August 11, 2025
With a background in occupational and environmental medicine, Dr. Roger Hinkson brings over a decade of experience to his role as Medical Director at H.H.C. Group. He reviews utilization and independent medical evaluation reports to ensure quality, clarity and clinical accuracy. His work helps to ensure that each determination is medically necessary, based on evidence and fairness to the patient.
In this interview, Dr. Hinkson shares how H.H.C. maintains clinical rigor, balances innovation with objectivity and delivers reporting that protects plan assets while supporting patient care.
Q: What's your background and what led you to H.H.C. Group?
A: I'm board-certified in occupational and environmental medicine and my background includes leadership roles in HMOs, large corporations and county-based medical programs in California. Prior to joining H.H.C. Group more than 14 years ago, I served as an associate medical director at a utilization review organization which helped to prepare me for this role.
Q: What sets H.H.C.'s medical review process apart?
A: Thoroughness. Compared to other organizations I've worked with or observed, H.H.C. Group puts a strong emphasis on detailed, high-quality reports. As Medical Director, I review a significant portion of the reports before they go out, not just spot audits. That level of oversight is not standard across the industry. We also respond quickly when the turnaround time is tight, often within 24 hours.
Q: How do you collaborate with peer reviewers and the review team?
A: There's constant communication. If there's an issue in a report, members of the H.H.C. Group will try to resolve it directly with the reviewer. If needed, they'll loop me in. I'll review the case, reach out to the reviewer by phone or email and walk through the revisions. New reviewers receive close oversight, especially during their initial reports, to make sure they meet our formatting and quality standards. We also hold quarterly quality control meetings to review trends and flag any deficiencies.
Q: What does your day-to-day role focus on?
A: Quality management. I don't write reports, I review them. I check for accuracy, thoroughness, proper references and well-structured rationale. Whether it's an IME or a utilization review, my job is to ensure the report is clear, defensible and grounded in current clinical evidence.
Q: What clinical specialties do you see most often?
A: Orthopedics leads the list, followed by pain management and dermatology. The challenge across all these areas is staying current with new procedures and devices. Sometimes, providers adopt new treatments before the supporting evidence is in place. For example, while devices like the Misha Knee System are already being used by some orthopedists, they're still considered investigational by many insurers.
Q: What do you look for when reviewing IMEs or utilization reports?
A: I look for clinical clarity, logical structure and alignment with evidence-based medicine. The rationale should reflect a true understanding of the patient, not just a copy-paste from a template. A solid report explains why a treatment is or isn't medically necessary and ties that explanation to credible sources.
Q: How do you ensure objectivity and clinical appropriateness?
A: Templates can help but they can't replace judgment. I want to see that reviewers are weighing the patient's situation against clinical guidelines, not just following routine. Especially in rare conditions or treatment-resistant cases, guidelines may not cover everything. That's where clinical judgment matters. It still needs to be evidence-informed and thoroughly justified.
Q: What are the red flags you watch for?
A: Over-reliance on templates. If I see a report that's too short, too generic or packed with references that aren't actually cited in the rationale, that's a concern. I look for reports that integrate evidence into the logic, not just list it. A strong clinical summary and an evidence-backed rationale are what separate a solid report from a weak one.
Q: How does H.H.C. ensure quality across its reviewer network?
A: It starts with credentialing. Reviewers must have at least five full-time years of clinical experience. New reviewers go through a close review process with early reports monitored for format, accuracy and scope. We match reviewers carefully to cases that fall within their specialties. Every issue is documented, followed up and addressed, nothing is left to chance. Quality management is continuous, not occasional.
Q: When it comes to drug claims, how do you handle emerging treatments like GLP-1s or biologics?
A: We follow the evidence. For drugs like Wegovy or Ozempic, we check for documented BMI, previous attempts at lifestyle modification, absence of contraindications and the presence of comorbidities if applicable. Off-label use is common, especially when shortages arise, so it's critical to evaluate whether the use is medically necessary and supported by guidelines.
Q: What's your approach to creating reports that are clear, defensible and actionable?
A: The rationale must do more than say a treatment is "reasonable." It should show why, using concise, well-supported reasoning. For example, don't just say a drug is appropriate. Say the patient meets criteria A, B and C per (X) guidelines. That creates a report that can hold up to scrutiny and is useful for both payors and providers.
Q: How has H.H.C. supported you in your role?
A: We stay in regular contact, often daily. If I notice something that needs to be addressed, I make a call. If the team spots an area where I can improve, they reach out as well. The communication is open and the respect goes both ways. After 14 years, we've built a solid working relationship that keeps our standards high and consistent.
Q: How does your work support fair, evidence-based treatment while protecting plan assets?
A: I focus on being thorough, relying on evidence and avoiding decisions based on habit or assumptions. My job is to make sure every recommendation is clear, well-supported and clinically appropriate. That's what gives the process credibility and helps protect plans from unnecessary costs and mistakes.
Q: Your background is in both workers' compensation and commercial claims. How does that shape your perspective?
A: It gives me a clear understanding of how different systems operate. Workers' comp and commercial claims each have unique challenges. Still, the goal stays the same, understand the facts, apply medical necessity, manage costs and ensure fairness throughout the process.
Trusted Oversight That Delivers Clarity and Confidence
H.H.C. Group's review process is built on one principle, quality matters. Every report is vetted for accuracy, medical relevance and transparency. That's what payors need. That's what providers deserve.
What Sets Us Apart:
- Attorney-Led Claim Negotiation: Slash large-dollar claims by up to 90%, even with PE-backed providers.
- Access to Major Preferred Provider Networks: Leverage existing agreements to maximize savings on claims down to $1.
- Independent Reviews/Utilization Reviews: Provide clients with expert medical necessity or experimental\Investigation internal or external reviews that reduce risk, strengthen claim decisions, and reinforce trust in your plan administration.
- Reference-Based Pricing: Anchor payments to fair, transparent benchmarks — not inflated fee structures.
- Fast Turnaround: Most claims resolved in 5–7 business days to keep you ahead of aggressive billing tactics.
- 30 Years of Proven Results: With a proven 30-year track record of successfully negotiating both in- and out-of-network facility claims, H.H.C. Group remains a trusted partner for cost containment nationwide.
Want to see how H.H.C.'s clinical review process can support your claims strategy?
Contact us today to learn more or submit 15–20 cases through our "Proof in the Pudding" program and review the results for yourself.
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