Health Insurance Consultants: 9

CMC Advisors Inc. (CMC) provides expert Insurance Consulting and offers clients the upper hand in managing their assets and liabilities. They assist clients in managing investment portfolios by helping to determine if current Financial Retirement plans such as IRA, Roth IRA, Rollover IRA, 401(K), Keogh Plans, Pensions and Profit Sharing Plans are meeting retirement goals.

Consulting Areas:

Annuities Life Insurance Term Insurance Single Premium Variable Insurance

Retirement Disability Insurance Consultant Expert Witness Services

Wayne Citron has 45 years of experience as an expert in Forensic Reconstruction of Insurance Transactions. He is an insurance expert and consultant.

Mr. Citron established the Citron Agency and CMC Advisors Inc. in 1972, where his duties included executive and managerial responsibilities, sales, service, compliance with all insurance matters as well as securities laws and regulations. Both firms are leaders in life, health, disability and property and casualty insurance.

Mr. Citron has served as an instructor for Prudential Insurance Company Brooklyn Agency (1973) educating personnel in general insurance matters, underwriting, and insurance law. He has worked with companies including Prudential Insurance Company, United States Life Insurance Company, North American Company for Life and Health Insurance, American General Life Insurance Company, William Penn Life Insurance Company, American Life Insurance Company, Chubb Insurance Company, Travelers Insurance Company, Mass Mutual Insurance Company, John Hancock Insurance Company, and American International Group (AIG), among other.

Mr. Citron recently volunteered for Ocean County Long Term Recovery Group (OCLTRG) to reopen Super Storm Sandy flood claims and examine National Flood Insurance Policies, as well as deal with FEMA in these matters (2015 & 2016).

View Wayne Citron's Expert Witness Profile.

Vera Dolan is an epidemiologist with over 30 years of experience in the life and health insurance industries. She is one of the leading mortality experts in the life insurance industry. She writes underwriting manuals and policy and procedure manuals for life and health insurance companies.

Vera has testified in both state and federal court, and has been retained in over 200 cases since 2006 for plaintiffs and defense on an equal basis. She is very credible testifying in deposition and on the stand.

* Life expectancies that are personalized and accurate to the standards of the life insurance and life settlement industries. Addresses the cases when life expectancies that are simply taken from a life table or estimated by a doctor, actuary or biostatistician are too long, too short, insufficient or not credible. Addresses the cases when a complete insight into the individual's medical conditions and/or personal history of high-risk behaviors is needed to assist the judge or jury in their decision. This information often decides the case, see article for details.

* Expert in bad faith/wrongful denial of life/health insurance claims.

* Expert in life/health insurance underwriting material misrepresentation.

* Expert in medical risk assessment and underwriting issues.

* Expert in life insurance underwriting policies and procedures.

* Expert in epidemiology. Previous cases include infectious diseases, occupational and environmental exposures, pesticides and tobacco.

* Approved life expectancy expert with the U.S. Department of Justice.

* Active consultant to the life insurance industry conducting cohort mortality studies, and writing underwriting and policy and procedure manuals.

* Over 100 articles published on mortality research and underwriting.

* Friendly, clear, concise, objective and quantitative.

* There is no charge for the initial phone consultation.

* There is no charge for travel time.

HLN offers Peer-reviewed methodologies and Appellate court proven testimony by experienced professionals who have provided consulting services and conducted audits and investigations for hundreds of hospitals, physicians and other healthcare providers nationwide. HLN's experts have provided expert testimony in administrative and regulatory proceedings, as well as in state and federal courts for civil and criminal cases, for plaintiffs and defendants.

HLN provides experts in: medical billing, reasonableness of charges, reasonable value of medical services, Medicare & Medicaid reimbursement and compliance, clinical documentation, medical record coding, economic damages, insurance disputes, lost profits and false claims. HLN's founder co-authored two editions of the AMA's best selling Mastering the Reimbursement Process book. 

