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.
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.
Cynthia (Cyndy) Minnery RN, BSN has over 30 years of experience caring for the elderly within Acute Care, Skilled Nursing, and Assisted Living Facilities. Ms. Minnery has worked as a Director of Quality Compliance in Skilled Nursing and Home Health Care. She now owns Residential Care Facilities and is familiar with the Standards of Care expected of caregivers in these settings.
John H. Fullerton, MD, MRO, CMD, CFP, FACP, AGSF, FAAHPM, FASAM is Board Certified in Internal Medicine, Geriatric Medicine, Addiction Medicine and Hospice & Palliative Medicine. Dr. Fullerton maintains active medical licenses in both California and Florida and holds additional national certificates of added qualifications as a Certified Medical Director (CMD) at multiple levels of care locally and in Home Care (AAHCP). Dr. Fullerton is a certified Clinical Forensics Expert, who has participated in nationally recognized Elder Abuse Cases, including the cases of "lay caregivers" misguidedly criminally charged with homicide or manslaughter after caring for a loved one at home with advanced dementias. He has been vetted by the Department of Homeland Security, the Department of Justice, the Office of The Inspector General, and the FBI to perform the duties of a government expert in cases of Criminal Healthcare Fraud. He has served as a key expert witness in the continuing efforts of 'Operation HEAT' and been on the winning side of three criminal convictions. Over roughly the past 14 years, Dr. Fullerton has provided independent medical expert testimony and clinical forensic medical testimony in more than 200 cases and reviewed over 1,500 files (including Medicare Audits for the Government). He has focused his medical expertise in mostly Personal Injury, Medical Malpractice, Determinations of Medicare Medical Necessity matters, and Civil & Criminal cases alleging Elder Abuse (including homicide) at either discovery, deposition or at trial testifying for both plaintiff and defense cases, respectively. Areas of Expertise:
