Curriculum Vitae

Curriculum Vitae of Phil Hefner

 

Blue Cross Blue Shield of Missouri, 1971 to 1995

North American Equipment Dealers Association, 1995

National Insurance Service, 1996 to 1997

Health Insurance Services, 1997 to present

Blue Cross Blue Shield of Missouri

Medicare responsibilities included:

·        Director of the Medicare Part A Intermediary Claims Operations

·        Manager of Corporate Medical Review

·        Manager of Quality Assurance

·        Manager of Medicare Fraud and Abuse Department

·        Implementation Officer for Medicare Prospective Payment System [DRG Reimbursement]

·        Implementation Officer for Medicare Laboratory Fee Schedule Reimbursement

·        Appeared in four part television series, The Medicare Maze, KMOV television, St. Louis CBS affiliate, hosted by medical reporter, Al Wyman, KMOV television

·        Speaker at the first National Continuous Ambulatory Peritoneal Dialysis Seminar, Kansas City, MO

·        Speaker for the Missouri Hospital Association on Medicare Prospective Payment System

·        Co-panelist with United States Representative, Leonore K. Sullivan, D-MO, at St. Louis County Senior  Citizen Program regarding the impact of the Medicare Prospective Reimbursement System on the Medicare beneficiary

·        Co-speaker with broadcast personality Anne Keefe of CBS owned and operated KMOX Radio, to senior citizens on Medicare benefits.  Program sponsored by the Social Security Administration and KMOX Radio

·        Member, HCFA Claims Processing and Benefit Interpretation Technical Advisory Group, Baltimore, Maryland 

·        Member of the National Medicare Systems Technical Advisory Group, Baltimore, Maryland

·        Author of three sections of the winning proposal for the first competitively bid Medicare Part A contract in the United States

·        Implemented the first Quality Assurance Program for Medicare Part A Operation.

This program resulted in a ZERO per cent failure rate assuring assessment of no liquidated damages under the terms of the contract with HCFA.

·        Member of the American Guild of Patient Account Managers

·        Member of the Healthcare Financial Managers Association

·        Intermediary Chairperson, Missouri Association of Home Health Agencies, UB-82 Implementation Committee

·        Contributing editor to the Missouri Association of Patient Account Managers monthly periodical

·        Intermediary liaison to the Missouri Association of Home Health Agencies

·        Implementation Officer, HCFA Contractor Performance Evaluation Program of Medicare Contractors

·        Liaison Officer for GAO audit of bill payments and general contract compliance

·        HCFA liaison, Contractor Performance Evaluation Program

·        Sampling and audits of bills, medical records and inquiries

Blue Cross Blue Shield Operations

Private-side responsibilities included:

·        Manager of Coordination of Benefits

·        Director of National Accounts

·        Director of Custom Accounts

·        Director of National Accounts Service Company, [NASCO]

·        Member of the NASCO Planning Committee, Atlanta, Georgia

·        Liaison Officer for United Auto Workers Employee Benefits Representatives for Region Five, Headquarters, St. Louis, Missouri

·        Liaison Officer for employee benefits, Peabody Holding Company, Enterprise Rent-A-Car, General Motors, Chrysler Corporation, Southwestern Bell Telephone and Service Master

·        Liaison officer for Hewitt and Associates;  Peabody Holding Companies external quality consultant

·        Implemented first time use of microfilming of claims history files

·        User Implementation Coordinator of numerous mainframe computer systems installations, design and conversion

·        Co-authored winning proposals for insurance coverage for Enterprise Rent-A-Car, Peabody Holding Company, General Motors, Chrysler Corporation, Wal-Mart, DePaul Health Systems, State of Missouri Employees Retirement System, and others

·        Speaker, NASCO Annual Participating Plan Meeting on Productivity Improvements, Stone Mountain, Georgia

