Managed Care Liability Consultants: 10

Paul M. Adler, DO, FACEP, MBA, Medical Director for the Ventura County, California, Department of Corrections, has worked in Correctional / Jail / Prison Medicine & COVID-19 Preparation & Response. 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:

• COVID-19 Preparation & Response
• 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.

Expert Witness: Retained in Washington, D.C., and over 25 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 the 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 a 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.

Huggins Actuarial Services, Inc is a full-service independent consulting firm with more than 100 years of experience providing innovative and clever solutions to a wide range of Actuarial and Risk Management Challenges. They offer a wide range of tactical consulting services providing valuable assistance in the day-to-day operation of your firm, as well as strategic consulting to inform decision-making on matters of extreme gravity.

Huggins employs leading professionals, having the combination of strong analytical skills, business knowledge, and understanding of human behavior to identify, measure, and manage risk. The firm has a reputation of actuarial excellence and a proven track record providing clients with the information and vital services they need to succeed. 

Huggins actuaries have issued more than 600 loss reserve opinions to date, and counting. Credentialed actuaries on staff average over 25 years of experience and have reached top levels of achievement in the actuarial profession, including Chief Actuaries of large multi-line national insurance companies and Partner of Big Four accounting firms Their Integrated team approach provides the highest quality work in a timely fashion.

Consulting Services:

Loss Reserving Enterprise Risk Management Appointed Actuary Economic Capital Modeling

Rate Making & Product Development Individual Claims Simulation Model Captive Feasibility Study Warranty and Other Accruals

Ronald T. (Rusty) Kuehn is a Consulting Actuary with Huggins Actuarial Services, Inc. and a Fellow of the Casualty Actuarial Society and the Conference of Actuaries in Public Practice, a Member of the American Academy of Actuaries and the International Actuarial Association. In addition, Mr. Kuehn holds the Chartered Enterprise Risk Analyst (CERA) designation, the Chartered Property-Casualty Underwriter (CPCU) designation, and the Associate in Risk Management (ARM) designation.

Mr. Kuehn is professionally active; he has served as the chairman of the Casualty Loss Reserve Seminar (CLRS), which is jointly sponsored by the Casualty Actuarial Society (CAS), the American Academy of Actuaries and the Conference of Consulting Actuaries. He has also served on the on the Casualty Practice Council of the American Academy of Actuaries, the CAS Examination Committee and Committee for Consultants’ Interests, and as past President, Education Chairman and Board Member of the Casualty Actuaries of the Mid-Atlantic Region (CAMAR).

In addition, Mr. Kuehn has served on the Insurance Services Office Private Passenger Automobile Subcommittee and the Homeowners Subcommittee. Mr. Kuehn has also served as a Member of the Conference Task Force on Public Policy Debate of the Conference of Actuaries in Public Practice. He currently serves on the Board of the Insurance Society of Philadelphia (ISOP), and he is a member of the ORSA subgroup of the ERM Committee of the Risk Management and Financial Reporting Council of the American Academy of Actuaries. His over 45 years in business have given him a thorough knowledge of the property-casualty business both from a company and consulting viewpoint. See Full Bio and Consulting Experience.

Grover M. Edie, MBA, FCAS, MAAA, CERA, CPCU, ARM, ARP, is a Fellow of the Casualty Actuarial Society, a Member of the American Academy of Actuaries, a Certified Enterprise Risk Analyst, a Chartered Property Casualty Underwriter, an Associate in Risk Management, and an Associate in Research and Planning. 

Prior to joining Huggins, Mr. Edie was Vice President and Chief Actuary at GMAC Insurance Company, where he oversaw all actuarial activities including pricing, loss reserving, and enterprise risk management in personal auto, commercial lines, auto extended service contracts, assumed reinsurance and other miscellaneous lines of insurance. He introduced Economic Capital Modeling to the organization during his tenure. His previous employers include Erie Insurance Group, John Deere Insurance, and the Insurance Services Offices.

Mr. Edie has over 25 years of actuarial experience. He started his insurance career as an underwriter. The primary services Mr. Edie provides to his clients includes Economic Capital Modeling, Enterprise Risk Management, profitability analysis, rate level reviews and filings, and loss reserve analysis. See Full Bio and Consulting Experience.

