1 2015 Regional Meeting January 29, 2015 Confirmed Speakers Rey Alvarez Rey (Reinaldo) Alvarez is the Managing Attorney for the Workers Compensation and Medicare Compliance Division of Luks, Santaniello. He also serves as the WC Committee Chair for the Florida Defense Lawyers Association (FDLA). Martindale Hubbell and his peers have also rated him AV Preeminent. Rey has substantial WC experience defending employers, insurance carriers, tpa's, government entities and self insureds throughout Florida. He also has more than a decade of experience in preparing Medicare Cost Projections, Medicare Set Asides and Conditional Lien negotiations with CMS. Rey handles all firm wide conditional lien negotiations. Prior to working at Luks, Santaniello, Rey managed a Medicare Reporting and Set Aside Department with his last firm. Rey authored and published a book on the new Medicare Reporting and MSA requirements. More recently, he coauthored with Dan Santaniello, a Medicare White Paper that was presented at the 15th Annual Florida Liability Claims Conference and was published in the FDLA issue of 'Trial Advocate Quarterly' (Volume 30, Number 4, Fall 2011). Rey also wrote an article on Reducing the Cost of Funding a Medicare Set Aside that was published in the Florida Bar Workers' Compensation Section 'News & 440 Report' (Summer 2011). A.M. Best released an Insurance Law Podcast (2012) featuring Dan Santaniello and Rey Alvarez discussing Medicare Compliance issues. Rey spoke in January 2014 at the NAMSAP Regional Conference on WC MSA trends and impact, reporting and conditional liens. He was a featured speaker at a Medicare Lien boot camp sponsored by the National Business Institute in November Rey was a speaker at the American Academy of Disability Evaluating Physicians on WC Impairment Ratings and Impairment Benefits. He also spoke in an AM Best Insurance Law pod cast on the SMART Act. Rey also possesses substantial knowledge of the Social Security Disability law and has represented all types of Social Security Disability matters. He also writes a blog on current Workers' Compensation case law and important decisions. It can be viewed at Rey works out of the Miami office and directs the assigned teams in Jacksonville, Tampa, Orlando, and Tallahassee. Monika Boswein, INS, AIS, AIC, CMSA Monika Boswein is a Claims Consultant for ACUITY, a Mutual Insurance Company and has been with the company since Monika is responsible for Project Management, Coverage Analysis, Training, Auditing, and Medicare Compliance. She was previously employed as a Senior Inside Claim Representative for ACUITY. Monika has an Associate in General Insurance, Associate in Claims and is a Certified Special Master Arbitrator. Brian M. Chance, MBA, CPCU, AIC Brian Chance holds his Bachelors of Science in Management from Rutgers University, and his masters of Business Administration from Drexel University. Brian has been with ECBM, Inc. & The Graham Company from 1991 to 1995 Graham., and ECBM since Brian has been a Commercial Insurance Broker for 20+ years, with concentration in claims management and oversight. Brian currently oversees the handling of all of the workers compensation and liability claims for several different clients. These clients annually report over 12,000 claims worth over $60,000,000 each year all over the country and to different degrees retain liability for the payment of the first several hundred thousand dollars of each claim. Over the course of my career I ve been responsible to oversee the handling of at least 25,000 workers compensation and liability cases all over the country. On a daily basis Brian am responsible for establishing claim handling procedures and guidelines, reserve and settlement authority, auditing claim files, advising adjusters and defense counsel on strategy, deciding which strategy to employ, Page 1 of 5
2 recommending investigations, selection of service providers including TPA s, investigators and medical case management and repricing companies. All of the above are done to assist the client with lowering the cost of their claims and ensuring compliance with generally accepted claim handling procedures. For the 3 years prior to Graham and ECBM, Brian was a Claims representative for CIGNA and ESIS in their Marlton, NJ office. William A. Delaney, MSCC William A. Delaney is a partner at Nyhan Bambrick Kinzie & Lowry focusing on Workers Compensation and Employer Liability and Medicare Secondary Payer Compliance and Medicare Set-Asides. Prior to joining Nyhan Bambrick Kinzie & Lowry, Mr. Delaney held positions as assistant defender for the Office of the State Appellate Defender, Second District in Elgin, Illinois; Law Clerk to Justice Marvin D. Dunn, Illinois Appellate Court, Second District, Geneva, Illinois; Associate at Linder, Speers & Reuland, P.C.; and the Senior Staff Attorney at Hartford Insurance Company, concentrating on defense of Workers Compensation claims and defense of personal injury cases. Mr. Delaney received his Bachelors of Administration in History from the University of Notre Dame and J.D. Cum Laude from New England Law. Mr. Delaney holds memberships in the Workers Compensation Lawyers Association and NAMSAP. Rasa E. Fumagalli Rasa