·        Sampling and audits of thousands of HCFA-1500 bills

National Insurance Service

·        Retained by attorney, Arch C. McColl, III, Dallas, Texas, as an expert witness, United States V. Burgos; prepared affidavit and exhibits for appeal

·        Retained by attorney, Jeff Kearney, Ft. Worth, Texas, as an expert witness, United States V. Yentis: testimony before Federal Court Judge McBryde at sentencing hearing resulted in a sentence reduction for Yentis and led to a change in the Federal prosecutors calculation of damages in the North Texas Region


 

Health Insurance Services

Expert research and testimony and depositions:

·        Retained by attorney, Tim Evans, Fort Worth, Texas, member of the board of directors of the National Criminal Defense Lawyer’s Association, in the IRS and FBI investigation of an Arlington, Texas physician

·        Retained by attorney, Arch C. McColl, III, Dallas, Texas, in the government’s largest investigation to-date, that of a Columbia/HCA physician in El Paso, Texas

·        Retained by attorney, Arch. C. McColl, III, Dallas, Texas, in the FBI and IRS investigation of a Plano, Texas physician

·        Retained by attorney, J. R. Hobbs, Kansas City, Missouri, in the case of the State of Missouri V. Boone County Retirement Systems and Pat Rackers, Administrator

·        Retained by attorney, Robert J. Bray, Jr., Philadelphia, Pennsylvania, in a successful civil case Jury verdict in favor of Bray’s client returned March, 1999

·        Retained by attorney, Michael Gagleard, Birmingham, Michigan, in a qui tam action

·        Retained by attorney, Tom Hayes, St. Louis, Missouri, in the FBI investigation of a Missouri social worker

·        Retained by McLean, Virginia law firm of Grayson and Kubli as expert witness in sealed qui tam action, February, 2000, deposed by Washington, D.C firm of Ropes and Gray

·        Retained by McLean, Virginia law firm of Grayson and Kubli law firm as expert witness in sealed qui tam action, March, 2000, deposed by Washington, D.C law firm of Reed-Smith

·        Hired by Olathe, Kansas nurse to complete OIG Integrity Audit, June, 1999

·        Hired by Colorado pharmacist to complete OIG Integrity Audit, March 2001

·        Hired by Wagstaff and Cartmell, Kansas City, Missouri law firm to consult on a civil action, August, 2001

·        Development of a Medicare Compliance Program for a Nevada Cardiology Group, December, 2001

·        Retained by Dallas, Texas attorney in the federal investigation of a Texas physician, 2003

·        Retained by a Ohio attorney in 2003 for the defense of a physician in a civil suit filed by a patient.

Medicare Compliance Audits:

·        Naples, Florida, The Willows at Naples Hospital, April 1998

·        Cleveland, Tennessee, anesthesiologists group, May 1998

·        Knoxville, Tennessee, five anesthesiologists groups, June 1998

·        Pennsylvania, Wilmac Corporations’ five Skilled Nursing Facilities, July 1998

·        Compliance Audit of a Nevada Cardiology Group, December, 2001

·        Compliance Audit of a Nevada Cardiology Group, June 2002

·        Compliance Audit of a Nevada Cardiology Group, January 2003

·        Compliance Audit of a Nevada Cardiology Group, September 2003

·        Compliance Audit of a Nevada Cardiology Group, May 2004

·        Compliance Audit of a Nevada Cardiology Group, October 2005

·        Compliance Audit of a Nevada Cardiology Group, May 2005

·        Compliance Audit of a Nevad Cardiology Group in 2006 and 2007.


 

OIG Corporate Integrity Audits

·        Olathe, Kansas Home Health nurse, June 1999

·        Colorado pharmacist, April 2001

·        Colorado pharmacist, April 2002

·        Colorado pharmacist, April 2003

·        Colorado pharmacist, April 2004

·        Colorado pharmacist, May 2005, 2006 and 2007.

Former Associate Member, National Criminal Defense Lawyers Association