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Printed Date: 9/22/2015
Answer: Harry Feliciano, M.D., MPH, is Palmetto GBA's Senior Medical Director responsible for all coverage policy activities at Palmetto GBA. Dr. Feliciano is also the lead Contractor Medical Director for home health and hospice coverage policy. His specialties are geriatrics and public health. Dr. Feliciano brings to Palmetto GBA an intense interest in implementing new approaches to improving provider-payer communications and performance based on the principles of Lean Six Sigma.
Antonietta (Toni) Sculimbrene, M.D., MHA, works with Dr. Feliciano and serves as the lead Contractor Medical Director for Part A and Part B coverage policy. Dr. Sculimbrene is an anesthesiologist and pharmacist by training and has served as medical director at several health insurers, most recently at Blue Cross and Blue Shield of Vermont. She brings to Palmetto GBA expertise in evidence-based policy development, quality improvement, and ICD-10.
Leland E. Garrett M.D., FACP, FASN, CPC, works with Dr. Feliciano and Dr. Sculimbrene and serves as a Contractor Medical Director for Part A and Part B coverage policy. Dr. Garrett is a nephrologist and internist by training. Before coming to Palmetto GBA, he served for 20 years as a physician in the United States Air Force, was in private practice in Raleigh North Carolina for 20 years and then was a Medical Director for Blue Cross and Blue Shield of North Carolina in the Medicare Advantage and Medicare Part D Programs and subsequently the Special Investigations Unit. He is a Fellow of the American College of Physicians, a Fellow of the American Society of Nephrology and a certified coder.
Paul Gerrard, M.D., is a physiatrist who works with Palmetto GBA's other Contractor Medical Directors. Prior to coming to Palmetto GBA he worked in both an academic practice and a solo private practice providing both inpatient and outpatient care. He has published articles on functional status measurement and post-acute care outcomes and co-authored a book on scientific computing. He has an interest in post-acute care and using data to improve payment accuracy and patient outcomes.
Dr. Gabriel Alejandro Bien-Willner, M.D., Ph.D., is the Medical Director of the MolDX program at Palmetto GBA, which seeks to understand the molecular testing landscape to implement payer controls, coverage, and to set policy. He is a leader in the Precision Medicine space and practices as a board-certified Anatomic Pathologist and Molecular Genetic Pathologist. Dr. Bien-Willner received his M.D. and Ph.D. from Baylor College of Medicine, with a doctorate in Human Molecular Genetics. His clinical training and academic tenure was at Washington University in St. Louis. Throughout his career, he has been active in research, development, and advancement of molecular diagnostic services, specifically next-generation sequencing. His experience spans both academia and industry. He has worked closely with clinicians to develop clear clinical diagnostic and treatment pathways directing Precision Medicine programs for community cancer centers.
Anitra Graves, M.D., MMM, is a pulmonary, critical care and sleep specialist who works as a Contractor Medical Director with Palmetto GBA. Prior to coming to Palmetto, Dr. Graves served as an Associate Medical Director at another MAC and has over a decade of experience in private practice. She is a fellow of the America College of Chest Physicians, a Fellow of the American Academy of Sleep Medicine and Vanguard Member of the American Association for Physician Leaders. Her interests are data-driven policies that optimize coverage and patient outcomes.
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Last Updated: 02/26/2019
Applies to: JM Part A, JM Part B, JM Home Health and Hospice, JJ Part A, JJ Part B, MolDx
Article Topics: Appeals, Redeterminations, and PTANs