2 Blue Cross/Blue Shield Companies Expert Witnesses Found

Results Sorted Below by State

Glenda E Flemister, MD, FACP, FCCP Medical Health Solutions.us

Frankfort, Illinois
Pulmonary Critical Care Medicine, Critical Care Medicine - Medical Management, Medical Utilization & Location of Care, Fraud & Abuse, Compliance, Medical Necessity, Medical Devices, Pharmacy Management, Genomics & Personalized Health, Insurance Reviews of Plan Benefits, Insurance Clinical Policy Reviews, Long Term Acute Care & Long Term Care,
...Over 12 years of experience in national insurance and payer companies. Has served as Medical Director for Aetna, Blue Cross Blue Shield Association, and interim CEO for Next Level Health Partners. Consultation services to companies and manufactures in various areas, (pharmacy, genomics, medical devices, medical management, utilization, etc.), regarding healthcare medical necessity, compliance and educational issues. Fraud and Abuse. Government plans: Medicare & Medicaid. Private insurers all plans: HMO, PPO, Specialty networks. Expert reviews and medical litigation support performed. Sub-specialty medical reviews in Pulmonary and Critical Care Medicine. Current license: Illinois; New Mexico; Oklahoma; Kentucky; New Mexico

Frank L Brown, Jr, MD, MBA, FACP AMERICLIN FORENSIC CONSULTING

Bluffton, South Carolina
HMO, Medical Management - Accountable Care, HMO & Managed Care, Appeals & Grievances, Hospital & Provider Credentialing, Utilization/Medical Necessity, Healthcare Fraud/Abuse, Utilization Review, Qui Tam, Physician Quality of Care, Physician Sanctions, Defamation, Disruptive Physicians, Population Health, Sleep Medicine
...Having worked for national insurance companies (Oxford Health Plans, Blue Cross & Blue Shield, Wellpoint, Anthem, Cigna), his areas of responsibility and accountability have included case management, disease management, population health management, fraud & abuse, physician credentialing, peer review, physician grievances & appeals, patient grievances & appeals, patient safety, value-based care, quality of patient care, patient outcomes, and patient safety. Metrics managed during his career include average length of stay; discharge and readmission rates; pharmacy management; physician follow-up; comprehensive quality, and patient safety metrics; emergency department visits; mental health management; and fraud & abuse by doctors and patients. He has conducted over 5,000 physician credentialing reviews; over 5,000 medical necessity/utilization management reviews; and over 2,000 patient/physician committee and in-person grievance & appeal reviews. In addition, Dr....