Prof. William J. Warfel, PhD, CPCU, CLU, specializes in Insurance Breach of Contract, Bad faith, and Agent / Broker Liability issues. He has been retained in 90 cases by attorneys who represent policyholders, insurance agents, insurers, and third parties.
Dr. Warfel is widely published in applied, professional journals. His experience includes actual courtroom testimony, as well as deposition testimony in numerous cases. He has been retained in cases involving:
The purpose of this teaching case study is (1) to present an illustrative first-party legal case in which the author was retained as a testifying expert witness by a plaintiff attorney, and reference how it can be used in the classroom to illustrate important IRM concepts in an introductory, undergraduate, IRM course, and (2) encourage
Mary Wickens, JD, CFE, CHC 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.
This brief describes: Which government agencies and health care providers have power to act and what are those powers? Who controls testing and reporting results and who has the power to isolate individuals, impose quarantines and take other steps to mitigate the outbreak.
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.
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.
Jim Leatzow has 46 years of "hands-on" practical, property / casualty insurance agency experience. Leatzow has literally worn "every hat there is to wear in the P/C insurance business. He provides expert & arbitration services nationally & internationally with no charge for travel time. He is articulate, efficient & equally comfortable within the U.S. & in foreign venues. His experience includes:
46 years national Property/Casualty insurance industry experience
30 years national, Property/Casualty insurance Agency Owner
23 years national, Property/Casualty Managing General Agent (MGA)
20 years national, Third Party Administrator (TPA) insurance claim adjuster
26 years Reinsurance experience & Company Founder/President
17 years Certified insurance Arbitrator (U.S. / U.K. / Bermuda)
55 years Licensed Pilot with Commercial, Instrument, Multi & Seaplane Ratings
Still licensed in Illinois (46 years) & Wisconsin (38 years)
Licensed in all states for 20-25 years until 2005 (agency sold)
Rule 26 Report specialization on complex cases
Bad Faith Expert qualifiednationally
History of representing plaintiff & defense equally
No charge for travel time "coast to coast"
Leatzow's specialties include: Agent-Broker-MGA standards of care / Bad Faith / Coverage / Agent-Broker E&O Claims / Agent-Broker custom & practice / Professional (E&O) Liability / Claims Adjusting Standard of Care / Claims-made coverage / Surplus Lines issues / Underwriting / Licensing / Property / General Liability /Aviation Insurance