Managed Care Liability Expert Witnesses: 14

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.

Thank you for viewing my profile.  Please click this link to view my CV.

2020 07 21 Michael F Arrigo Expert CV and Supplemental Material WATERMARK NOT RETAINED.pdf

Please view a ruling published in Westlaw by U.S. District Judge Ronald S. Lew pertaining to my expert qualifications here:

United States v Pacific Health Corporation.pdf

For more about me, please click here:

https://noworldborders.com/expert-witness/ 

I am the Managing Partner, Healthcare Practice for our firm.  We work with health systems, health IT companies, and health plans. My 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

Hospital liens in personal injury cases without considering insurance as a collateral source

Medicare fraud, Medicare damages, Managed Medicaid, capitation, rate setting. Federally Qualified Health Centers (FQHC)

• 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.

Related posts :

Medical Billing Expert Witness

https://noworldborders.com/expert-witness/medical-billing-expert-witness/

HIPAA Expert Witness

https://noworldborders.com/expert-witness/hipaa-privacy-and-security/hipaa-expert-witness/ 

Healthcare Intellectual and Property, particularly pertaining to insurance claims processing, medical coding, medical billing and information privacy:

https://noworldborders.com/expert-witness/healthcare-patent-expert-witness/ 

Grace T. Mondina, DNP, MSN, RN, PHN, has 14 years of experience as a Nurse in Skilled Nursing Facility / Long-Term Care and 6 years as a Case Manager and Post-Acute Care Management. 

Ms. Mondina has served as an Expert Practice Consultant for the California Board of Registered Nursing. She is currently an Expert Witness for the Department of Justice, where she reviews investigative case materials and prepares written opinions and assists investigators, prosecutors, and administrative law judges in understanding the nursing aspects of a case.

 Ms. Mondina also serves as a mentor for the Master of Science in Nursing (MSN) students from the University of San Francisco.

Litigation Support: Ms. Mondina is available to review medical records, medical facts, and other medical situations for standard of care. She is licensed in California, Arizona, and Colorado.

Areas of Expertise:

Nursing Standard of Care Long Term Care (LTC) Skilled Nursing Facilities (SNF) Nursing Homes Geriatrics Title 22

Post Acute Care Nursing Case Management Pressure Ulcers / Bed Sores / Wounds Falls Restraints Medication Errors

William (Bill) C. Mohlenbrock, MD, FACS, 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.

In addition to orthopedic experience, Dr. Mohlenbrock is a nationally recognized expert in the objective assessment of hospital medical outcomes, Clinical Quality and Cost Efficiencies for inpatient care. He has consulted for hospitals who have found themselves in potential legal situations where the quality of their clinical care has been called into question.

Dr. Mohlenbrock received his BS degree from the University of Illinois and his MD from the St. Louis University School of Medicine. He holds fellowships in the American Academy of Orthopaedic Surgeons, American College of Surgeons and the American Association of Physician Leadership. He is a noted lecturer and has published numerous articles on measuring and improving the quality and cost efficiency of medical care.

Comprehensive Quality Data used to Defend Hospitals for Med Mal

Litigation Support - Attorneys wishing to take advantage of Dr. Mohlenbrock's orthopedic and quality assessment experience as well as his communication skills, will receive unbiased, evidence-base opinions. He assists the legal profession whose clients are either plaintiffs or defendants.

Areas of Expertise:

Orthopedic Surgery Adult Reconstructive Surgery Total Joint Surgery Scoliosis Surgery Arthroscopy Surgeries

Sports Medicine Sport-related Injuries Hospital Medical Outcome Assessments Medical Care Efficiency Medical Care Quality

View Dr. Mohlenbrock's Consulting 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

Kenneth C. McCawley RN, BSN, VWCN, CICP, has been a Nurse since 1992, and is a Combat Decorated Military Veteran who was active and served as a “doc” in the field. He is now a retired Major.  

Mr. McCawley started the open heart program at CMC hospital in Scranton PA, has worked in trauma and ICU, and has 23 years of experience as a successful Director of Nursing, writing policies and ensuring compliance with federal and state regulations,. He also served as Senior Clinical Specialist for a national healthcare company.  

Mr. McCawley is currently the director of nursing for a 120-bed rehab facility in Pennsylvania. He has extensive experience in working in skilled nursing facilities where he deals with pressure ulcers, wound care, and nursing home falls. He has reviewed cases for attorneys on Nursing Home Negligence and has been deposed and/or testified numerous times.

Areas of Expertise:  

Pressure Ulcer /Pressure Ulcer Prevention Arterial Ulcer Diabetic Ulcer Wound Care Bedsores

Pressure Sores Nursing Homes Nursing Home Falls Nursing Home Fall Prevention Certified Infection Control Preventionist through CMS

Education: Diploma Prepared Registered Nurse (RN), Community Medical Center School of Nursing, Scranton PA; Bachelors of Science in Nursing (BSN), Penn State University; Critical Care Registered Nurse (CCRN), National Certification; Wound Care Certified, VOHRA National Certification

View Tracy Liberatore's Attorney / Physician Assistant Consulting Profile.

