Michelle Allan, Principal, has been a nationally recognized MSP expert since 2003. She is a frequent speaker and thought leader in the MSP industry. Michelle has been instrumental in successfully settling tens of thousands of cases nationwide involving Medicare Secondary Payer issues and makes recommendations on how to best consider and protect Medicare’s interests. She negotiates Medicare conditional payments and has saved her clients tens of millions of dollars throughout her career.
Brian Bargender
Management Consultant, Subrogation and Other Payer Liability
Brian Bargender Management Consultant, Subrogation and Other Payer Liability
Humana
Brian Bargender is an internal consultant with Humana, one of the country’s largest Medicare Advantage organizations. In recent years, he has helped to lead Humana’s efforts to clarify and enforce the Medicare Secondary Payer (MSP) rules that pertain to Medicare Advantage and Medicare Prescription Drug plans. He is also responsible for monitoring trends that may impact subrogation and MSP recovery efforts, developing new cost avoidance and payment recovery projects and advising operational leaders regarding subrogation and MSP issues.
Brian has almost 20 years of experience in leading and improving health benefit subrogation and MSP operations. He is frequently invited to speak with liability, no-fault and workers’ compensation carriers to explain emerging MSP issues. He holds a Certified Subrogation Recovery Professional (CSRP) designation from the National Association of Subrogation Professionals and previously served as both a co-chair of NASP’s Wisconsin chapter. He frequently conducts presentations on MSP and health subrogation issues for both the injury payer and health payer audiences.
Amy E. Bilton, Esq., is a shareholder, workers’ compensation defense trial attorney, and Medicare Secondary Payer professional at the Chicago law firm of Nyhan, Bambrick, Kinzie & Lowry. She received her B.A. from the University of Michigan and J.D. from DePaul University College of Law. She has been licensed to practice law in Illinois since 1998 and has her Medicare Secondary Payer Consultant certification (MSCC) through the International Commission on Health Care Certification and Certified Medicare Secondary Payer Fellow (CMSP-F) certification.
Ms. Bilton is a frequent lecturer in workers’ compensation and all aspects of Medicare Secondary Payer compliance, as well as in the intersection of the opioid epidemic with both areas of law. She serves on the boards of: the National Alliance of Medicare Set-Aside Professionals, for which she is a past President and also the co-chair of the Annual Educational Conference committee; the International Commission on Healthcare Certification, for which she serves as the chair of the Board of Commissioners for the Medicare Set-Aside Certified Consultant (MSCC) certification; and the Illinois Workers’ Compensation Medical Fee Advisory Board. She is also a member of the Chicago Bar Association, Illinois State Bar Association, Illinois Workers’ Compensation Lawyers Association, American Bar Association, California Coalition on Workers’ Compensation, DRI and the National Council of Self-Insureds.
TJ Bradley is Senior Legal Counsel with ProAssurance. She provides legal advice and support to executive and operational employees on a variety of complex legal, insurance, and regulatory issues. Ms. Bradley is the designated Medicare compliance attorney for the ProAssurance companies. In that capacity, she manages the Medicare Mandatory Insurer Reporting; conducts employee, defense attorney, and insured education regarding Medicare requirements; and developed the Medicare reporting compliance procedures. Prior to joining ProAssurance, she was in private practice in Birmingham, AL, with a general legal defense firm specializing in the defense of health care providers, railroads, and employers.
John V. Cattie, Jr. is one of the nation’s most well-respected Medicare Secondary Payer (MSP) legal scholars. Cattie received his BA from the University of North Carolina and his JD/MBA from Villanova University. Cattie has personally reviewed or overseen the review of over 12,000 distinct fact patterns for Medicare Set-Aside (MSA) purposes. Federal and state court opinions such as Smith v. Marine Terminals of Arkansas, Tye v. Upper Valley Medical Center, and Doe v. Company X cite his analysis favorably. In each case, his client’s future medical exposure was minimized or extinguished based on how Cattie analyzed the MSA issue. In the Doe case, that difference amounted to a 90% or almost $900,000 reduction in future medical exposure for his client, the injury victim. The Doe Court stated the following in its opinion: “The Court finds that Mr. Cattie’s analysis is more credible [than his opponent’s] in the liability context.” To date, Cattie has been able to save his clients over $30 million in MSA exposure. Cattie actively participates in many organizations nationwide, including NAMSAP, RIMS, CLM and DRI. For DRI, Cattie recently concluded a four (4) year term as the Chair of DRI’s Medicare Secondary Payer Task Force. During that time, he served as Executive Editor for DRI’s Defense Practitioner’s Guide to Medicare Secondary Payer Issues. He also served as a co-author for the American Bar Association (ABA) treatise “What Are … Medicare and Medicaid Secondary Payer Laws?” Cattie is the Managing Member of Cattie, P.L.L.C. His law firm is dedicated to minimizing/extinguishing a client’s future medical exposure under the MSP Act. He focuses his law practice on MSA issues, providing legal opinions regarding MSA requirements, a client’s future medical exposure under the MSP Act and proper MSA funding. His firm also handles Medicare conditional payments, writes traditional medically based MSAs, and medical cost projections among other services. For more information, please see www.cattielaw.com.