HLN's Consultants include:

• Certified Public Accountants (CPA) 
• Certified Coding Specialists (CCS and CCS-P)
• Certified in Financial Forensics (CFF) 
• Certified in Healthcare Compliance (CHC) 
• Certified Fraud Examiner (CFE) 
• Certified Healthcare Chart Auditor (CHCA) 
• Certified Professional Coder (CPC and CPC-H) 
• Licensed Insurance Agents
  
• RNs, MDs, DOs and DCs
• Financial Analysts
• Statisticians 

KBS Consulting and Expert Witness (KBS) is a privately owned Healthcare Compliance consulting firm serving the healthcare industry since 1996. Principal of KBS, Kimberly A. Baldwin-Stried-Reich, MBA, MJ, PBCI, CPHIMS, RHIA, CEDS, CPHQ, FAHIMA, is a Health Care Compliance consultant with over 30 year of experience in various healthcare settings. 

KBS Consulting services focus on:

Healthcare Regulatory Compliance (HIPAA) Operations Work Redesign Management Facilitation

Healthcare Contracts Medical Invoicing Medical Collections

Ms. Reich holds a Master’s of Business (MBA) from the Lake Forest Graduate School of Management, a Master’s of Jurisprudence (MJ) in Health Law and Policy from the Loyola School of Law - Beazley Institute for Health Law and Policy in Chicago, IL and a Post Baccalaureate in Clinical Informatics (PBCI) from the Johns Hopkins School of Medicine Clinical Informatics Certificate Program. 

Ms. Reich is the first Registered Health Information Administrator (RHIA) to complete the Johns Hopkins Division of Health Sciences Informatics Certificate Program and certification in EDiscovery. She is the lead author of the 2012 AHIMA publication "E-Discovery and Electronic Records" a first of its kind healthcare e-discovery resources. 

Ms. Reich is a national speaker and author on the topics of health information operations, e-discovery, information governance, and healthcare compliance. She is also the lead author on the first of its kind e-discovery healthcare resource guide, E-Discovery and Electronic Records, by AHIMA Press (May, 2012).

Background Experience:

• Assistance in development of policies and procedures for healthcare regulatory compliance programs
• Assistance in client preparation for Department of Insurance review and investigation
• Management of a large health information management work redesigns engagement for a 900-bed facility
• Information management planning and facilitation for executive management
• ICD-9-CM and CPT4 coding compliance and medical record documentation reviews, on both inpatient and outpatient medical records
• Medical records and quality management operations integration for a 350-bed Midwestern medical center

View Kimberly A. Reich's Expert Witness Profile.

Jeffrey D. Diamond specializes in Insurance Coverage Disputes and Litigation. He has established his law firm as one of the premier Insurance Coverage law firms in the Metro Atlanta area on behalf of policyholders, as well as throughout the State of Georgia and, as he was initially admitted to the State Bar of California in 1978, he serves policyholders in California, as well. 

In addition to his full time law practice, Mr. Diamond has served as an Adjunct Professor of Insurance Law since 1995 in both California and Georgia, having joined the Georgia State University College of Law faculty in 2009 as an Adjunct Professor of Insurance Law and, in 2012, he joined Atlanta’s John Marshall Law School in a similar capacity. 

Mr. Diamond  is also a law instructor for the National Association of Certified Valuators and Analysts (NACVA), a national educational organization which conducts continuing education programs for financial professionals across the country, teaching in NACVA’s Expert Witness Bootcamp program. Mr. Diamond has been an invited guest speaker on topics of interest at numerous insurance conferences throughout the country. 

Over his 37 year career, Mr. Diamond has successfully represented policyholders, and formerly Insurance companies, in a wide variety of insurance coverage and bad faith actions including:

• Business Insurance Litigation
• Homeowners Insurance Litigation 
• Construction Defect Litigation
• General Business Property and Liability Claims
• Long Term Disability Claims
• Life Insurance Claims

 Litigation Support - Mr. Diamond's experience as an insurance litigator and insurance law professor allows him a unique perspective as a consulting expert witness. His extensive knowledge of insurance law and keen insights into insurance policy interpretation, as well as the covenant of good faith and fair dealing under each State’s insurance related statutes and case law, make him an exceptional consulting expert witness with regard to insurance coverage disputes and issues concerning insurance bad faith issues.

 View Jeffrey Diamond's Expert Witness Profile.

