Managed Care Expert Witnesses

Napa, California

Medical Management, Risk Management - Medical Quality, Hospital and Medical Management, Hospital Compliance, Medical Compliance, HIPAA, Grievance and Appeals, Managed Care, Joint Commission, CMS, Utilization Review, Patient Safety, Hospital Governance

Dr. Geni Bennetts is an experienced physician executive in healthcare and is a Certified Physician Executive. She has been a hospital subspecialist and Chair of that division. She has chaired hospital care management and managed care compliance. She served as a hospital risk management chair. She is a founder and principal of Resolve Healthcare Consulting. She was Vice Chair, Chair of the Asset/Liability Committee and then Chair of a Bank Board, the latter position held for 5 years. She has been an examiner for the California Department of Managed Health Care and has reviewed over 40 health plans for Quality, Utilization, Grievance and Appeals, and Access and Availability. She has consulted for a number of health plans and held positions for health plans, hospitals and IPAs as consulting interim CMOs, Medical Directors, and Advisors. For the past 14 years Dr. Bennetts has consulted in the following areas of expertise: Patient safety and hospital responsibility and compliance...

Santa Monica, California

Family Medicine, Geriatrics - family medicine, primary care, general medicine, urgent care, managed care, utilization management

I have vast experience providing medical legal expertise for both medical defense as well as plaintiff counsels. I also serve as an expert for the medical board of California. I have been in clinical practice for 34 years in the Los Angeles area, 21 years in private/group practice and 13 years in outpatient family medicine in a community practice affiliated with UCLA. I also serve as medical director for the UCLA primary care network, and am involved in clinical operations as well as quality improvement activities for the primary care physicians. The network includes primary care offices as well as urgent care locations and also incorporates telehealth services. While I no longer provide inpatient care, I do maintain hospital privileges at 2 community hospitals and follow my patients closely upon hospital discharge. I have vast experience in managed care, providing utilization review for health plan beneficiaries under HMO insurance. My clinical practice includes pediatrics, ad...

Miami, Florida

Medical Genetics, Insurance - Reinsurance, Managed care, Metabolism, Inborn errors of metabolism, Brittle bones, Non-accidental trauma, Osteogenesis imperfecta, Birth defects, Cancer genetics, Prenatal, Genomic Medicine Legal Expert, Genetic Counseling Legal Consultant, Medical Genetics Legal Advisor, DNA analysis legal expert

Dr. Sajel Lala Kana is a distinguished clinical geneticist with extensive expertise in genetics and pediatrics. She is board-certified in Pediatrics by the American Board of Pediatrics (ABP) and in Genetics by the American Board of Medical Genetics and Genomics (ABMGG). With over eleven years of experience in academia and clinical practice, Dr. Kana has successfully led numerous research projects, contributed to high-impact publications, and presented her work at prestigious conferences. She is a Fellow of both the American College of Medical Genetics and the American Academy of Pediatrics. She also has a passion for biotechnology and has consulted with numerous start-ups and industry giants. Current Roles: Founder, NotBrands: Dr. Kana has developed a patent-pending supplement, Focused, using her deep subject matter expertise in metabolism. It is now commercially available for purchase (Instagram: @focusedsupp; Website: www.notbrands.com) Clinical Geneticist, Pediatric Specialist...

Chicago, Illinois

Public Health, Hospital Administration - medical necessity, utilization management, Insurance clinical policy reviews, managed care, obstetrics, gynecology

Board Certified Obstetrician and Gynecologist with more than 3 decades of experience in healthcare. Experience with peer review including 10 years on State Medical Disciplinary Board. More than a decade of experience as Medical Director on provider and payor side, authoring policies and procedures, performing medical necessity review with specialization in prior authorization.

Silver Spring, Maryland

Medical Management, Long Term Care - Home Healthcare, Managed Care, Transitional Care Management, Medical Necessity Determination, Long-Term Care Planning, Evidence-Based Care Guidelines Expert, Patient-Centered Care Expert, Geriatric Services, Utilization Review, Medical Valuation, Infectious Disease

Vera Dvorak, MD, has broad and extensive experience in a continuum of care, with over 40 years working in diverse healthcare settings including home health services, palliative care, and hospice. She has also served as medical director in all of these areas. Dr. Dvorak has been a practicing physician, a managed care executive, a strategic member of corporate leadership, and vice president and medical director of hospital-based care coordination. She has been in charge of the appeals department in various managed care organizations; and is the founder of transitional care management for one of the largest healthcare systems in Northern Virginia. Dr. Dvorak’s focus has been on medical necessity determination, appropriate discharge disposition with defined short and long-term care needs. She has been a proponent of consistently applying evidence-based care guidelines to support clinical decision-making on a case-by-case basis and across the continuum of care to maximize the potenti...

Upper Arlington, Ohio

Family Medicine, Preventive Medicine - Primary Care, General Medicine, Failure to Diagnose, Cancer Screening, Standard of Care, Internal Medicine, Managed Care, Utilazation Management, Nutrition, Exercise counseling

Board Certified by American Board of Family Medicine. Full time clinical practice in adult Primary Care, 2013-present. Voted as Top Doctor in Columbus, OH 2022, 2023. Serving on Board of Directors for the largest physician owned Primary Care Organization in the U.S., 2020-present. Highly experienced in Standard of Care. Completion of SEAK Expert Witness Training 2023. Able to provide witness consultation services to both plaintiff and defense cases.

Texas

Medical Genetics, Insurance - Reinsurance, Managed care, Metabolism, Inborn errors of metabolism, Brittle bones, Non-accidental trauma, Osteogenesis imperfecta, Birth defects, Cancer genetics, Prenatal, Genomic Medicine Legal Expert, Genetic Counseling Legal Consultant, Medical Genetics Legal Advisor, DNA analysis legal expert

Dr. Sajel Lala Kana is a distinguished clinical geneticist with extensive expertise in genetics and pediatrics. She is board-certified in Pediatrics by the American Board of Pediatrics (ABP) and in Genetics by the American Board of Medical Genetics and Genomics (ABMGG). With over eleven years of experience in academia and clinical practice, Dr. Kana has successfully led numerous research projects, contributed to high-impact publications, and presented her work at prestigious conferences. She is a Fellow of both the American College of Medical Genetics and the American Academy of Pediatrics. She also has a passion for biotechnology and has consulted with numerous start-ups and industry giants. Current Roles: Founder, NotBrands: Dr. Kana has developed a patent-pending supplement, Focused, using her deep subject matter expertise in metabolism. It is now commercially available for purchase (Instagram: @focusedsupp; Website: www.notbrands.com) Clinical Geneticist, Pediatric Specialist...