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HMO - Managed Care Expert Witnesses

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Mary Wickens, JD, CFE
2237 Raby Road
East Lansing MI 48823
USA
phone: 248-770-4906
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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.

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.

Litigation Support - Mary Wickens provides litigation support, including skilled expert services, reports and testimony in federal False Claims Act cases, arbitrations, and provider-payer disputes. She is an experienced testifying expert, responsive to the needs of counsel, with excellent report writing skills. Ms. Wickens' services are available to counsel representing both plaintiff and defendant.

Areas of Expertise:
  • Medicare
  • False Claims Act (FCA)
  • Health Insurance
  • HMO
  • Medicare Advantage
  • Provider / Payor Disputes
  • Claims Audits and Appeals
  • Federal Employees Health Benefits Plans (FEHBP)
  • Medicare Part D
  • Government Audits
  • DME
  • Home Health Care
  • Hospice
  • Managed Care Contracting
  • Anti-Kickback Compliance
  • Self-disclosures
  • View Mary Wickens' Consulting Profile.
    6/6/2018 · Healthcare
    The US Department of Justice (DOJ) recently joined a federal qui tam lawsuit1 brought against a private equity firm that specializes in health care pharmacies. Notably, the case also charges individual partners of the private equity firm, Riordan, Lewis & Haden, Inc. (RLH) based in Los Angeles2. They are charged with violations of the federal Anti-Kickback Statute (AKS) and the federal False Claims Act (FCA) in connection with their management of Diabetic Care Rx/Patient Care America (PCA), a compounding pharmacy. The case involves reimbursements from TRICARE, the health care program for the military and their families.

    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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    James B. Wener, BSME, MBA
    Founder
    3132 North Volz Drive West
    Arlington Heights IL 60004
    USA
    phone: 847-927-5377
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    James Wener Business Systems Expert PhotoJames B. Wener, BSME, MBA is a Business Systems Consultant with over 45 years of experience in successfully managing small through very large projects and implementing a large number of computer systems for healthcare, manufacturing, and distribution organizations.

    Mr. Wener is a certified HIPAA professional, having performed several HIPAA compliance assessments, staff training programs, writing policies and procedures and developing and implementing HIPAA Breach Programs. Health care clients include Rush/Prudential Health Plans in Chicago, HMO Illinois, Mayo Clinic in Minnesota, Harris Health Plans in Dallas, HealthFirst in New York and Mercy Health Plans in Wisconsin and Illinois, Mercy Hospital in Chicago and other health maintenance organizations (HMOs).

    A Management Systems consultant since 1991, Mr. Wener has a significant record of accomplishment. His Information Technology (IT) projects include the implementation and management of a wide variety of application software systems. He has decades of experience in process automation for payers (health plans, third party administrators or TPAs), providers (hospital and physician groups), Management Service Organizations (MSOs), and clients in other industries. Mr. Wener specializes in:
    • Analyzing Operational Flow
    • Identifying Information Requirements
    • Preparing Vendor Requests for Proposal
    • Selecting, Developing, and Implementing Computerized Solutions
    Litigation Support - James B. Wener has been an expert witness for several plaintiffs and defendants regarding failed projects, failed system implementations, and HIPAA breaches. His extensive litigation support and expert witness engagements have focused on assisting attorneys in understanding the industrial and best practices related to the facts of their case, preparing the "message" that best represents the client's position, assisting in preparing pleadings, assisting in settlement negotiations, writing expert witness reports understandable to the non-professional, preparing for opposing side depositions, being deposed, and preparing for and appearing at trial.

    Areas of Expertise:
    • HIPAA Assessments
    • Failed System Implementation Projects
    • Intellectual Property Damages
    • Wrongful Employee Termination
    • Project Management
    • System Implementation
  • Systems Implementation Management
  • Disaster Recovery Planning
  • Breach of Patient Privacy
  • Software Company Bankruptcy
  • Failed Project Management
  • IT Advisor Independence
  • View James B. Wener's Consulting Profile.
    7/5/2018 · Computers
    Companies invest considerable time, effort and money when selecting and implementing a major mission critical computer system. Successfully completing the process can be complicated and frustrating; as a result, it doesn't take a lot for implementations to fail. The problem is that the business organization that undertook the implementation in the first place is stuck - stuck with the time, money and the inconvenience of not having the system they purchased. The company has not only left without the new system, they are back to using the systems that they originally thought so inadequate that they committed to spending the time and money for a new system.

    6/5/2018 · Computers
    Implementing a mission critical computer system has a significant impact upon a business organization. Successfully completing the process can be complicated and frustrating; as a result, it doesn't take a lot for the implementation to fail. Once an implementation fails, there is always enough blame to go around. The problem is that the business organization that undertook the implementation in the first place is stuck – stuck with the time, money and the inconvenience of not having the system they purchased. The company has not only left without the new system, they are back to using the systems that they originally thought sufficiently inadequate that they committed to spending the time and money for a new system. Successful litigation will help – but will not make them whole. But worse, a failed litigation only compounds the problem. Preparing the strategy for litigating a failed implementation takes time and thought. This article will take the reader through the development and implement of a litigation strategy that worked and discuss why it worked.

    3/29/2018 · Expert Witnessing
    The role of the litigation attorney is to tell a story to the arbiter in such a way to effectively represents the client's position. Often the attorney requires a person with unique expertise to understand and present technical information in a manner that is understandable to the lay person. Attorneys often determine the need for an expert witness after discovery and after depositions have been taken for many of the witnesses. In many cases this is too late for an expert to most effective. My experience as an expert witness has led me to recommend considering the use of an expert at the following times