Lieberman Financial & Consulting Services, LLC provides high quality Financial Planning services and Insurance Investment to advice to clients in all walks of life. Principal, Maurice Lieberman, CLU, ChFC, RHU, LUTCF, has over 40 years of experience specializing in Life Insurance, Annuities, and Health Coverage.

Mr. Lieberman also offers Financial Planning Workshops and conduct large and small group seminars. He provides individual and family financial counseling sessions to active duty members of the United States Military (all branches.)

Mr. Lieberman holds three professional designations from the American College, Chartered Life Underwriter, Chartered Financial Consultant, and Registered Health Underwriter. He is a Life Insurance Training Council Fellow, and a member of the American College of Financial Services Professionals, Forensic Expert Witness Association, and the American College of Forensic Examiners International.

Background Experience - Mr. Lieberman started as an insurance agent for Metropolitan Life and then advanced in his career to manage brokers. He successfully built agencies for Aetna, and Principal Financial Group. He was later promoted to Regional Director for New England Financial, and CSAA Life. Over the years he mentored hundreds of insurance agents, brokers, financial planners and agency managers to build their own successful careers and agencies. He was also a member of the Million Dollar Round Table and utilized his selling and management experience to train insurance agents, brokers and financial planners in advanced areas of estate, business insurance, and financial planning.

View Maurice Lieberman's Expert Witness Profile.

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.

Milliman’s Tampa Office provides a variety of Health Insurance, Health Care services, and Pharma consulting services to law firms, health plans, insurance companies, HMO’s, Blue Cross/Blue Shield plans, hospitals and other providers, employers and government agencies. Stuart Rachlin and other staff are experienced actuaries and related consultants.  

We provide support to our clients with all types of health related services including Medicare Advantage and Prescription Drug plans (MAPD), Part D plans (PDP), ACA plans, 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, claim cost analysis, and fee schedule analysis.

These health care services are used in litigation relating to:

• Life care planning
• Contract development and fee schedule analysis
• Pricing & Underwriting
• Senior Services
• New benefit plan design

Prof. William J. Warfel, PhD, CPCU, CLU, specializes in Insurance and Risk Management. Currently on faculty at Indiana State University, his subjects have included Property / Liability Insurance, Health Insurance, Life Insurance, Introduction to Risk and Insurance, Commercial Liability Insurance, and Insurance Seminars. 

Dr. Warfel is widely published in applied, professional journals. He has formally agreed to make a presentation concerning the “Application of the Separation of Insureds Condition” to the Indianapolis Bar Association as part of its Continuing Education Program (Winter Symposium, Indianapolis Bar Association, Insurance Coverage Section) for its members on December 9, 2021.

Dr. Warfel is a Member of the Board of Directors Overseeing the Development and Use of a Monetary Investment Software Tracking System for the purpose of holding contractors and subcontractors connected to construction projects accountable, and protecting the insurable interest of banks who finance these construction projects.  He has also participated as a panelist in a plenary session sponsored by the United Campus Ministries, and the
Indiana State University Center for Economic Education. The title of this session was, “Healthcare Reform: Industry Implications, Insurance Complications, and the Economics of it All.”

Insurance Industry Studies:

• Commissioned by the National Association of Mutual Insurance Companies (NAMIC), to prepare an Issues Analysis paper concerning legislative expansion of policyholder remedies for first party bad faith. Prf. Warfel's role was to present the legal landscape concerning first-party bad faith law across the United States.
• Commissioned by Networks Financial Institute at Indiana State University to draft a working paper concerning issues related to insurance regulatory reform.
• Commissioned by the Coalition for Quality, Affordable Housing to conduct a study concerning why reliance on litigation to resolve disputes relating to alleged construction defects has contributed to a price/availability problem with respect to contractors liability insurance in California.
• Completed a faculty internship with Safeco Insurance Companies, the purpose of which was to examine the response of state legislatures to disruption in property insurance markets that occurs in the aftermath of a natural disaster, and examine the need for federal reinsurance.
• Commissioned by State Farm Fire and Casualty Insurance Company to conduct a study concerning the impact of natural disasters on insurers and the insurance marketplace.

View Dr. William Warfel's Expert Witness Profile.