Healthcare Expert Witnesses

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What is a healthcare expert witness?

Healthcare expert witness candidates typically have extensive experience as physicians, legal nurse consultants, specialized medical experts, nurse practitioners, and may have experience in the healthcare insurance industry, or health law. Healthcare patents expert witnesses can support matters related to development of new medical devices.  If a project involves a medical device, an expert with a background in mechanical engineering or biomedical engineering may be called in. Healthcare damages expert witnesses and healthcare damages valuation expert witnesses are in high demand to support cases related to personal injury and/or malpractice.

What types of cases require a healthcare expert witness?

The term health care, or healthcare, covers the prevention, diagnosis, treatment, recovery, or cure of mental and physical issues of a patient or group of people. The broad term covers healthcare providers in a plethora of fields including internal medicine, dentistry, emergency medicine, pharmacy, pediatrics, nursing, optometry, audiology, psychology, physical therapy, mental health, and athletic training – to name just a few medical specialties.

Example litigation support matters requiring a medical expert witness include medical malpractice, medical maloccurrence, personal injury, managed care health plan disputes, breach of contract, public health policies, standards of care, medical negligence, product liability (i.e, medical device failure), HIPAA issues, and health insurance. Intellectual property issues, such as patent infringement and trade secret suits, can also utilize the expertise of healthcare professionals.

Healthcare expert witness case examples

Example matters that Cahn Litigation Services has placed experts for have involved:

• biologics,
• contract disputes,
• copyright infringement,
• health plan pricing,
• pharmaceutical U.S. patent litigation,
• Inter partes reviews (IPR),
• healthcare information technology,
• life sciences patent damages,
• therapeutics,
• medical product patent cases,
• valuation and damages,
• failure analysis,
• medical device FDA approval, and
• medical product labeling.

What litigation support work might a healthcare expert witness be expected to perform?

Expert witness services by a subject matter expert in health care could include medical records reviews, research, literature review, authoring expert reports, providing expert opinions, deposition testimony, and courtroom testimony. In addition, a law firm may utilize a healthcare professional for pre-litigation consulting services. In a high-profile case, or litigation involving a significant financial stake, the lead attorney may request a health care professional with prior expert witness testimony experience.

Representing the plaintiff or defendant, Cahn Litigation Services has the experience required to turn a search for a healthcare industry expert witness around quickly and provide the right balance of expertise and testimony experience.

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Healthcare 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.

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The below expert witness bios represent a small fraction of those Healthcare experts known by Cahn Litigation Services. These bios are provided to give lawyers a sense of the Healthcare landscape.

• Expert Witness #234755

  This expert is a consultant in physician pro fee medical coding, billing and compliance. This expert is President & CEO of a firm where this expert performs audits for practices in many specialties, including Urology. This expert has spent an entire career in the medical field, and has consulted for many organizations including the American Medical Association (AMA), and the Center for Medicare & Medicaid Services (CMS).

  This expert is a seasoned expert witness for Healthcare Attorneys in need of coding, reimbursement or process review, audit, opinion and testimony. This expert has testified in federal court for physicians accused of criminal fraud and has defended physicians in civil cases, which involved writing reports and giving depositions.

  This expert is on the Editorial Advisory Boards of multiple specialty newsletters, and is a frequent speaker for many organizations including the American Academy of Professional Coders (AAPC), Medical Group Management Organization (MGMA), AudioEducator, CodingConferences.com, The Coding Institute, and Ingenix. Current certifications include: Certified Professional Coder (CPC) - AAPC; Certified Professional Coder for Hospital Outpatient Services (COC) - AAPC; Certified Professional Coder for Third Party Payers (CPC-P) - AAPC; Certified Professional Coder Instructor (CPC-I) - AAPC; and Certified Professional Compliance Officer (CPCO) - AAPC. This expert holds a BS in Industrial Engineering and an MBA.

  
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• Expert Witness #250310

  This expert is a Medicaid Fraud, medical billing, and hospitals best practices expert. This expert is the managing partner of a healthcare compliance and process consultancy which focuses on healthcare regulations, and medical coding and billing. This expert has served as an advisor to healthcare providers on hospital and practice management, and has thorough understanding of treatment plans, and their importance in the admission process. This expert was selected as an expert for a landmark Federal Trade Commission case regarding healthcare data, regulations and economics. This expert has also served as an expert witness for the United States Department of Justice in a federal investigation into medical data, Health IT / E.H.R. stimulus funds and False Claims Act. This expert has also been involved in Medicare and Medicaid fraud matters. This expert has dozens of publications and is a frequent lecturer at industry conferences

  
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• Expert Witness #250672

  This expert has many years of experience in healthcare and in implementing information systems and technologies for process change and value creation. This expert provides consulting on healthcare software development, healthcare product positioning, Healthcare Transformation and Strategic Planning, and Process/Technology Improvement. Through a highly successful consultancy, this expert has provided consulting for many healthcare organizations. This expert has consulted with many companies, leading to many award winning software, technology and product development projects.  This expert was the Executive Vice President of a core administration systems software provider to the Health Plan Market where this expert directed new product development. This expert also has served as Associate Professor of Medical Informatics and Director of eHealth Initiatives at a University's School of Health Systems. This expert was the co-founder and Executive Director for an EMR services company. This expert was Vice President of an international healthcare consulting company; and a founding member and CEO of an eHealth Application Solution Provider (ASP). This expert co- founded and was the Chief Technology Officer of an enterprise managed care solutions provider for healthcare networks.  This expert was involved with the Department of Health and Human Services in the formulation of the HIPAA Rules. This expert has been intimately involved with the security, privacy, transaction and code set rules. This expert is a past member of the HL7, ANSI X.12, and ActiveX for Healthcare standards groups.

