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.
Mary C. Meinhard RN-BC, BS, JD, CLCP, MSC-C is a Nurse Attorney/ Legal Nurse Consultant, Certified Life Care Planner, Board-Certified Nurse Case Manager, and Medicare Set-Aside Consultant-Certified. She has offices in California and Nevada, and provides Medical/Legal Consulting services nationwide. She has over 35 years of experience working with catastrophically injured patients/clients as a Registered Nurse, in addition to 20+ years of experience as a California Attorney, and is retained by both Plaintiff and Defense as a consultant in Personal Injury, Medical Malpractice and Workers' Compensation cases.
Representative diagnoses include, but are not limited to:
Traumatic Brain Injury
Acquired Brain Injury
Spinal Cord Injuries / Paralysis
Complications of Pregnancy, Premature Births and Birth Injuries
Complications of Diabetes
Chronic Pain / Illness
Chronic Renal Failure
End Stage Renal Disease
Legal Nurse Consulting
Medical Record Review / Summary
Case Merit Evaluation/Standards of Care
Life Care Planning
Mini / Preliminary Life Plans
Medicare Set-Aside Allocations
Expert Fact and Opinion Testimony
Attendance at Independent Medical Exams
Litigation Support - Formulation of Discovery Plans, Preparation of Deposition/Cross Examination Questions, Conducting Medical Expert/Opposing Life Care Planner Depositions
Ms. Meinhard also holds certification from the Pepperdine University School of Law Straus Institute for Alternative Dispute Resolution and is available as a Mediator for personal injury cases of all types - especially when competing Life Care Plans are at issue.