Healthcare Insurance Expert Witnesses
What is a healthcare insurance expert witness?
Healthcare insurance expert witness candidates may be physicians and typically have backgrounds in insurance law, healthcare administration, health law, medical billing, and/or in the healthcare insurance industry. The chosen expert could be associated with a healthcare industry organization such as America’s Health Insurance Plans (AHIP), the National Association of Insurance Commissioners (NAIC), the American Health Information Management Association (AHIMA), or the Healthcare Business Management Association (HBMA).
What types of cases require a healthcare insurance expert witness?
Example litigation support matters requiring a medical insurance expert witness include medical malpractice cases, personal injury cases, managed care health plan disputes, standards of care, medical negligence, and health insurance fraud.
Whether the case involves professional liability insurance, workers’ compensation, employee benefit, medical coding, medical billing, underwriting, insurance claim fraud, managed care, or a clinical research program, Cahn Litigation Services has the experience required to turn a search for a health care insurance subject matter expert around quickly. The firm has an earned reputation for providing experts with the right balance of expertise and testimony experience for each unique project.
What litigation support work might a healthcare insurance expert witness be expected to perform?
Expert witness services by a subject matter expert in health care insurance could include dispute resolutions, research and authoring expert reports, providing expert opinions, deposition testimony, and courtroom testimony. In a high-profile case, or litigation involving a significant financial stake, the lead attorney may request an expert with prior expert testimony experience.
Cahn Litigation Services has the experience required to turn a search for a healthcare insurance expert witness around quickly, providing the right balance of expertise and testimony experience.
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Healthcare Insurance Expert Witness - Representative Bios
Please Note: All Cahn Litigation expert witness searches are customized to attorneys' precise specifications and preferences. Attorneys are encouraged to discuss search parameters with a Cahn search specialist.
The below expert witness bios represent a small fraction of those Healthcare Insurance experts known by Cahn Litigation Services. These bios are provided to give lawyers a sense of the Healthcare Insurance landscape.
Expert Witness #255635
This expert is an independent software and information management consultant. This expert's focus is the design, and implementation of Software as a Service ("SaaS") platforms. This expert's experience has run the gamut from start-ups to large multinational corporations in Healthcare, Insurance and Ag-Tech.
Start Healthcare Insurance Expert SearchExpert Witness #214179
This packaging engineering expert has over 40 years of experience in packaging, logistics, and human factors, with specialties in product liability, personal injury, and warning labels. This expert is a Certified Professional in Packaging (CPP) and Certified in Materials Management (CMM), holds a B.Sc. in Packaging Engineering from a well-regarded university, and has taught in a university packaging program. This expert has held packaging roles for major consumer products and healthcare companies.
This expert is an experienced expert witness and litigation consultant. Typical causes of action involve product liability, personal injury, failure to warn, regulatory violations, insurance claims, and intellectual property infringement. This expert has given testimony at depositions and trial in both state and federal courts.
Start Healthcare Insurance Expert SearchExpert Witness #272527
This M&A expert has over 45 years of distinguished credentials in investment banking, mergers and acquisitions, and corporate finance.
This expert has demonstrated investment banking and capital-raising expertise through a variety of turnaround management assignments in the healthcare, medical device, manufacturing, insurance, gaming, student housing, and real estate industries. This expert has managed acquisitions of similar companies through the roll-up process and has worked to consolidate those companies to help maximize profitability.
This expert's consulting work focuses on M&A lead advisory services, complex corporate turnaround services, litigation support services, comprehensive real estate advisory services, and debt and equity financing, and includes litigation support in over 30 cases.
Start Healthcare Insurance Expert SearchExpert Witness #275174
This healthcare finance, audit, and risk assessment expert holds an MBA and founded and leads a well-known healthcare consulting firm providing healthcare consulting, auditing, and forensic services. Services offered include reviews of coding practices, policies and procedures, medical record documentation, and general administrative procedures. This expert began a career as an intensive care nurse and transitioned into auditing for risk and compliance. The healthcare consulting practice includes general medical data audit support services, predictive data analytics, data assessments and strategy support, internal control audits, compliance, risk, and vulnerability assessments.
This expert has extensive experience working directly with patients and within healthcare provider settings, and has observed systemic procedural failures that can render medical debt reporting unreliable. Patients routinely execute consent and financial responsibility agreements before services are rendered and before receiving disclosure of actual charges. Upon discharge, patients typically do not receive itemized statements; often the first bill arrives 30 to 60 days post-service, precluding timely verification or error identification. The Fair Credit Reporting Act (15 U.S.C. ? 1681s-2) establishes accuracy requirements for information furnishers, and the Consumer Financial Protection Bureau has documented pervasive medical billing errors including duplicate charges, fees for services never rendered, and amounts that should have been covered by insurance. California Senate Bill 1061, effective January 1, 2025, prohibits consumer credit reporting agencies from including medical debt on credit reports and bars healthcare providers and collection agencies from furnishing such information to credit bureaus.
This expert is an experienced expert witness and litigation consultant.
Start Healthcare Insurance Expert SearchExpert Witness #278446
This healthcare reimbursement expert holds CPA/CFF and FHFMA credentials and has worked in healthcare finance for over 45 years. This expert has held a senior founder-level role at a healthcare consulting organization that provides consulting services and experts in medical billing, Medicare and Medicaid reimbursement, health insurance, false claims, regulatory compliance, clinical documentation, medical records, ICD and CPT coding, hospital and professional billing, reasonableness of charges, damage quantification, statistics, and quality of care.
