Partners

CES
CES LLC is a professional firm which provides intelligence, analytical and investigative services to law firms, corporate clients, and the U.S. Government.  CES has  offices in St. Augustine and Miami, Florida, Atlanta, Georgia and in Greensboro, North Carolina.    CES currently provides investigative services as a sub-contractor to Health Integrity on the SE MEDIC CMS contract. 

Carl Florez
Carl Florez is the President of CES serves as the BI Manager on the SE MEDIC contract and previously served as the BI Manager on the WIC PSC contract.    Mr. Florez retired from the FBI where he last served as the Assistant Special Agent in Charge of the Seattle FBI Division.  While with the FBI Mr. Florez oversaw Healthcare and other fraud related matters

Martina Gilly
Martina Gill is a Supervisory Investigator with CES is retired from HHS OIG where she last served as an Assistant Special Agent in Charge in the Office of Inspector General ’s Atlanta Division.  Mrs. Gilly has over twenty years of investigative experience and knowledge concerning healthcare fraud matters.

Jackson, Dunham, Sato and Associates, LLC
Veteran Owned Small Business

Ben Jackson
Ben Jackson is currently the audit manager for the Health Integrity MEDIC contract.  Ben retired as the Director of Field Operations for Medicare and Medicaid Audits, Centers for Medicare and Medicaid Audits Division, Office of Inspector General (OIG), U.S. Department of Health and Human Services in January 2004.  In that position, Ben was responsible for the technical direction and management of nationwide audits of  Medicaid and Medicare that included audits of pharmaceutical companies, Medicaid State agencies and various Medicare provider types.  Ben served four years of active duty in the U.S. Coast Guard prior to receiving his B.S. degree from Virginia Commonwealth University in Richmond, Virginia.  He was a Certified Government Financial Manager, and a Certified Fraud Examiner.

Mike Keogh
Mike Keogh currently works as an auditor/investigator for the MEDIC contract.  Mike retired in 2003 after a 31-year career in combined military and Federal civil service.  After serving in the United States Army, Mike held many different positions during his long career at the Social Security Administration and the Centers for Medicare & Medicaid Services (CMS, formerly the Health Care Financing Administration).

IMS
Operating in more than 100 countries, IMS Health is a world leader in providing healthcare market intelligence. Clients include federal, state, and local government agencies. With revenue of $2 billion in 2007 and more than 50 years of experience, IMS offers leading-edge informatics products and services that are integral to clients’ day-to-day operations, improving the delivery of quality healthcare worldwide.

Major pharmaceutical and biotech companies world-wide are customers of IMS. The unique mix of IMS experience and expertise optimizes portfolios, ensures successful launches, manages brands, and improves the effectiveness of sales teams. IMS offers:

• Unparalleled data resources and the advanced analytics and consulting expertise to put them in context.
• A strategic commitment to viewing business needs and issues from the customer's point of view.
• A continuum of capabilities - from data and applications to services and consulting that tailors offerings to match core activities common to all pharmaceutical companies.

IMS has forged long-term relationships with the industry’s decision-makers, who view IMS as a valuable partner. IMS provides clients with evidence-based, customized intelligence about the pharmaceutical and healthcare markets - delivering critical information, analytics, and consulting that drives superior client business strategies, decisions, and results.

Richard Ptachcinski, PharmD, is an expert in pharmacy operations and investigations.  Dr. Ptachcinski has experience in industry fraud and abuse auditing, operating specialty pharmacies and teaching at the university level.  He serves as the lead pharmacy investigator for the National Benefit Integrity MEDIC contractor. Dr. Ptachcinski has held several positions with the University of Pittsburgh School of Pharmacy and Rx Partners, Inc.  He is a Board Certified Pharmacotherapy Specialist and a Fellow of the American College of Clinical Pharmacy.

Clifton Gunderson LLP
Clifton Gunderson, one of the nation’s largest certified public accounting and consulting firms, provides a wide range of services to federal and state healthcare agencies.  Since the mid-1960s, Clifton Gunderson's Team Health Care has worked on behalf of federal and state government agencies to ensure that Medicare and Medicaid providers receive only what they are entitled to under federal and state laws and regulations. Our staff of audit and consulting professionals is one of the largest and most experienced in the United States. The health care services that we have provided for government agencies include:

• Health Care Compliance Services (Medicaid and Medicare)
• Fraud Investigation and Litigation Support Services
• Performance Auditing Services
• Managed Care Financial Related Audits
• Consulting Services

For more information on the healthcare services provided by Clifton Gunderson, please visit our website at http://www.cliftoncpa.com/Industries/Healthcare.

Robert Bullen, CPA, CFE
Bob Bullen is a Partner at Clifton Gunderson with over 20 years of experience relating exclusively to health care related audit and compliance services and applying Medicare and Medicaid principles of reimbursement. He also has extensive experience auditing both Medicare Advantage/ Prescription Drug plans and State Managed Care Organizations.

Andrew Ranck, CPA
Andy Ranck, Senior Manager at Clifton Gunderson, is a Certified Public Accountant with more than 10 years of experience in auditing healthcare companies.  He has extensive experience in Medicaid and Medicare reimbursement, including experience auditing both State and Federal Managed Care Organizations.

Mark K. Hilton, CPA
Mark K. Hilton is a Partner at Clifton Gunderson with over 25 years of experience relating exclusively to performing health care related services and applying Medicare and Medicaid principles of reimbursement.  He has directed Clifton Gunderson's health care fraud investigation and litigation support services provided to various agencies of the Department of Justice including the Criminal and Civil divisions of the United States Department of Justice Commercial Litigation Branch, the Federal Bureau of Investigation, and various Assistant United States Attorneys.  These services include investigation of cost report fraud and various other false claims asserted by the government.

Mir Fox and Rodriguez (MFR)
MFR, located in Houston, TX, provides services to multinational enterprises, private companies, not-for-profit organizations, colleges and universities, and government agencies. MFR has an experienced and diverse team with strong multi-lingual and multicultural capabilities. Core professional services include assurance, internal audit, healthcare advisory services, IT assurance, and domestic and international tax. MFR formed its Healthcare Advisory Business practice to provide professional advisory services to support and assist providers, payers, and government agencies to improve business processes, strengthen internal controls, and enhance regulatory compliance. MFR’s staff includes former federal healthcare regulators, internal auditors, compliance managers, clinicians, financial officers, and health information management directors.

MFR is certified as a federal Small Business, a State of Texas registered Historically Underutilized Business (HUB), and a City of Houston certified Minority and Women-Owned Business (MWBE).

Wertz Consulting, LLC

Linda Wertz
Ms. Wertz has over 27 years experience in the Medicaid Program.  She is very knowledgeable of all aspects of the Medicaid program-federal regulations, state statutes, policy and operational requirements. Since 2003, Ms. Wertz has established a health care management and consulting organization specializing in governments programs including Medicare, Medicaid, and Children’s Health Insurance.  As Deputy Commissioner for Medicaid and CHIP, State Medicaid Director, Ms Wertz was responsible for the administration of a $13 billion health care program serving approximately 2.4million low income families, elderly and disabled persons. She was also responsible for the Children’s Health Insurance Program serving over 526,000 Texas children with a budget of $1.6 billion. She was chairperson of the National Association of State Medicaid Directors (1999-2002) and Vice Chair (1997-1999).  Ms. Wertz earned a Bachelors Degree in Business Administration from University of Texas, at Austin, TX.