Vipul Kella, MD, MBA FACEP is a board-certified Emergency Medicine Physician who has been practicing for 15 years. Dr. Kella is a Fellow, of the American College of Emergency Physician, and is licensed in Advanced Cardiac Life Support (ACLS) and Advanced Trauma Life Support (ATLS).

Prior to his current position as a Physician and Partner in a multispecialty national acute care services company, Dr. Kella was Chief of a regional health system managing 100,000 patient visits in Frederick, Maryland. His responsibilities included developing quality initiatives, improving operations and efficiencies, patient experience, staffing, and recruiting.

Dr. Kella has delivered seminars and given presentations on healthcare administration, fraud and abuse, critical care, myocardial infarction, trauma, aortic dissection, sepsis and shock, and medical ethics

Litigation Support: Dr. Kella has served as a medical expert for 10 years. He has reviewed over 100 cases, and spent over 1,000 hours on case reviews and preparing reports.  He is dedicated to providing expertise to clients in a variety of areas, including medical malpractice, personal injury, forensics, disability, and others. 

Over the past ten years, Dr. Kella has been retained in the following areas: 

Emergency Medicine Critical Care Medical Negligence Forensics and Sexual Abuse Standard of Care

Nursing Home Liability Wrongful Death Independent Medical Examination Medical Device Liability Medical Fraud and Abuse

Areas of Expertise:

Critical Care Medicine                                                                      Emergency Medical Services Health Care Economics HIPAA Hospital & Medical Ethics Hospital Administration Medical Devices Medical Fraud

Medical Records Nursing Homes Wrongful Death Myocardial Infarction Trauma Aortic Dissection Sepsis Shock

View Dr. Vipul Kella's Consulting Profile.

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:

Medicare False Claims Act (FCA) Health Insurance HMO Medicare Advantage Provider / Payor Disputes Claims Audits and Appeals Federal Employees Health Benefits Plans (FEHBP)

Medicare Part D Government Audits DME Home Health Care Hospice Managed Care Contracting Anti-Kickback Compliance Self-disclosures

View Mary Wickens' Consulting Profile.

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. 

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 delivers speaks and delivers seminars throughout the nation on topics including dementia, exercise for aging adults, falls and fall risk mitigation, and Person-Centered Care.

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
• Catherine Worthingham Fellow of the American Physical Therapy Association Award

Litigation Support - Dr. Ciolek is available as an expert witness for attorneys representing plaintiff and defendant. Her services include medical record review, thorough reporting, depositions, and trial testimony as needed.

Areas of Expertise:

Falls Nursing Home Negligence Dementia Functional Decline Person-Centered Care Nursing Home Standard of Care Goals of Care Long Term Care Continuing Care Retirement Communities

Resident Rights Independent Living Transfers Restraints Safety Anti-psychotics Home Health Exercise Pain

View Dr. Cathy Ciolek's Consulting Profile.

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

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.

Cruzora Physician Solutions, PLLC are board-certified, licensed and actively practicing Physicians and Life Care Planners. Cruzora specializes in Medical-Legal Documentation Review and Assessment Reports. We pride ourselves on the highest quality medical reports and expert testimony. 

Litigation Support: Cruzora provides objective, defensible and unbiased opinions in a clear and easy-to-understand format. We work with clients, plantiff and defense attorneys, insurance and government agencies. As physicians, we can independently formulate medical opinions and conclusions. 

Cruzora physicians are well-versed on standards of care and delivery of medical services within the healthcare community. Our services are available nationally and internationally.

Medical-Legal Services:

Life Care Planning due to Catastrophic and Non-Catastrophic Injuries Medical Cost Projections Medical Records Review with attention to Causation and Liability Life Expectancy Hospital Institutional Medical Errors

Third Party Physician Documentation Reviews Determination of Required Medical Services Reasonableness of Past Medical Care Future Medical Costs Associated with the Elderly Expert Witness Designation

Yolanda Anderson, RN, BSN, CEN, CLNC is a Registered Nurse and has been working in the Emergency Department for more than 25 years. A Certified Legal Nurse Consultant with a detail-oriented approach, Ms. Anderson is knowledgeable about all aspects of Hospital Care and Standards of Care for Physicians, Nurses and Ancillary Personnel.

Ms. Anderson's background experience includes work in the Emergency Department of Los Angeles County, USC Medical Center, a level I Trauma Center and 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 worked 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.

Ms. Anderson has been retained as an Expert 27 times. Her litigation support services include chart review for merit, chronologies, medical care research, Independent Medical Assessments, and more. Ms. Anderson's services are available to attorneys for both Plaintiff and Defense.

Areas of Expertise:

Emergency Department Care Inpatient Hospital Care Trauma, Cardiac, Neurological Emergency Adult, Pediatric, and Infant Care

Triage & Documentation Nursing Home Care Electronic Medical Records Worker's Compensation

View Yolanda Anderson's Consulting Profile.

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