Meet Our Team
The van Halem Group has become one of the nation’s most respected healthcare audit and consulting firms.
Together, our team has more than 150 years of related experience. We have worked collaboratively with key government stakeholders, such as Centers for Medicare and Medicaid Services (CMS), the Office of Inspector General (OIG), Medicare administrative contractors (MACs), recovery audit contractors (RACs), unified program integrity contractors (UPICs), private payors, and other government contractors and agencies. This expertise provides clients the benefit of knowing proper communication channels and processes reducing the regulatory burden.
Wayne H. van Halem, AHFI, CFE
Wayne H. van Halem, AHFI, CFE founded The van Halem Group in 2006. The Atlanta-based firm merged with VGM Group in 2014 and Wayne currently serves as its President as they assist providers navigate complex issues related to audits, appeals, enrollment, and compliance. As a CMS contractor for 10 years, he spent a majority of that time as a fraud investigator and national Appeals Director. Wayne is also a published author and well-known lecturer. He is an Accredited Healthcare Fraud Investigator through the National Health Care Anti-fraud Association (NHCAA); a Certified Fraud Examiner through the Association of Certified Fraud Examiners (ACFE), and an active member of the Health Care Compliance Association (HCCA). He has served on the faculty for each of these national organizations. He also sits on the American Association for Homecare’s Regulatory Council, Medtrade’s Educational Advisory Board, Medicare DME MAC Jurisdiction D Advisory Council, Advisory Board for HME Business Magazine, and Board of Directors for Friends of Disabled Adults and Children (FODAC) and the Georgia Association of Medical Equipment Suppliers (GAMES). He has also served as an expert in various criminal and civil proceedings. Under his leadership, The van Halem Group has saved clients over $100 million in overpayments and denial recoveries. Follow me on LinkedIn
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Carrie Nienberg, RN, CPC
Carrie Nienberg, RN, CLNC, CPC serves as the Clinical Operations Director for The van Halem Group responsible for overseeing and managing the clinical teams. Carrie has over 30 years of nursing experience in multiple settings including a hospital, physician office, ambulatory surgery center and a Medicare program safeguard contractor (PSC). Her specific areas of expertise include peri-operative (including pre-op), surgical assistance, recovery, and Medicare medical review and benefit integrity. During her time with a Medicare program safeguard contractor, Carrie was responsible for traditional medical review functions and medical review in support of benefit integrity of durable medical equipment claims. Carrie is also a certified professional coder. Follow me on LinkedIn
Kelly Grahovac, MBA
Kelly Grahovac serves as the General Manager for The van Halem Group where she focuses on audits, appeals, education and training, and business development, in addition to management duties. Kelly is a known lecturer in the DME industry, speaking at national conferences, state associations, and for private events. Kelly came to The van Halem Group with nearly 10 years of experience at one of the nation’s leading Medicare contractors where she worked for the Durable Medical Equipment Regional Carrier (DMERC), Qualified Independent Contractor (QIC), and A/B Medicare Administrative Contractor (MAC). Her various roles with Medicare include working as a senior provider relations representative, QIC Adjudicator and Training Specialist. Kelly has in-depth knowledge in Medicare appeals, policy and education and training. Kelly is an active member of the Health Care Compliance Association (HCCA) and currently serves on the Medicare DME MAC Jurisdiction D Advisory Council, as well as the National Supplier Clearinghouse (NSC) Advisory Council. Kelly is also an active board member for both the Big Sky Association of Medical Equipment Suppliers (AMES) and the South Carolina Medical Equipment Suppliers Association (SCMESA). In addition to her client work at The van Halem Group, Kelly is also a contributor to several industry publications nationally. Follow me on LinkedIn
Natasha Daugherty
Natasha serves as the Office Coordinator to the President of The van Halem Group. Natasha holds a Bachelor of Arts degree in Psychology and has over 20 years of career experience in the fields of Client Services, Front Office Administration, Claims Management, and Medicare Plan Enrollment. She has worked with The van Halem Group since 2014, starting out as a Medical Records Administrative Coordinator. Since that time, Natasha has taken on additional roles, to include HIPAA Compliance Consultant and also served as a member of the VGM ESOP Communications Committee. Natasha transitioned into her role of Executive Assistant in 2018.
Sandra Gauron
Sandra Gauron serves as an Audit and Appeals Coordinator for The van Halem Group. Sandra has 18 years of experience working in the healthcare auditing field. For 10 of those years, she worked as a Medicare Fraud Analyst and Fraud Investigator with one of the first Medicare Program Safeguard Contractors (PSC). She conducted benefit integrity audits of medical equipment suppliers working hand in hand with carriers and law enforcement. She has worked with The van Halem Group in a similar capacity since 2011 and assists clients through the challenging appeals processes.