Shawn Deane is General Counsel and leads the legal team at Ametros. He has over a decade of experience practicing law and in Medicare Secondary Payer (MSP) compliance as an industry thought leader. He was previously Vice President of Medicare Compliance & Policy at ISO Claims Partners. Prior to that he practiced insurance defense litigation and healthcare law.
Shawn is a member of the Massachusetts Bar and is licensed in both state and federal courts in Massachusetts. His law degree is from the Massachusetts School of Law. He also holds a master’s in education from Cambridge College and undergraduate degree from Berklee College of Music. He resides north of Boston with his family.
Frank Fairchok is Vice President of Medicare Compliance Reporting and Development for Optum Settlement Solutions. He has nine years of experience in MMSEA Section 111 reporting and Medicare Secondary Payer compliance. In his expanded role, Frank helps formulate strategic direction and drive new product and technology-driven solutions for our
clients. Frank previously managed MedicareConnect℠, Optum’s proprietary platform for Non-Group Health Plan reporting requirements mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. With almost thirty years of experiencing crossing over the financial, telecommunication and workers’ compensation industries, Frank has a deep background in contract administration, order management, billing, revenue recognition and data management. He has worked for global multinational companies such as AT&T, Orange, and now the UnitedHealth Group family of companies at Optum. Frank knows the work his team performs for Optum clients in the area of Section 111 reporting plays a critical role in the Medicare Secondary Payer processes. He realizes the data must reflect an accurate picture to not only protect Medicare’s interest in the claim, but also to protect his clients from absorbing costs beyond their legal responsibility. Frank appreciates having a team of people handling the day-to-day operation of MedicareConnect with dedication, tenacity and, very importantly, a deep understanding of this area of Medicare compliance. He is also grateful that his team has been with the MedicareConnect program since the go-live of reporting to Medicare in 2011—or earlier. In a world of call routing and inconsistent customer service, our clients have the comfort of hearing the same voices and knowing they are in great hands when they need to contact us. Frank has a Bachelor of Applied Science in Technology Management from St. Petersburg College and resides in Tampa, FL.
Robert Finley Civil Litigation and Medicare Compliance Counsel
Hinshaw & Culbertson, LLC
Robert Finley's national civil defense litigation and trial practice focuses on defending businesses and insurers in high value and complex matters involving specialized tort, employment, and healthcare issues. Robert has a wealth of experience in Medicaid third party liability and Medicare secondary payer compliance matters. He offers elite counsel to primary payers and other interested parties under auto, property/casualty, and no-fault policies, as well as workers' compensation insurance plans involving: conditional payment resolution; Medicare Part C and D recovery claims; future medical settlement considerations; Section 111 reporting compliance/monetary penalties; statutory private causes of action; and related regulatory matters. Robert serves Flagship Services Group as its Chief Legal Consultant on Medicare compliance for insurers and regularly contributes to Flagship’s blog. Before pursuing a law career, Robert worked in the sports radio industry producing and reporting on major spectator events, including the Super Bowl, NBA Finals, Kentucky Derby, U.S. Open Golf Championship, NCAA men's and women's basketball tournaments, and 1996 Summer Olympics in Atlanta. While attending DePaul University College of Law, Robert was selected for legal studies abroad at University College Dublin (Ireland), where he concentrated in comparative and European Union law studies and volunteered with a Dublin-based law firm.
