Medical Research and Clinical Reimbursement Director

Fred I. Polsky, MD, MA, FACP

435 North Andrews Avenue, Suite 401
Fort Lauderdale, Florida 33301

Double Board-Certified physician executive with 17-year clinical career (Internal Medicine/Nephrology/Transplantation), followed by 25-year background in Health Care Public Policy. Extensive programmatic experience in Traditional Medicare, and Medicare, Medicaid, and Commercial managed care.  Special interest in Medicare, Medicaid, pharmaceutical, & ESRD  Fraud & Abuse. Managed Medicare Risk Adjustment Methodologies; Medical Director, A/B Medicare Administrative Contractor, Jurisdiction N; Medical Director for Administrative Law Judge Hearings through CMS Office of Medicare Hearings and Appeals (OMHA).

image description

Career Highlights

  • 17-year clinical career: Internal Medicine, Nephrology, Dialysis, and Renal Transplantation; Clinical responsibility for ESRD Network 15 QI Programs;
  • Medical Director of 2 Dialysis and Post-Transplant Patient Management Programs. Acute, In-Patient Critical Care Consultations;
  • Attending Faculty: Columbia College of Physicians & Surgeons; Case Western Reserve School of Medicine;  Faculty teaching appointments for Fellows, Residents, and Medical Students;
  • Medical Director, First Coast Service Options, Inc; Medicare (Part A/B) Administrative Contractor, Jurisdiction N; Extensive background in adjudication of UM decisions; Medicare LCD and NCD policy; preparation of briefs for non-party participation in Administrative Law Judge hearings;
  • Medical Research Director to national legal organization; review of fraud committed against Medicare and Medicaid under the Federal False Claims Act; review of medical quality issues in potential Qui Tam actions;
  • Medical Director to CMS (ZPIC) Zone 7 Program Integrity prime contractor, including pre- and post-pay medical review;
  • Medical Director for a consortium of commercial managed care organizations pursuing relief for pharmaceutical and ESRD billing and clinical practice fraud;
  • Transformation of the Medicare Prospective Payment System from Demographic to (HCC) Health Status Risk
  • Senior Medical Director/ CMO: Traditional Medicare, Medicaid, & Commercial Managed Care Organizations;
  • Quality Management, Physician Network and Account Relations, QIO and Regulatory Compliance, NCQA/URAC Accreditation;
  • Rate-setting and Predictive Modeling Systems, Implementation of Medicare Prospective HCC Payment System and Medicaid ACG Reimbursement Systems;
  • Management Medicare Part D Benefit, Formulary Management, Mitigation of Coverage Gap;
  • Research Fellowship, National Institutes of Health, Bethesda, MD: Genomics, Molecular Biology, Recombinant DNA Research;
  • Active, unrestricted licenses in 5 jurisdictions; fully licensable in any state.



OUR PROMISE When it feels like you are facing insurmountable odds, we will be there for you!

We know the struggles whistleblowers face before contacting us, and know that deciding to be a whistleblower can be difficult. We will be with you every step of the way, strong and proud, helping you stand up for what is right.

Contact Us