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:
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:
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.
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:
Dawn Cook Consulting is based out of Las Vegas, Nevada but provides services nation wide. Services include life care plans, life care plan rebuttals, past medical bill reviews and future medical cost projections for plaintiff and defense attorneys. Life care plans are developed for individuals with injuries or chronic conditions requiring complex long-term healthcare intervention and management. The report provides an organized, concise plan that estimates the reasonable and necessary current and future healthcare needs with the associated costs.
Dawn Cook is licensed Registered Nurse (RN) who has worked with serious and catastrophic illness and injury for over 30 years including clinical settings and home care. Dawn is an experienced life care planner who holds the certified life care planner (CLCP) and certified nurse life care planner (CNLCP) designations.
Dawn has completed over 600 medical damage reports in 28 states in life care planning and has testified as an expert witness at deposition or trial over 70 times since 2012. Dawn has testified at Federal Court in Illinois and New Mexico and at State Court in California, Nevada and New Mexico as an expert in life care planning. Dawn has also testified in Nevada State Court as an expert in past medical bill reviews.
Dawn enjoys working both plaintiff and defense cases; from complex birth or brain injuries to trucking and motor vehicle accidents, each case requires attention to detail and consistent methodology.