Background and Experience

BACKGROUND INFORMATION Over 25 years of experience in the health insurance industry. Eight years as director of the Medicare Part A Intermediary operation for Blue Cross Blue Shield Director of the Medicare Intermediary Fraud and Abuse Unit Former member of the Healthcare Financing Administration [HCFA] Claims Processing and Benefit Interpretation Techinical Advisory Group Witness for the the United States government in health care fraud prosecution and in the criminal defense of health care providers indicted by federal and state prosecutors for health insurance fraud   Health Care Fraud Expert In Investigation, Research and Testimony Expert Witness for Blue Cross Blue Shield of Missouri in several St. Louis City, County and State prosecutions on numerous occasions; civil and criminal prosecutions Expert Witness for the Federal Government for Insurance Fraud case in Missouri, late 1980's. Expert Witness for the defense, United States V.Burgos Expert Witness for the defense, United States V. Yentis Retained by counsel for the review of a Columbia, HCA physician client in El Paso, Texas, under FBI investigation; indictment pending. Retained by a Fort Worth, Texas attorney for a physician under IRS and FBI investigation for Medicare, Medicaid and insurance fraud. Retained by counsel in the case of the State of Missouri V. Boone County Retirement Center, Inc. and Patrick D. Rackers Retained by counsel in the matter of a psychiatrist under FBI and OIG investigation for health insurance fraud, February, 1998 Retained by a Dallas, Texas attorney in November, 2002 to assist in investigation and research for a physician under federal investigation. Retained by a Dallas, Texas attorney on numerous cases to assist in the investigation and research of physicians under federal investigation from 2002 to present. Retained by numerous attorneys in qui tam actions from 2000 to 2007   COMPLIANCE AUDITS Compliance Audit of Florida Psychiatric Hospital, April, 1998 Compliance Audit of Cleveland, Tennesse Anesthesiology Group, April 1998 Compliance Audit of Knoxville,Tennessee Anesthesiology Group, June, 1998 Compliance Audits of Five Pennsylvania Skilled Nursing Facilities, July 1998 Development of a compliance program for a Nevada cardiology group in December, 2001 Compliance audits of a Nevada cardiology group in 2001, 2002, 2003, 2004, 2005, 2006 and 2007.   INTEGRITY AUDITS Completion of an Integrity Audit for a Kansas home health nurse in July 1999. Completion of an Integrity Audit for a Medicine Shoppe Pharmacy in 2001, 2002 2003, 2004, 2005, 2006 and 2007.       CIVIL CASES Retained in a major midwestern qui tam case, July 1998, case still pending. Retained in a "sealed" civil suit, June 1998, Judgement in favor of the plaintiff. Retained in a "sealed" qui tam action in March, 2000. Case awaiting trial. Retained in a sealed qui tam action in June, 2000. Retained by a North Carolina law firm in a case involving negligience resulting in an alleged wrongful death and possible false claims in 2002. Retained by an Ohio attorney in mid 2003 to assist in the defense of a physician defendant sued by a patient. Retained by two Dallas, Texas law firms in 2005 and 2006 for the preparation and presentation of an affidavit reporting fraud to the United States Attorney involving millions of dollars of fraud. Retained by a Michigan attorney in June of 2007 as an expert witness in an oingoing qui tam action. Qui Tam Relator     COMPLIANCE AUDITS AND COMPLIANCE PROGRAMS Compliance audits are performed in accordance with the OIG guidelines. Compliance plans are developed in accordance with the OIG model compliance plans. Compliance audits and compliance plans are individually and specifically developed for the client to address specific areas of concerns. A qualified Compliance Contact for Corporate Integrity Agreements. A qualified Independent Review Organization (IRO) for Corporate Integrity Agreements.         Eight years as director of the Medicare Part A Intermediary operation for Blue Cross Blue Shield Director of the Medicare Intermediary Fraud and Abuse Unit Former member of the Healthcare Financing Administration [HCFA] Claims Processing and Benefit Interpretation Techinical Advisory Group Witness for the the United States government in health care fraud prosecutions, and wintess for the defense in the criminal defense of health care providers indicted by federal and state prosecutors for health insurance fraud

pahefner01@sbcglobal.net