Fumagalli holds a law degree from IIT s Chicago Kent College of Law with an undergraduate business degree from the University of Illinois. Prior to joining Protocols, she spent over twenty years specializing in workers compensation defense work in the Chicago area. She has worked for private firms as well as in-house counsel for several insurance companies. Rasa oversees quality control in Protocols product line and is an active member of the Evidence Based Medicine Committee of the NAMSAP trade group. She is admitted to practice law in the State of Illinois and holds a Medicare Set- Aside Consultant Certification. Roy A Franco Over the past two decades, Roy A Franco has emerged as one of the principal architects of policies and practices that define the world of Medicare Secondary Payer (MSP) compliance. From his experience as Director of Risk Management for Safeway, Inc. from , he realized the need for greater clarity and efficiency in matters related to Medicare compliance. Pursuant to that realization, he became a serious student of Medicare policy and its impact on risk management and revenue. This, in turn, prompted him to work for reform of Medicare regulatory policy. The Medicare Advocacy Recovery Coalition (MARC) became the chosen vehicle for that reform effort. Founded in 2008 by Franco and other persons interested in Medicare policy, its membership comprises most sectors of the MSP-regulated community, including plaintiffs, defense attorneys, brokers, trade associations, and third part administrators. The coalition s primary mission is to advocate for MSP on behalf of Medicare beneficiaries and companies. Its major achievement to date is the Strengthening Medicare and Repaying Taxpayers (SMART) law of Drawing on his experience with Safeway and MARC, in 2011 Roy Franco and Jeff Signor founded Franco Signor LLC, which specializes in Medicare compliance. In his capacity as Chief Legal Officer, Roy Franco continues to lead national efforts to streamline the world of Medicare Secondary Payer compliance. He is the Co-Author of Medicare Secondary Compliance, which may be found on the Juris Publishing website. Allison Haley Allison Haley is an attorney with the firm O'Meara, Leer, Wagner & Kohl, P.A. She concentrates her civil litigation practice in the areas of Medicare Secondary Payer compliance, general liability litigation, and worker's compensation. She speaks nationally on the issue of Medicare Secondary Payer compliance in litigation. She focuses on creating and implementing Medicare Secondary Payer compliance protocols for national corporate insurance clients. She is a Medicare Set-Aside Consultant Certified by the International Committee on Health Care Certification.
3 Daniel W. Hayes Daniel W. Hayes is a partner with Teague Campbell Dennis & Gorham, LLP s Asheville, North Carolina office, where his main area of practice is workers compensation. He has been designated a Medicare Set-Aside Consultant Certified (MSCC) by the International Commission on Health Care Certification. Mr. Hayes presents regularly to national and local organizations on the topic of Medicare Secondary Payer issues and in 2014 launched the website to further educate attorneys, mediators, and insurance professionals on the role of considering and protecting Medicare s interests in workers compensation and liability settlements. Mr. Hayes is currently licensed in South Carolina and North Carolina. He has been included in Best Lawyers in America for workers compensation law from 2010 to the present and was chosen by his peers to be listed as a Rising Star in the South Carolina Edition of Super Lawyers. He is peer-review rated AV-Preeminent by Martindale-Hubbell. Mr. Hayes earned his B.S. degree from the University of South Carolina Honors College and his J.D. degree from the University of South Carolina School of Law. Anita Hunt Anita is a graduate of North Carolina Central University and received her legal training at NCCU School of Law. Shortly after graduation she founded The Hunt Law Firm, PLLC (HLF) in The Firm started as a general practice representing clients in both civil and criminal matters. Currently, Anita and her husband Ralph, work and practice together at The Hunt Law Firm. Anita has participated in and completed several National Institute for Trial Advocacy (NITA) programs and courses including Trial Advocacy Skills and Deposition courses. A longstanding member of the North Carolina Advocates For Justice (formally known as the North Carolina Academy of Trial Lawyers), she has over a sixteen years of courtroom experience and is licensed to practice in both North Carolina State and Federal Courts. As an attorney at HLF, Anita s primary concentration has been in the area of Personal Injury, Workers Compensation and Contract and Settlement negotiations. Having lectured on numerous issues relating to personal injury practices, Anita considers her niche to be the use of experts, medical or otherwise, to increase or maximize the value of an injury case. She has also served as General Counsel for various businesses and organizations. Tracey L. Jones Tracey L. Jones is a partner with Teague Campbell Dennis & Gorham, LLP s Raleigh, North Carolina office. She focuses