Mr. Whitten leads the Government Programs and Regulatory Reporting and Compliance Service Lines of HFS Consultants.

The Regulatory group focuses on reimbursement, revenue management, risk mitigation, finance and compliance services. He specializes in reimbursement strategy validation and implementation, mergers and acquisitions, and strategic financial management. Mr. Whitten has a comprehensive understanding of the operational and financial issues surrounding a provider’s revenue and cost structure from CDM standardization, pricing, and departmental operational improvement programs to Medicare reimbursement. Mr. Whitten is the former National Managing Partner of Ernst & Young’s Government Programs, Reimbursement and Compliance Service Lines in the United States.

• Assisted clients in achieving appropriate reimbursement levels from the government, managed care and other third-party payers, by providing a wide range of services supporting providers’ strategic, operational and capital needs in today’s environment.
• Developed and directed global revenue management strategies for inpatient, outpatient, sub-unit services and physicians.
• Directed numerous Independent Review Organization (IRO) engagements associated with Corporate Integrity Agreements (CIA) while working side by side with the Office of the Inspector General and Department of Justice.
• Led numerous labor and non-labor operational cost reduction and realignment engagements enabling clients to benchmark inpatient and outpatient costs by department to similar facilities with a focus on more efficient delivery of high quality care.
• Managed clinical, financial and operational impact analysis and implementation strategies for the successful transition to the new reimbursement methodology of the BBA, BBRA, BIPA and MMA. These changes span the entire healthcare delivery system including Ambulatory Payment Reform (APCs), Prospective Payment System (PPS) for skilled nursing and home health services, prescription drug improvement programs and the RBRVS modifications for physician remuneration.
• Led countless system-wide strategies for rate setting that have helped large systems develop and document a rational approach for setting prices in diverse markets that are defensible in this climate of public scrutiny.
• Redesigned the operations reimbursement and cost reporting divisions for large organizations including of three of the nations largest healthcare chain organizations.
• Directed diverse third-party reimbursement engagements for health care systems, hospitals, nursing homes and home health agencies including preparation, appeals, RCL and TEFRA exceptions, and source documentation review of Medicare, Medicaid, OSHPD, HMSA 65C+ cost and compliance reports.
• Performed home office cost report reviews and compliance studies including developing the original home office cost reporting process for clients with Hospital, Nursing Home, Home Health, Assisted Living, and Independent Living services.
• Conducted numerous financial and operational feasibility studies for hospitals and long-term care facilities, including strategic and operational analysis and pro-forma reimbursement analysis.
• Performed merger and acquisition analyses for several health care facilities including hospitals, nursing homes, ambulatory surgical centers, home health agencies and physician practices.
• Consulted with providers on capitated contract negotiations with third-party payors for hospitals, long-term care facilities and physician practices.
• Provided interim staffing at the CEO and CFO levels at numerous hospitals.

Prior to joining HFS, Mr. Whitten was the National Managing Partner of Ernst & Young’s Government Programs, Reimbursement and Compliance Service lines in the United States. He was awarded the 2000, 2001 & 2002 National Outstanding Practice Leadership award, both the 2004 National Innovation and Distinguished Mentor awards. He has a Masters Degree in Business Administration from Colorado State University and a Bachelor of Science degree from the University of Utah.

Government Programs and Reimbursement Services