Managed Care Liability Consultants

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

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.

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.

Dawn Cook Consulting is based out of Las Vegas, Nevada but provides services nation wide. Services include life care plans, life care plan rebuttals, past medical bill reviews and future medical cost projections for plaintiff and defense attorneys. Life care plans are developed for individuals with injuries or chronic conditions requiring complex long-term healthcare intervention and management. The report provides an organized, concise plan that estimates the reasonable and necessary current and future healthcare needs with the associated costs.

Dawn Cook is licensed Registered Nurse (RN) who has worked with serious and catastrophic illness and injury for over 30 years including clinical settings and home care. Dawn is an experienced life care planner who holds the certified life care planner (CLCP) and certified nurse life care planner (CNLCP) designations.

Dawn has completed over 600 medical damage reports in 28 states in life care planning and has testified as an expert witness at deposition or trial over 75 times since 2012. Dawn has testified at Federal Court in Illinois and New Mexico and at State Court in California, Nevada and New Mexico as an expert in life care planning. Dawn has also testified in Nevada State Court as an expert in past medical bill reviews.

Dawn enjoys working both plaintiff and defense cases; from complex birth or brain injuries to trucking and motor vehicle accidents, each case requires attention to detail and consistent methodology.

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John 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.

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.

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

Kohler Healthcare Consulting, Inc., is an effective, cutting-edge Healthcare Consulting firm employing credentialed nurses, accountants, and coders since 1980. With clients across the United States and Virgin Islands, Kohler Healthcare Consulting has extensive relationships with healthcare organizations including academic medical centers, large and small hospitals, critical access hospitals, physician / medical practices, long term acute medical facilities skilled nursing facilities, and other healthcare providers.

Consulting Services:

Revenue Cycle Fiscal and Clinical Operational Improvement Financial Operations

Regulatory and Compliance Consulting Education and Training Due Diligence

Charlotte L. Kohler, [RN], CPA, CVA, CRCE-I , CPC, CHBC, President of Kohler HealthCare Consulting, Inc., specializes in litigation, investigation, accounting, auditing, and consulting. She has over 30 years of healthcare experience starting with the clinical side of nursing to the finance and compliance side of healthcare.

During her years at Kohler HealthCare Consulting, Ms. Kohler and her firm provided regulatory compliance services to over 60% of all hospitals in Maryland as well as hospitals and other health related organizations outside of Maryland. She continues to provide reimbursement regulatory support to attorneys regarding billing, coding, and documentation in the areas of home care, radiology, hospital billing, DME, Therapy, ASC, anesthesia, and physician practices. She also provides services as an independent review organization for providers under Integrity Agreements.

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

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 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

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.

Managing Partner, Healthcare Practice works with health systems, health IT companies, and health plans. Recent retentions by the U.S. Department of Justice (DOJ). Drug pricing, patent infringement, medical coding and billing and Qui Tam False Claims Act and fraud case specialties. 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 Privacy Rule, HIPAA Security Rule, HIPAA Breaches, 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.

Georgia 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, State, Federal, and Joint Commission regulatory issues in hospitals and long term care facilities. Dr. Persky provides private consulting for 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 and nursing homes 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 has served as Vice-President of Nursing and Patient Care Services for 25 years and most recently, 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 care employees. 

View Dr. Persky's Expert Witness Profile.

Daybreak Retirement Villas is a healthcare professional owned and operated Residential Care Facility whose goal is to provide quality care for residents in a comfortable setting. Daybreak Retirement Villas offers premier and Luxurious Senior Living Alternatives within elegant surroundings.

Licensed for ambulatory, non-ambulatory, and bedridden residents, the professionals at Daybreak have extensive experience with Hospice Care, Incontinence, Stroke, Parkinson’s, and Dementia.

Principal, Cynthia (Cyndy) Minnery RN, BSN has over 30 years of experience caring for the elderly within Acute Care, Skilled Nursing, and Assisted Living Facilities. Ms. Minnery has worked as a Director of Quality Compliance in Skilled Nursing and Home Health Care. She now owns Residential Care Facilities and is familiar with the Standards of Care expected of caregivers in these settings.

Ms. Minnery has years of experience and training in care of the elderly and common disorders like Alzheimer’s Dementia, Parkinson’s Disease, and other Geriatric Syndromes. She currently serves on the San Diego Dementia Consortium board of directors and Clinical advisory committee.

View Cyndy Minnery's Expert Witness Profile.