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Melissa Pederson, RN,BSN
Melissa Pederson serves as a Clinical Consultant for The van Halem Group. Melissa has 27 years of nursing experience, working in a hospital and at a plasmapheresis center. Prior to joining the van Halem Group, Melissa worked at one of the nation’s Medicare Administrative Contractors (MAC), in the medical review department. During her tenure, she was a clinical reviewer of durable medical equipment claims in the redeterminations area.
Kit Shellhouse, MBA
Kit Shellhouse serves as the Director of Business Development for The van Halem Group, where she focuses on business development and compliance. Kit holds a Bachelor of Business Administration and a Master's Degree in Business Management. With over 20 years' experience in business operations management, she has conducted educational training webinars, provided client consultations on business operations and strategic development, and contributed to national industry publications. Kit now serves on the board of directors of the Ohio Association of Medical Equipment Services and has been a featured speaker at national conferences, state associations, and industry groups around the United States. As part of The van Halem Group's support for the healthcare industry, she has traveled to Washington, DC, to partake in grass-roots lobbying efforts on Capitol Hill and continues to participate virtually. Her experience with organizational development, managerial processes, and marketing has led her to participate in the Tiffin University Alumni Symposiums and become an adjunct professor teaching undergraduate and graduate level marketing and management classes. Follow me on LinkedIn
Kathy van Halem
Kathy van Halem serves as an Administrative Coordinator and Client Liasion for The van Halem Group. Kathy previously worked as a pharmacy technician for 17 years, serving long term and assisted living facilities. During that time her duties included handling medical records and transcribing physician orders. Kathy has been a part of The van Halem Group since 2013 and her responsibilities include intake for all clients, audit transmission, medical records requests and work on special projects. Kathy is also proficient with a variety of software, including Frameworks, RNA, Segue, Brightree, and Medforce. Follow me on LinkedIn
Dr. Doran Edwards, M.D.
Dr. Doran Edwards serves as the Medical Director consultant with The van Halem Group, specializing in coding and reimbursement strategy. Following a successful 25-year practice as a General Surgeon in his native Tennessee, Dr. Edwards joined a Medicare contractor in the Durable Medical Equipment (DME) sector. In the next two decades, he served in all aspects of coverage, coding, payment and Appeals. As medical director of the Pricing, Data Analysis and Coding (PDAC) division, he oversaw creation of new wheelchair codes and placement of manufacturing standards into the coding of many devices, including diabetic shoes and inserts. He was known in the industry for providing a level playing field for the diverse manufacturers of over 8,000 DMEPOS HCPCS Level II codes. He resides the Nashville area. Follow me on LinkedIn
Dr. Will Felix, M.D.
Dr. William Felix, formerly the VP Medical Director of Policy at Cohere Health, specializes in integrating new technologies into healthcare policy and overseeing clinical guideline development. He previously served as Chief Medical Officer for Medicare DMEPOS and Medical Director of the Pricing, Data Analysis, and Coding (PDAC) division at Palmetto GBA. In this role, he developed coding standards for various medical devices, and played a significant role in helping CMS recognize 3-D printing as a viable method for custom fabrication of orthoses. He also expanded the integration and definition of powered-orthotics for CMS billing and coding. Dr. Felix is board-certified in Emergency Medicine and completed a fellowship in Sports Medicine at Duke University. He holds a Master's Degree in Artificial Intelligence in Healthcare from Universidad de Alcalá and specializes in CMS evaluation and standards of new medical technologies. He resides in Orlando, Florida. Follow me on LinkedIn
Matthew Mercurio, PhD
Matthew Mercurio, PhD, is an expert statistician and independent consultant with The van Halem Group, specializing in applied statistical analysis/econometric modeling and sample design and analysis. He applies these skills to both private and public litigation, as well as other legal and regulatory matters. His experience includes designing and critiquing sample design and extrapolation in a variety of matters, including over 150 healthcare reimbursement audits. Matthew holds a PhD and MA in Economics from Princeton University and a BA in Economics and Mathematics from Boston University.
Susean Nichols, RCP, RRT, CHC
Susean Nichols serves as the Accreditation Consultant for The van Halem Group. She has been involved in healthcare for more than 30 years, with expertise in acute care, post-acute care, and the sales/delivery of respiratory products and services. Susean has developed policies, procedures, and training programs for providers seeking both mandatory and elective licenses, certifications, and accreditations, to include home medical equipment companies, physician groups, hospitals, pharmacies, outpatient clinics, and managed care organizations. Her guidance and collaboration have resulted in improved operations, successful achievement of accreditation and accomplishments for many of her clients. Currently, Susean teaches the Exemptee training course for compliance with the California Home Medical Device Retail license for the California Association of Medical Products Suppliers, CAMPS. Susean also surveys with an accreditation organization. Susean is an active member of the American Association of Respiratory Care, AARC, California Society of Respiratory Care, CSRC, Health Care Compliance Association, and HCCA. Follow me on LinkedIn