Contact this Expert Witness
- Phone: (843) 949-0927
- Cell: (843) 949-0927
- Fax: 843-837-7778
Specialties & Experience of this Expert Witness
General Specialties:Medical Management and Insurance
Specialty Focus:Accountable Care Organizations (ACO), Health Insurance, Grievances, Pharmacology, Provider Credentialing, Medical Management, Medical Necessity, Medicare, Medicaid, Healthcare Fraud & Abuse, Medical Billing & Coding, Medical Utilization, Utilization Review, Qui Tam, Clinical Case Theory Development.
Education:MD, Yale University School of Medicine; MBA, Virginia Commonwealth University; BS, Pharmacy, Howard University College of Pharmacy
Years in Practice:> 30
Senior physician executive in the health insurance industry, with licensure in Kentucky, North Carolina, Pennsylvania, and Virginia. Certified as Health Insurance Executive. National insurance companies worked for include Oxford Healthplans, Blue Cross & Blue Shield, Wellpoint, Anthem, and Cigna. Responsibilities have included case management, fraud and abuse, physician credentialing, peer review, physician grievances & appeals, patient grievance & appeals, and patient safety. Board-certified in both internal medicine, and emergency medicine. Holder of multiple patents. Experienced public speaker. Chief Medical Correspondent WVGB-FM in Beaufort, South Carolina. Yale-educated, NIH trained. Conducted over 5,000 physician credentialing reviews; over 5,000 medical necessity/utilization management reviews; patient & physician appeals, & hearings; and over 2,000 committee and in-person patient grievance & appeal reviews. Served as an Examiner for the Malcolm Baldrige National Quality Award, as well as the National Committee for Quality Assurance.