her practice exclusively in the field of workers compensation and has extensive experience defending both insurance companies and employers throughout North Carolina. She further specializes in defending asbestosis and other occupational disease claims. In addition to her trial practice before the North Carolina Industrial Commission, she has a significant appellate practice, having defended numerous workers compensation claims before the North Carolina Court of Appeals and North Carolina Supreme Court. Ms. Jones is a member of the North Carolina Association of Defense Attorneys, North Carolina State Bar, North Carolina Bar Association, and Wake County Bar Association. She has also been a member of the North Carolina Bar Association s Workers Compensation Section Council. She has participated in numerous seminars discussing the North Carolina Workers Compensation Act and presented on numerous topics at seminars and continuing education programs for adjusters. Ms. Jones is a certified Superior Court and workers compensation mediator who enjoys educating and representing insurance companies and employers in workers compensation claims. She was designated a Medicare Set-Aside Consultant Certified (MSCC) by the International Commission on Health Care Certification. In 2010, she was designated a Rising Star in the North Carolina edition of Super Lawyers, and in 2013, 2014 and 2015 she was listed with Best Lawyers in America for Workers Compensation-Employers. Ms. Jones earned the highest (AV-Rated) ranking awarded by Martindale-Hubbell. She received her B.A. degree from the University of North Carolina at Chapel Hill and her J.D. degree from Wake Forest University. Marci Moorehead, RN, CRRN, CLCP, CRP, CMAS, MSCC Marci Moorehead, RN, CRRN, CLCP, CRP, CMAS, MSCC is a legal nurse consultant with 25 years of nursing experience. She is co-owner of Professional Resource Network, LLC with her husband who is a Certified Professional Coder offering services including medical record reviews, medical bill review/audit, second opinion medical coding, life care planning, and
4 Medicare Set-Aside allocations. She has extensive experience in multiple areas of medical legal consulting including medical records review, life care planning, Medicare Set-Aside allocations, medical cost projections, medical bill audit/review, expert witness testimony preparation, as well as expert testimony for workers compensation, life care planning, and medical bill review/audit. Ms. Moorehead holds national board certifications in life care planning (CLCP since 1998), rehabilitation nursing (CRRN since 1998), medical audit consulting (CMAS since 2010) and Medicare Set-Aside allocation consulting (MSCC since 2005). She also holds a state certification as a rehabilitation provider (CRP since 1998). She has reviewed/audited over $50,000, in medical bills including workers compensation, private health care insurance, Medicare claims, personal liability, and auto liability. She is a member of the American Association of Rehabilitation Nursing (ARN), the Virginia Association of Rehabilitation Nursing (VARN), National Alliance of Medicare Set- Aside Professionals (NAMSAP), and the American Association of Medical Audit Specialists (AAMAS). Ms. Moorehead has worked as a consultant for most of that time with clinical experience in neonatal care, adult critical care, geriatric nursing, and rehabilitation nursing. In addition to her clinical experience she has worked as an educator in geriatric nursing teaching IV certification, CPR, nurse aide certification, and in-service training. Ms. Moorhead has been involved in geriatric research coordinating and monitoring multiple studies including phase III and phase IV wound care and drug studies for Marion Laboratories, Coloplast, and Ciba Geigy. She first began working with workers compensation in First working as a field case manager then providing legal nurse consulting services such as life care planning, legal nurse review, medical cost projections, medical bill review, and Medicare Set-Aside preparation. She attended Medipro seminars for life care planning (120 hour post graduate studies) and Medicare Set-Aside preparation (32 hour program). Ms. Moorehead has worked with the Veterans Administration preparing independent living assessments for disabled veterans and serving as a consultant to the vocational case managers. Ms. Moorehead has spoken at the Department of Veterans Affairs Annual Training for Vocational Case Managers, the American Association of Legal Nurse Consultants, Central Virginia Chapter Meetings, the American Association of Consulting Pharmacists, and the American Health Care Association. She serves as an expert witness in workers compensation hearings and the civil court system for Virginia as a life care planner, medical cost expert, medical audit specialist, and medical case manager. Mark Poplizio, Esquire Mark Popolizio, Esquire is the CP of MSP Compliance and Policy at ISO Claims Partners. Mark is a nationally recognized authority in Medicare Secondary Payer (MSP) compliance. Mark practiced insurance defense litigation for ten years concentrating in the areas of workers compensation and general liability. During this time, he