Rafael Gonzalez, Esq. is President of Medicare and Medicaid Compliance, providing Medicare and Medicaid education to the auto, liability, no-fault, and work comp industries. Rafael has over 35 years of experience in the insurance, claims, legal, regulatory, legislative and compliance industries. He is one of the country’s leading authorities on Medicare and Medicaid secondary payer issues, including mandatory reporting, conditional payments, set aside allocations, approval, and administration, as well as special needs trust formation and administration. He blogs on all social safety net programs, including social security, affordable care, and social determinants of health. He speaks throughout the country on these substantive issues, teaches these subject matters at his local law/medical schools, and remains engaged in the legislative process at both the state and federal levels on these topics. He continues to be very active on social media, including LinkedIn, Twitter, Facebook, Instagram, and YouTube. Rafael can be reached at rgonz@tampabay.rr.com or at 813.967.7598.
• Early involvement since 2009 in the MMSEA Section 111 Mandatory Insurance Reporting “MIR”
• Internally manage and track Conditional Payment progress across the country for our organization and clients
• 8 years of experience in technical and soft skill training
• Manage a team of “SCHIP” experts responsible for reporting on behalf of a large client base and a high number of Responsibility Reporting Entities “RRE’s”
• Experience working with The Center for Medicaid/Medicare Services “CMS” on matters related to reporting including the development of written recommendations to CMS
• Well-versed with the “CMS User Guide” that defines the rules and regulations for MMSEA Section 111 Reporting
• Understands and develops internal training to support claim adjusters in SCHIP reporting regulations
• Extensive knowledge on issues related to Medicare Beneficiary denials
• 15 years of experience as an IT Manager within the Insurance Industry including managing large scale infrastructure support, projects and implementation of new technology within Fortune 500 companies
TOTAL YEARS OF INSURANCE INDUSTRY EXPERIENCE: 17 years
YEARS IN CURRENT POSITION: Nine years
EMPLOYMENT:
Broadspire Services (A Crawford Company) Since: 2009
• Professional Designations: ITIL Manager Certified, Help Desk 2000 Manager Certified
• Geographical Experience/States: North America, Canada, India, Philippines
Jeff Knipper is the VP of Medicare Service at Contract Claims Services Inc (CCSI) /Adjuster Preferred Solutions (APS). He speaks and writes frequently on Medicare compliance issues. He has over 25 years of workers’ compensation claims experience. He has completed Medicare Set-Aside Analyses (MSAs) on over 1000 workers’ compensation claims. He has assisted parties in navigating the CMS review process on over 500 settlements. He has managed the MMSEA Section 111 reporting process for clients since it began in 2011. He has held the Medicare Set-Aside Certified Consultant (MSCC) credential since 2009. He has held the Certified Medicare Secondary Payer (CMSP) professional designation since 2011. He completed the MSA pre-certification program at the University of Florida. He holds a Bachelor’s Degree in Finance from the University of South Alabama.
Ciara Koba, Principal, combines her education in law and medicine with technology skills and nearly a decade of practical experience to deliver comprehensive solutions to her clients. Ciara is one of the nation’s foremost authorities on Medicare Mandatory Insurer Reporting and auditing. She is a licensed attorney and nurse with significant general and surgical nursing experience, and she brings a unique understanding of the healthcare industry to the resolution of Medicare issues.
Rachel LaMontagne is a Partner in the Class Action and Mass Litigation Group of Shutts & Bowen, LLP. Rachel maintains a diverse legal career, with a focus on personal injury protection litigation in the class action setting, as well as actions arising under the Medicare Secondary Payer Act. Rachel serves as lead counsel for various insurance carriers with regard to defense of primary payers’ claims for reimbursement of conditional payments under the MSPA. In addition to defense on the merits, Rachel also defends against class certification of these MSPA matters. Ms. LaMontagne received her JD from St. Thomas University School of Law in Miami, Florida and has been admitted to practice in Florida since 1996. She is admitted to practice before the Florida Supreme Court, the United States Court of Appeals for the Eleventh Judicial Circuit, the United States Bankruptcy Court for the Southern District of Florida and the United Stated District Courts for the Southern, Middle and Northern Districts of Florida.
Susan Montoya Managing Director, Medicare & Debt Resolution
Travelers
Susan Montoya is a Managing Director at Travelers Insurance leading the Medicare & Debt Resolution program. Over the last 25 years, she has held various roles in the Worker Compensation organization including claim data reporting to NCCI, Claims EDI and Medicare. Susan was a key member of the project team tasked with understanding and implementing the MMSEA Section 111 Mandatory Insurer Reporting in 2010 and has expanded her Medicare focus to include debt reduction. Susan has pioneered the way in ensuring compliance with all aspects of S111 reporting leveraging creative, collaborative and technological solutions.
She holds a Bachelor of Nursing degree and a RN license in Florida, is an active member of the Asian & Allies Diversity Network and a past member of the IAIABC Claims Strategy Steering Committee.
Jennifer Sherber, JD serves as the Vice President of Claims at the Kansas Medical Mutual Insurance Company (KAMMCO). In her role she provides guidance and support to the Claims Department on legal issues specifically related to the investigation, evaluation, and resolution of professional liability and general liability claims in Kansas and Missouri. Prior to joining KAMMCO, Mrs. Sherber was a Claims Attorney at the Kansas Health Care Stabilization Fund (Fund), where she managed the defense of high-exposure medical malpractice cases for eleven years. Prior to joining the Fund, Jennifer was in private practice at a law firm providing Insurance Defense, Commercial Litigation, and Complex Litigation services.
Jennifer is licensed to practice law in Kansas and is a licensed Casualty Adjuster for all lines except Workers' Compensation in Connecticut. In 2014, Jennifer completed the Claims and Litigation Management Alliance Litigation Management Institute at Columbia Law School and is a Certified Litigation Management Professional (CLMP).
Ms. Sherber is an active member of the Medical Legal Committee of the Claims & Litigation Management Alliance (A member of The Institutes – a Risk & Insurance Knowledge Group). She has been an active speaker on topics including: Opioids, Medicare Secondary Payer, and Evaluating and Defending Pain and Suffering Damages in Medical Malpractice Cases.
Monica Williams has over 25 years of Managed Care and Workers Compensation experience. She is currently the Medicare Compliance Manager for Innovative Claims Strategies (ICS) where she has oversight of the Medicare Set Aside Program which includes CMS Legal Submission and Conditional Payment Resolutions. As Manager she has developed and implemented the Medicare Compliance Department internal workflows. She was formerly the District Manager for Georgia and then the National Catastrophic Program Manager for Intracorp. She is a graduate of Jacksonville State University where she earned a B. S. In Biology/Sociology then a B. S. In Nursing. Monica is also the President of MWilliams Consulting (MWC) a Southeast Regional Case Management Company which specializes in Catastrophic Field Case Management, Life Care Plans and Complex Case Reviews for the past 10 years. Area coverage of Georgia, Alabama, Northern Mississippi, Carolinas, Southern Tenn and Florida. She is a member of American Association of Nurse Life Care Planners, Board Member for the National Association of Medicare Set Aside Professional (NAMSAP). She is a member of the Annual Conference Committee, Liability Committee and Co-chair of Membership Committee for NAMSAP. She enjoys teaching nurses the case management process and assist to develop new nurses in the case management area. Monica has hosted webinar trainings to large third-party payer and employer groups on Medicare Secondary Payor Compliance. She is known as a speaker on Case Management across the continuum for all lines of business, Medicare Set Asides and Medicare Secondary Payor Compliance.
Kathleen Wyeth
Director, Office of the General Counsel Claims Litigation
Melisa Zwilling is a shareholder with Carr Allison and is a resident in its Birmingham, Alabama, office. Her practice focuses exclusively on Medicare Compliance and she chairs the firm's Medicare Compliance Group. She has been practicing in this area for over 20 years and is considered a national authority on Medicare Secondary Payer issues. Melisa has published numerous articles in major journals nationwide and has been a guest speaker at countless seminars and conferences across the country. She is admitted to practice before the United States Supreme Court. Melisa earned a rating of AV, the highest available, with the national lawyer ranking service of Martindale Hubbell. Additionally, in 2014 and again in 2015, she was selected as one of Fortune Magazine’s Women Leaders in the Law. In 2013 she was named a Top Rated Lawyer in Insurance Law. She has also been recognized by Alabama SuperLawyers as one of Birmingham’s Top Rated Lawyers and ranked one of the Top 100 Women Lawyers in Birmingham. In addition, Melisa was invited to Time Magazine’s list of the Most Influential Women in America and Fortune’s List of Premier Lawyers."