Kim E. Piersol, FCAS, MAAA, is a Fellow of the Casualty Actuarial Society and a Member of the American Academy of Actuaries. Prior to joining Huggins, he served as Senior Vice President & Chief Actuary for Crum & Forster Insurance Companies. Prior to that he served as Group Vice President & Chief Actuary for CNA Insurance Companies, and was a consulting actuary for KPMG LLP, Arthur Andersen LLP, and CFO of AIG Risk Management (AIGRM). 

Mr. Piersol is professionally active; he has served on the American Academy of Actuaries Environmental Liabilities Work Group, the NAIC Technical Advisory Committee on Catastrophe Reserves, the Workers’ Compensation Reinsurance Bureau Actuarial Committee, and has been a Director and Treasurer of the Professional Liability Underwriting Society (PLUS). He also served on the Professional Liability Actuarial Subcommittee of the Insurance Services Office (ISO). He has also served as a 1st Lieutenant in the United States Army Field Artillery. His over 40 years in the actuarial field have given him a thorough knowledge of the property-casualty business both from a company and consulting viewpoint. See Full Bio and Consulting Experienc.

View Huggins Actuarial Services, Inc.'s Expert Witness Profile.

Cathy Ciolek, DPT, FAPTA, Cathy Ciolek, DPT, FAPTA, President of Living Well With Dementia, LLC, has over 30 years of experience as a Geriatric Physical Therapist. Dr. Ciolek is board certified as a Geriatric Clinical Specialist, a Certified Dementia Practitioner (CDP), and Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT) by the National Council of Certified Dementia Practitioners. 

Consulting Services: Consultation for individuals, care partners, and facilities to address challenging issues that impact well-being and quality of life for people with dementia.  Examples include:

• People with frequent Falls and developing Falls Assessment Process and Teams
• Behavioral Expressions of Unmet Needs
• Inappropriate Medications and Anti-psychotic Medication Reduction
• Unrecognized Pain
• Alarm Use Reduction
• Culture Change and Change Management

Background Experience: Dr. Ciolek previously served as Regional Director for the Pennsylvania Restraint Reduction Initiative (PARRI), providing education and consultation for issues related to well-being (falls, engagement, medication reduction) to nursing homes throughout the Commonwealth of Pennsylvania via a CMS grant. 

Prior to that, Dr. Ciolek served as assistant professor and director of clinical education for the University of Delaware, Department of Physical Therapy. She has practiced as a physical therapist in outpatient, SNF, home health and CCRC facilities over the course of her career.  She is a former Instructor/ Guest Lecturer/Lab Instructor at multiple universities including: Drexel University, Temple University, AT Still University/Arizona School of Health Sciences, Widener University, and Rocky Mountain University.

Dr. Ciolek speaks and delivers seminars throughout the nation on topics including dementia, exercise for aging adults, falls and fall risk mitigation, and Person-Centered Care. She is also a noted author on geriatric issues with books entitled, “Cognitive Issues in the Older Adult," “Restraint Assessment,” and “The Older Adult With Multiple Comorbidities.”

Geriatric Physical Therapy Thought Leader

• President, Academy of Geriatric Physical Therapy (APTA Geriatrics)
• Past President, Delaware Physical Therapy Association (APTA Delaware)
• American Physical Therapy Association
• APTA Geriatrics
• APTA Delaware 

Awards and Accolades

• Catherine Worthingham Fellow of the American Physical Therapy Association
• Marilyn Moffat Leadership Award (APTA)
• Joe Lucca Service Award (APTA Delaware)
• Lucy Blair Service Award (APTA)
• Joan Mills Award (APTA Geriatrics)
• Clinical Educators Award (APTA Geriatrics)

View Dr. Cathy Ciolek'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

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.

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.

Research & Planning Consultants, LP (RPC) has been assisting clients with expert services for over 45 years, including consulting and expert witness testimony for personal injury, healthcare litigation, commercial litigation and Certificate of Need matters. RPC also offers a wide selection of health data. They have served clients across the U.S, from Alaska to Florida and from New England to California. 

A Complete Team of Damages Experts for Personal Injury Litigation

Research & Planning Consultants, LP provides the following services: 

• PERSONAL INJURY - RPC provides comprehensive damages analysis in personal injury litigation. Their expert team has life care planners, vocational evaluators, board-certified physicians, economists and neuropsychologists. 