developed a national Medicare practice that included Medicare Set-Asides (MSA) and general MSP compliance. While in private practice, Mark represented numerous carriers, third party administrators and self-insureds. Since 2006, Mark has dedicated his practice exclusively to MSP compliance working with carriers, self-insureds, TPAs and other claims professionals in addressing MSP compliance issues. Mark is a regularly featured presenter on MSP issues at national seminars and other industry events. He provides presentations and educational training on a wide array of MSP topics, including Medicare Program Basics, MSAs, Medicare Conditional Payments, Medicare Part D (prescription drugs), and Section 111 of the Medicare, Medicaid & SCHIP Extension Act. Mark has authored numerous articles addressing several topics related to MSP matters, including a chapter in the California Bar CLE publication, Special Needs Trusts: Planning, Drafting and Administration. Mark also served as Vice President of the National Alliance of Medicare Set-Aside Professionals (NAMSAP) from Mark remains active with NAMSAP concentrating on education and legislative matters. He was also a featured instructor on Medicare and Life Care Planning issues with the former University of Florida/Medipro LLC program. Mark grew up in Wallingford, Connecticut. He graduated Summa Cum Laude from Quinnipiac University in Hamden, Connecticut with Bachelor of Science degrees in Legal Studies and Sociology. Mark relocated to South Florida in 1992 to attend law school at Nova Southeastern University School of Law in Ft. Lauderdale, Florida. While at law school, Mark served as a Judicial Clerk to the late Honorable John D. Wessel (15th Judicial Circuit, Palm Beach County, Florida) and was a research assistant for Professor Leslie Larkin Cooney. Mark graduated from Nova in 1995 and is licensed to practice law in Florida and Connecticut. He resides in Miami, Florida.
5 Doug Shaw Doug Shaw is the President of Medivest Benefit Advisors, Inc. and Medivest Allocation Services, Inc. (collectively know as Medivest). He has written and lectured frequently across the country about issues related to Medicare Set-Asides. Doug has served as President, CFO and controller for companies ranging from a large Fortune 500 company to an entrepreneurial growth company. He began his career in the international accounting firm of Price Waterhouse Coopers. He received his BS in Accounting from Florida State University and Masters in Accountancy (emphasis in tax) from Virginia Tech. He is a Certified Public Accountant, Certified Management Accountant and Certified Medicare Secondary Payer Professional. Medivest is a national leader in the professional administration of custodial accounts used in settlement of liability and workers' compensation cases and in providing Medicare Set-Aside (MSA) allocations that accurately project the claimant's future medical needs. Doug resides in Orlando Florida. Thomas Spratt As Senior Vice President Technical Operations, Tom is responsible for the Protocols Claims Management Consulting Group. He oversees assessment of clients Medicare compliance programs, training of staff and client settlement strategies for costly or complex cases involving both Workers Compensation and Liability. Tom, as AVP and Manager, was responsible for the Home Office Workers Compensation Claims Examining Unit for Liberty Mutual for 15 years. His expertise spans all state and federal statutory jurisdictions. Tom has a long record of active involvement in the insurance industry, serving on committees for the Workers Compensation Research Institute, the Property Casualty Insurers Association of America, the Strategic Services on Unemployment and Workers Compensation and the National Structured Settlement Trade Association. He is also on the faculty as a facilitator for the Certified Medicare Secondary Payer designation program (CMSP). Educated at St. Anselm College in Manchester, N.H., Tom holds a bachelor degree in Economics and Business Michael E. Westcott Michael is an associate at Ringler Associates. Michael has expertise in the use of structured settlements in the resolution of claims involving Medicare Set Asides, Workers Compensation, Long Shore and Harbor Worker Claims, Common Carrier and Trucking Claims, Complex Medical Claims, Religious Organization claims and Specialty Risk claims. Michael s business experience includes 24 years of structured settlement experience having worked for several national firms. While working for AON Brokerage at their world headquarters in Chicago, Michael served as National Vice President Technical Markets prior to joining SFA. Prior to that he served as Sales Manager for JMW Settlements of Washington, D.C. and was an officer with MWC Settlements of Wisconsin. Michael received his B.A. from the University of Wisconsin. In addition Michael holds insurance licenses in multiple states. He is a member of the National Structured Settlement Trade Association and serves as Co-Chair of the Government Benefits Committee, The Long Shore and Harbor Workers Claims Association, the Trucking Industry Defense Association and is a Charter Member of the National Alliance of Medicare Set Aside Professionals.