This expert is a CPA, Certified Healthcare Financial Professional, and Fellow of the Healthcare Financial Management Association. This expert's work has included Medicare dialysis documentation, coding, billing, and reimbursement issues, including issues related to EPO, Medicare requirements, and evaluation of opposing expert reports.
This expert and associated consulting teams have experience in healthcare reimbursement disputes involving Medicaid payment disputes, statistical sampling, sample selection, extrapolation processes, UCR analysis, hospital billing claims, Medicare contractor recovery audit findings, CPT coding, medical necessity determinations, and administrative hearing testimony.
This expert and associated team members are experienced expert witnesses and litigation consultants.
Start Healthcare Insurance Expert SearchExpert Witness #287756
This economic damages expert has worked on hundreds of litigation consulting engagements and has testified as an expert in arbitration, state courts, and federal courts, while also providing mediation assistance in disputes requiring economic, financial, and statistical expertise, including class action litigation, labor and employment litigation, and healthcare disputes.
This expert has substantial experience in wage and hour class actions, including combining and standardizing data from large employment-related databases, payroll data, timekeeping records, telephone records, e-mail records, point-of-sale systems, video recordings, and records from other electronically stored systems generated throughout an employee's work life. These systems typically create electronic timestamps that can be used for data analysis purposes.
This expert has statistically analyzed combined databases and used the results to opine on potentially uncompensated time worked; applied advanced statistical methods such as data imputation, Monte Carlo simulation studies, time series and predictive modeling, and forecasting and backcasting to address missing data issues; designed and conducted surveys, time and motion studies, and observational studies; and statistically analyzed the results of such surveys and studies. This expert also has experience applying statistical sampling methodologies to extrapolate results from a random and representative sample to a universe of individuals, as well as applying economic theory, statistical models, and statistical tests to develop scenarios of economic loss to class members.
This expert has been retained in approximately 250 wage and hour class actions across a broad range of industries, including retail, healthcare providers, hospitality and restaurants, freight services, entertainment, banking, insurance, state workers, warehousing, call centers, software, professional services, law enforcement, newspapers, ferry crews, social workers, IT support staff, help desk employees, shipping, and administration.
Start Healthcare Insurance Expert SearchExpert Witness #296793
This health claims sampling expert holds a B.Sc. in Accounting, is a Certified Public Accountant (CPA), holds the FAAMA credential, and serves in senior executive and principal healthcare consulting roles specializing in healthcare finance, Medicare, regulatory compliance, pricing, and managed care and insurance payment and contracting.
This expert has provided expert witness testimony in court and administrative proceedings and has presented testimony to state healthcare rate-setting authorities, federal oversight bodies, and federal healthcare agencies on issues including healthcare facility rate setting, Tri-Care funding and reimbursement, air ambulance prospective fee schedules, and physician fee schedules for MOHS dermatology surgeons. This expert also served for over 10 years as a national regulatory practice leader at a major professional services firm recognized for healthcare professional services.
This expert has evaluated claims handling and payment procedures in a prompt-pay dispute involving member hospitals, identifying process improvements intended to expedite processing and reduce denials. In another healthcare compensation dispute involving primary care physician partners and allegations of upcoding, this expert evaluated a statistical sample of claims, identified sampling flaws and coding bias, and provided deposition testimony on those issues.
This expert has managed installation and maintenance projects for a decision-support claims management system designed to track expected payment of patient claims based on contract terms with payors across dozens of hospitals.
This expert has analyzed statistical sampling issues in healthcare post-payment audits, including audits using samples over multiyear periods to disallow claims and seek multimillion-dollar recoupments. In one matter, this expert's rebuttal of the statistical sampling methodology supported placing recoupment on hold while the merits of alleged errors were resolved, and the redetermination appeal was successful.
This expert has also analyzed Medicare time-record audits involving clinical and non-clinical staff records maintained in short time increments. The analysis showed that auditors had effectively examined each time increment within sampled time records, substantially increasing the effective sample size and reducing the calculated error rate to below 1 percent. Based on that analysis, no audit adjustment was appropriate.
This expert has conducted primary research and survey work in healthcare reimbursement disputes, including surveys of thousands of skilled nursing facilities addressing cost-reporting and reclassification issues. The survey evidence was used in an administrative appeal to address a federal healthcare agency's position on reporting practices.
This expert is an experienced expert witness and litigation consultant whose experience includes thousands of PRRB appeals, including hearings, mediations, telephonic hearings, and on-the-record hearings; hundreds of Administrative Law Judge hearings for workers' compensation appeals; U.S. District Court and appellate court hearings involving civil litigation and government investigations; and criminal investigations involving expert witness testimony and interviews with oversight investigators and U.S. Attorneys.
Start Healthcare Insurance Expert SearchExpert Witness #302521
This medical privacy expert is an MD, MBA, and FACP, and is a licensed physician executive with experience in healthcare administration.
This expert has worked in the health insurance industry with increasing areas of responsibility regarding leadership and patient care system management. This expert has also served as an examiner for a prominent national healthcare quality award and a national healthcare quality-assurance accreditation organization, which promote standards for accreditation of healthcare organizations with respect to patient care quality, safety, and HIPAA compliance.
Start Healthcare Insurance Expert Search