Areas of Expertise include: Life Care Plans, Loss of Earning Capacity or Support, Present Value of Damages, Medical Bill Analysis, Chargemaster Analysis, Neuropsychological Testing & Traumatic Brain Injury, Vocational Evaluations, IMEs, Section 18.001, Prestanding ED Chargemaster Analysis

• COMMERCIAL LITIGATION- RPC has provided expert analysis on commercial litigation concerning many industries: chemicals, refining, forestry, waste management, pipelines, water resources, oil and gas EDP, fisheries, agriculture, electrical generating plants, transmission lines, telecommunications, and real estate development. Our special expertise in the healthcare industry has proven valuable to business litigators unfamiliar with this complex industry.

Areas of Expertise: Breach of Contract / Commercial Economic Damages, Construction Disputes, Litigation over Non-Competitive Agreements, Environmental Torts and Toxic Torts, Commercial Disparagement, Wrongful Termination

• HEALTHCARE LITIGATION - RPC offers economic, statistical, data and clinical analysis in a wide range of healthcare litigation. They have experience with payment disputes, qui tam litigation, physician-hospital disputes, practice valuations and construction litigation. 

Areas of Expertise: Qui Tam Healthcare Litigation, Medical Staff Disputes, Professional Liability, Payment Disputes, Health Facility Construction Disputes, Freestanding ED Chargemester Analysis

• CERTIFICATE OF NEED - RPC provides Certificate of Need (CON) planning services nationwide. We have over 35 years of experience developing regulatory strategy, preparing applications and testifying in public and administrative hearings.

Areas of Expertise: Satellite Hospitals, New Hospitals, Relocation and Transfer of Beds, Observation Beds, Geriatric Psychiatric Units, Children’s Hospitals, Comprehensive Inpatient Rehabilitation Units, Neonatal Intensive Care Units, Open Heart Surgery Services, Long Term Acute Care Units, Projects that exceed CON Capital Threshold Limits, Projects for Specifically Listed Services, Programs Requiring CON, Hospices, Senior Living Facilities

Ronald T. Luke, JD, PhD, is a principal consultant and President of RPC, LP. Ron joined RPC in 1976 and became its president and principal owner in 1979. He has consulted on projects for health care providers, managed care plans and public agencies in more than 25 states. He also serves as an expert witness in trials, administrative proceedings and legislative hearings.

Active in the Health Policy Arena, Dr. Luke has been accepted as an expert in Economics, Socioeconomic Impact Analysis, and Policy Analysis by state and federal courts, and state administrative agencies. The types of cases in which he has provided expert testimony include personal injury, contractual disputes, health care payment disputes, construction defects, utility construction permitting, and certificate of need. He has testified on health care matters including market structure, billing fraud and abuse, reasonableness of charges, medical staff credentialing, workers’ compensation fee guidelines, utilization review, physician contracts, and managed care contracts.

Kacy L. Turner, MS, CRC, CVE, CLCP, is a Certified Life Care Planner and Vocational Consultant with RPC. She has over 20 years of experience in Rehabilitation. Ms. Turner has experience writing life care plans for both plaintiff and defense clients. She has experience as a rehabilitation consultant in three states and has been qualified as a testifying expert in state and federal court.  

Ms. Turner has worked on cases in several states as well as the country of Trinidad. To determine the pre-injury and post-injury employability in personal injury cases, she provides vocational testing, transferable skills analysis, job requirements analysis, rehabilitation plans, and definition of reasonable accommodations under the American with Disabilities Act. She is a member of the International Association of Rehabilitation Professionals, the Texas Association of Rehabilitation Professionals and Providers of Services, and Vocational Evaluation and Career Assessment Professionals.

Brian Piper, PhD,  is an Economist with RPC specializing in Quantitative Analysis and Modelling. He works on a variety of cases including personal injury and certificate of need. He is experienced in data extraction, management, simulation, and analysis using STATA, SQL, ARC GIS and a variety of other programs. Dr. Piper has taught graduate classes in statistics and econometrics in both MBA and Ph.D. programs.

Dr. Piper is an experienced expert, providing testimony, reports, and affidavits on the issues of economic damages in personal injury litigation, healthcare litigation, False Claims Act litigation, and other commercial litigation. He has testified on behalf of plaintiffs and defendants. 

Dr. Piper specializes in the economics of healthcare. He has been retained by healthcare providers and insurers in payment disputes. He has analyzed the reasonableness of charges and expected payment for past and future medical services for providers, insurers, plaintiffs, and defendants. Besides work in litigation, Dr. Piper has provided analysis of Certificate of Need applications and the economic impacts of proposed legislation.