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:
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. Areas of Expertise:
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 43 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:
44 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)
56 years Licensed Pilot with Commercial, Instrument, Multi & Seaplane Ratings
Still licensed in Illinois (44 years) & Wisconsin (37 years)
Licensed in all states for 20-25 years until 2005 (agency sold)
Rule 26 Report specialization on complex cases
Bad Faith Expert nationally
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
Mr. Beringer is the Principal of Beringer & Associates (B&A) and Liability Program Management (LPM). He is an approved consultant by the A.M. Best organization, since 2006, for claims, liability, and insurance program management, including matters involving construction, OCIP, TPA, JPA, Captives, Memorandum of Coverage, and insurance coverage analysis. The Cayman Island Monetary Authority approved Mr. Beringer as a licensed captive owner in 2002 for Segregated Portfolio Company Creative Solutions, SPC.
Mr. Beringer holds an LPCS, RPA; is a founding member of CLM, a published author in various publications, and presenter at the CIMA, CPA, A.M. Best, and other conferences.
Mr. Beringer, as B&A, has provided expert services for risk analysis and management services to the insurance, reinsurance, construction, and transportation industry since 2000. Previous to the formation of B&A, he worked in the insurance industry for 30 plus years as a region Litigation Manager with Automobile Club, Industrial Indemnity, Great American, and The Hartford's Speciality Risk Service. Since B&A’s formation, Mr. Beringer assisted Reliance, AIG, Swiss Reinsurance, and Sterling Insurance for review of their insurance programs, analysis, and performance of claims systems and operations.
Mr. Beringer has participated in over 300 mediations, managed handling of over 30,000 cases in federal, state, and local venues on behalf of clients, and provided expert services to plaintiff and defense counsel.
In conducting a legal fee audit, the framework of the analysis considers three primary standards: the rules of professional services provided by the California Bar, the retainer agreement, and applicable court standards. Those three standards reflect a balance between the interests of the attorney's client and the economic interests of the attorney as a professional service provider.
Donald W. Bendure, MBA, CPCU, RPLU, RF, ACI, is an Insurance Expert with a concentration within the areas of Commercial Liability, Captive Underwriting, Professional Liability, Commercial Automobile, and Property Insurance. He has over 40 years of experience and provides services for clients nationwide. Litigation Support - Mr. Bendure provides unbiased and impartial expert testimony and litigation support services for both plaintiff and defense attorneys. He has currently completed over 350 engagements. Mr. Bendure serves as a Pre-litigation Consulting Expert, a Policyholder Expert Witness, and an Insurance Defense Expert Witness. Mr. Bendure's particular area of expertise in the areas listed below is within the discipline of Underwriting and Insurance Coverage. He possesses specialized knowledge of Captive Insurance and commercial insurance as they relate to coverage issues, particularly within pollution, environment, construction, oil and gas exploration, risk mitigation, enterprise risk management, self-insured and retention programs, and claims made policy language. Expertise:
Hugh W. Black CPCU, ARM, AIC, CCLA, entered the Insurance Industry in 1974 and has spent the last 45 years reviewing and analyzing thousands of claim files for several different insurance companies and third party administrators. This experience has given him tremendous insight into the custom and practice of insurance claims departments.
Devonshire Group (2002 – 2004) Claims Analyst - Responsible for the handling of over 100 litigated Construction Defect claims on behalf of several Lloyds of London syndicates. Responsibilities included coverage analysis; issuing reservation of rights letters; setting reserves; controlling and directing defense counsel and coverage counsel; controlling and directing the investigation of independent adjusters; attending mediations and mandatory settlement conferences; reporting to the lead syndicate in London; and negotiating settlements
West Coast Casualty Service, Inc. (1998 – 2002) Branch Manager/Claims Adjuster - Technical & Administrative responsibility for four adjusters and two secretaries for the handling of Construction Defect, General Liability, Automobile, and Property claims. Handled 40 to 60 complex Construction Defect and General Liability claims
Mr. Black is available to consult as an expert witness in cases involving: