Dr. Dubberly holds a Doctor of Pharmacy degree and a Masters of Business Administration with a concentration in Health Services Management, and he maintains licensure in multiple states as a pharmacist.
He has led numerous IT and operational reviews, risk assessments, and audits of Medicaid Management Information Systems (MMIS), Medicaid claims administrator operations, pharmacy claims and rebate administrator operations and systems, and managed care organizations. In addition Mr. Franke has led numerous third party audits (SAS 70 and SSAE 16 audits), and he has also led HIPAA Privacy and Security risk assessments and compliance audits. He managed the information system auditing function for the State of Texas at the Texas State Auditor's Office, and managed numerous IS audit projects at state agencies and academic institutions.
Mr. Franke is a Certified Internal Auditor, Certified Information Systems Auditor, Certified Fraud Examiner, Certified Internal Controls Auditor, and Certified in Risk and Information Systems Control. He is a member of the Association of Certified Fraud Examiners and the Information Systems and Audit Control Association, where he served on the Chapter Board for many years. He is currently a member of ISACA International’s Professional Standards and Career Management Committee.
Mr. Duzan serves as the Chair of the BPI Strategic Planning Committee, coordinating the management, administration, and operations of the national practice, which includes fraud and abuse detection, payment error rate measurement, recovery audit contractor services, Medicaid integrity contractor services, audits of electronic health records, audits of Medicaid enterprise systems and delivery system reform incentive payment programs. The BPI engagement team is dedicated to assisting government health care and social service programs with improving the quality and efficiency of health care delivery while identifying, minimizing, and recovering fraud, waste, and abuse.
Mr. Duzan’s career has been dedicated to program integrity, public health policy, statistical analysis, rate setting and reimbursement, auditing and operational policy consulting. He has led numerous engagements involving fraud and abuse detection, health economic studies, health care quality, data analytics, and specialized audits for more than 25 state Medicaid programs. Prior to joining Myers and Stauffer in 1997, Mr. Duzan was a Policy and Procedure Analyst for the Indiana Medicaid Program. Mr. Duzan’s responsibilities with the Office of Medicaid Policy and Planning included oversight of the Surveillance and Utilization Review unit, as well as home health and acute care reimbursement policies and procedures. He assisted in the development and analysis of program budgets and prepared fiscal impact studies of proposed legislation at the State and Federal level.
Mr. Duzan is a Certified Fraud Examiner and a member of the Association of Certified Fraud Examiners, the Indiana Society of Certified Public Accountants and the Georgia Society of Certified Public Accountants.
Mr. Hansen has played a significant role in pharmacy reimbursement consulting engagements with numerous state and federal clients including Alaska, Arkansas, California, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Nevada, Oregon, Texas, Virginia, Wyoming and the Centers for Medicare and Medicaid Services (CMS). He has advised state Medicaid programs regarding pharmacy dispensing fees and managed dozens of pharmacy cost of dispensing surveys. Mr. Hansen has also been involved in the firm’s pharmacy ingredient cost studies, State Maximum Allowable Cost (SMAC) projects and Average Acquisition Cost (AAC) engagements including Myer’s Stauffer’s contract with CMS to develop and maintain the National Average Drug Acquisition Cost (NADAC) benchmark.
Mr. Hansen’s other involvement with pharmacy related projects has included consulting to state Medicaid programs regarding reimbursement rates for physician administered drugs and performing audits of Pharmaceutical Benefit Manager (PBM) contracts. He has provided pharmacy reimbursement related litigation support activities to the states of Kentucky, Louisiana, Washington and Florida and to the United States Department of Justice.
Since 2003, Mr. Hansen has managed the firm’s project to perform program integrity audits of Medicaid providers for the Alaska Department of Health and Social Services. This project involves the analysis of Medicaid claims data from all providers and the selection of providers for desk review as well as additional on-site review procedures. Under Mr. Hansen’s direction, the project team collects clinical and other documentation for audit from a set of sampled claims. The team reviews the documentation and applicable policies to determine if the provider’s billings are appropriately supported. Additionally, Mr. Hansen provides expert testimony on behalf of the state when reported overpayments are appealed by the audited providers.
Over a period of ten years, Mr. Hansen assisted the Montana Department of Justice with a project to monitor the financial performance of two consolidating hospital systems. Mr. Hansen performed an annual review of facility revenues and cost and reported findings to the state using an economic model that incorporated expected enhancements to facility efficiency, inflation changes and acuity trends.
Mr. Hansen has also assisted with a number of other Medicaid reimbursement consulting engagements include rate setting for home and community based services, mental health services, hospital reimbursement through Diagnosis Related Groups (DRG) and physician reimbursement through Resource-Based Relative Value Systems (RBRVS).
He also administers multiple BPI engagements, including state Medicaid Recovery Audit Contractor (RAC), Fraud Waste and Abuse Detection (FWAD), and Payment Error Rate Measurement (PERM) projects. He has significant experience directing Medicaid managed care audit and consulting engagements, electronic health record (EHR) incentive payment audits, Medicaid Management Information System (MMIS) testing and consulting projects, as well as provider rate setting engagements.
His engagement responsibilities include providing strategic input, planning and technical expertise to various teams conducting on-site agreed-upon procedures and medical record audits, performing post-payment review of service utilization claims, providing integrity monitoring for reimbursement systems, performing analyses of aberrant provider billing and/or reimbursement practices, creating and manipulating complex data sets, and analyzing expenditure trends. Mr. Farrell also prepares written and oral reports and presentations, develops statistical models and assists in the development of cost containment strategies for clients.
Mr. Farrell is a Certified Fraud Examiner and a member of the Association of Certified Fraud Examiners, the Indiana Society of Certified Public Accountants and the American Institute of Certified Public Accountants.
Mark has extensive experience working on health care and government compliance audit engagements, having served most recently as the Director for the Division of Provider Audit Operations, Office of Financial Management for CMS in Baltimore. Some of his accomplishments include overseeing the development and updating of Medicare cost report audit and reimbursement protocols used by contractors nationwide. He managed the national Medicare audit and reimbursement process, the cost report appeals process, quality review processes, and worked closely with other CMS components to develop, review, and implement policy updates.
Mark worked closely with the Office of the Inspector General, Federal Bureau of Investigation and Department of Justice regarding instances of fraud, and to provide litigation support. He led the development and implementation of the CMS Electronic Health Record Meaningful Use Audit Program used by Medicare, which included the development of the overall audit strategy, as well as the audit methodologies, such as obtaining and processing pertinent data, building risk assessments, and development of the protocols used by the contractors.
Mark Hilton, partner-in-charge of the cost report audit and DSH engagement team, said "Mark brings excellent experience to the firm, most recently from his days at the Centers for Medicare and Medicaid Services. Mark is recognized as an expert in the industry and has a network of resources that will allow the firm to reach new levels of services in the Medicare arena. Mark has already contributed to multiple project teams in his short time with the firm. We are very pleased about Mark's promotion and excited about his impact on the success of the firm in the future."
Mark joined Myers and Stauffer in 2015. He received a bachelor’s degree in accounting from Syracuse University and holds a Certified Fraud Examiner license.