice and Healthcare Entity Valuation
  • Economic, Financial and Statistical Analysis Expert Witness
  • Physician Economic Disputes
  • Billing, Collection, Accounts Receivable Reviews
  • Managed Care Contract Reviews
  • Office Sharing and Physician Compensation Overhead Allocations
  • Physician Contract Disputes
  • Lost Profits and other Damage Analysis / Calculations
  • Physician Regulatory Compliance

    Reed Tinsley is a Houston-based CPA, Certified Valuation Analyst, and healthcare consultant. His entire practice is devoted to providing tax, accounting, and healthcare consulting services to physicians and their attorneys. Reed has published numerous articles in national and regional publications and is frequently asked to speak on a variety of health care topics, including capitation, revenue enhancement, and integration strategies. His articles have been published in the Journal of Medical Practice Management, MGMA Journal, Hospital Physician, Texas Medicine Family Practice Journal, and Group Practice Journal. Mr. Tinsley also serves on the Editorial Panel of Consultants for the publication Managed Care Contract Negotiator.
  • 10/22/2011 · Medical
    Medical Practice: Regulary Evaluate Your New Doctor Associate
    Any expectations you have for a new Associate only works if you follow through with frequent evaluations. However, I am often struck by how little attention senior doctors give to basic personnel management of newly employed physicians.

    Assessing Intangible Value in a Physician Practice Acquisition
    Due in large part to concerns over healthcare reform and declining reimbursement rates, physicians are increasingly looking for opportunities to sell their practices to hospitals and work as employees.

    Strategic Planning Programs For Medical Practices
    As you are well aware, physicians and their practices face new and complex challenges.

    4/12/2011 · Accounting
    Business Process Improvement - Best Practices Rather Than "Best Efforts"
    Similar to the mid to late 1990's, medical practice management today has begun to be dominated by mergers, affiliations, and other external strategic initiatives aimed, ideally, at enhancing economic potential and performance within a rapidly-changing industry landscape.

    3/2/2011 · Accounting
    Due Diligence - The Most Important Part Of The Physician Merger Process
    You and another or a group of physicians are considering a merger with each other.

    Reed Tinsley, CPA
    Complete guide to accounting, tax issues, managed care, and daily operations.
    Reed Tinsley, CPA
    This practical resource has the information and tools you need to obtain the most favorable legal and financial terms possible in today's competitive managed care market. It explains how to successfully negotiate both discounted fee-for-service and capitated managed care contracts and offers strategies designed to improve managed care contracting relationships.
    James W. Karling, Reed Tinsley, CPA, Joe Havens
    tHIS is the first comprehensive guide to setting up an IPA, detailing the many operational, legal, and logistical complexities of managing a physician-owned organization. Since controlling the financial and tax aspects of an IPA is critical to its survival, the Manual addresses an entire range of financial accounting concerns, including accounting concepts and methods for an IPA, internal control procedures, insurance issues, tax issues, policy guidance, and profit-making issues.
    Reed Tinsley, CPA, Rhonda W. Sides, CPA, Gregory D. Anderson
    Covering the specific issues that impact valuation, this book takes you through the entire process, highlighting pitfalls and mistakes that are commonly made and that should be avoided.
    Reed Tinsley, CPA & Joe Havens
    Written by one of the foremost experts in the field, this book—the first of its kind—provides expert guidance on how to perform an operational and strategic assessment of a medical practice. It includes proven suggestions and ideas on how to maximize the operational efficiency of a practice, enhance the medical office revenue stream, position the practice for future success, and maintain and increase income. Contains evaluation and assessment forms, as well as sample financial reports.