HMO, Managed Care, and Credentialing Expert

Specialties & Experience of this Expert Witness

Additional Information

AMERICLIN® FORENSIC CONSULTING (AFC) is a physician-led collaborative of skilled consulting clinical expert witnesses. There are currently over 50 clinicians in the AF network who seek to provide case-winning strategies for lawyers nationwide. Upon contacting us, we provide a no-charge consultation to discuss the case. Our full suite of services includes: • Free initial phone consultations with expert clinicians • Flat fee initial case reviews • Dynamic clinical case theory analysis and development Phone: (843) 949-0927 Email: [email protected] AREAS OF EXPERTISE: Accountable Care Organizations Appeals & Grievances Case Management Correctional Healthcare Disease Management Disruptive Physicians Elder Abuse Emergency Medicine Geriatrics Healthcare Fraud/Abuse HMO & Managed Care Hospital & Provider Credentialing Internal Medicine Medical Insurance Medical Necessity Patient Grievances and Appeals Patient Safety Pharmacy Pharmacology Physician Burnout Physician Credentialing Physician Defamation Physician Grievances & Appeals Physician Quality of Care Physician Sanctions Population Health Management Public Health Qui Tam Sleep Medicine Utilization Review Value-Based Care Workplace Discrimination LEADERSHIP: Dr. Frank L. Brown, Jr. serves as the Chief Medical Officer for the firm; he is Yale-educated and NIH-trained. Dr. Brown is an experienced physician executive in the health insurance industry and has been certified as a Health Insurance Executive. 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. Brown has served as an Examiner for the Malcolm Baldrige National Quality Award, as well as the National Committee for Quality Assurance. He holds patents for improved emergency patient flow system design and improved effectiveness for patient engagement in obesity, cholesterol, high blood pressure, and diabetes management. With current licensure in Kentucky, North Carolina, Pennsylvania & Virginia, Dr. Brown is board-certified in emergency medicine and internal medicine. As an experienced public speaker and communicator, he serves as Chief Medical Correspondent at station WVGB-FM in Beaufort, South Carolina.