HMO - Managed Care Consultants: 4

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:

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.

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

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, physician compensation disputes, and overhead allocation reviews. He has also been engaged as a court appointed Special Master and Receiver.

Areas of Expertise:

1. Practice and Healthcare Entity Valuation
2. Economic, Financial and Statistical Analysis Expert Witness
3. Physician Economic Disputes
4. Billing, Collection, Accounts Receivable Reviews
5. Managed Care Contract Reviews
6. Office Sharing and Physician Compensation Overhead Allocations
7. Physician Contract Disputes
8. Physician Compensation
9. Lost Profits and other Damage Analysis / Calculations
10. Physician Regulatory Compliane

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.