  
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• Expert Witness #262476

  This expert is a nationally recognized subject matter expert in healthcare information management, quality management, and compliance. This expert has conducted healthcare fraud and abuse coding compliance defense reviews and clinical documentation audits for healthcare organizations. This expert has worked as a compliance consultant and conducted medically necessity reviews for healthcare organizations and law, having worked on Urology specifically.

  This expert is a national speaker, author and adjunct professor on the topics of health information operations, information governance, e-discovery and healthcare compliance. This expert is an active member of the Health Level Seven (HL-7) Working Group, responsible for the review and development of the Records Management and Evidentiary Support (RM-ES) profile for the design and development of the functional profile for electronic health record systems. This expert has also been an active member and contributor in AHIMA task forces and working groups related to information governance and the functional design and profile of electronic health record (EHR) systems. This expert is a member of The Sedona Conference Working Group on Best Practices for Electronic Document Retention and Production, the American Medical Informatics Association (AMIA), the Health Information Management Systems Society (HIMSS), the American Society for Healthcare. This expert holds an MBA, a Master of Jurisprudence degree in Health Law and Policy, and Post Baccalaureate in Clinical Informatics. This expert has provided expert witness services to both plaintiff and defense counsel.

  
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• Expert Witness #262614

  This expert has worked on more than 185 cases regarding fraud and abuse matters, medical coding, billing, and usual customary and reasonable charges. Each case required a review of medical records to determine the correct level of coding and medical necessity based on documentation, in addition to the audit of many other aspects. Past projects involved Medicare, Medicaid, and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) documentation standards. This expert has provided consultation services on auditing and compliance matters, and has provided testimony via deposition, reports, and affidavits for both Plaintiffs and Defendants. This expert has provided seminars and audits for physicians, office personal, and government agencies.

  This expert is a Certified Fraud Examiner (CFE), Certified Professional Medical Auditor (CPMA), Certified Medical Coding Specialist (CMCS), Qualified Medical Coder (QMC), and is a member of the National Health Care Anti-Fraud Association (NHCAA).

  
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• Expert Witness #250688

  This healthcare IT expert holds a Master of Science in Administration, CPA, and CCP (Certified Computer Professional), and has senior-level experience in the use of healthcare IT. This expert has over 60 years of IT experience and over 40 years of experience owning and directing a healthcare IT consulting firm.

  This expert has a proven track record across many aspects of healthcare IT, including IT operations, IT planning, system selection, system implementation, IT contract negotiation, and project management. This expert has extensive experience implementing major healthcare information systems and electronic medical record platforms for hospital clients, including directing hospital system installations as an independent consultant. This expert has deep knowledge of healthcare IT scheduling and implementation processes, as well as experience evaluating system design, hospital fit, comprehensiveness, and implementation success.

  This expert has developed and taught graduate-level courses in the management of healthcare IT for well-regarded universities. The coursework has been required for an MBA specialization in health administration and has been taught to students affiliated with an academic health sciences center.

  This expert has extensive prior expert witness experience, including depositions, trials, mediation, and arbitrations, and is an experienced litigation consultant.

  
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• Expert Witness #275172

  This usual, customary and reasonable (UCR) expert leads a healthcare consultancy specializing in medical data audit support services, predictive data analytics, data assessments and strategy support, internal control audits, compliance, risk, and vulnerability assessments for patients, providers, payers, plan sponsors, and other healthcare industry support vendors.

  This expert has extensive expert testimony experience, primarily in UCR matters. The healthcare consultancy this expert founded over 30 years ago was established with a focus on UCR matters. This expert has testified on behalf of both plaintiffs and defendants and has reviewed many medical bills, evaluating them with a wide variety of industry resources, including national fee analysis tools, medical fee directories, healthcare pricing databases, federal healthcare fee data, and workers' compensation fee schedules. This expert is frequently retained as a resource for UCR matters.

  This expert is an experienced expert witness and litigation consultant. This expert has provided expert testimony in both federal and state courts, as well as mediation support in areas involving finance, business, and domestic-related issues.

  
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• Expert 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.

  
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• Expert Witness #281183

  This lost earnings/damages expert leads a healthcare consulting firm focused on valuation and financial analysis for hospitals, physician practices, and other healthcare enterprises. This expert has served a diverse range of healthcare industry and medical professional clients nationwide, including physician solo and group private practices across medical specialties, subspecialties, and allied health professions; hospitals and health systems, both tax-exempt and for-profit; managed care organizations; ancillary service providers; outpatient services; management services organizations; government agencies; public health and safety agencies; other related healthcare enterprises and agencies; and advisory professionals.

  This expert provides a wide range of technical assistance to legal counsel through litigation support services focused solely on the healthcare industry, including lost or enhanced earnings capacity, antitrust issues, provider relationships, healthcare valuation of enterprises, assets, and services, commercial damages, merger, acquisition, or divestiture transactions, managed care issues, healthcare industry research, shareholder disputes, economic and utilization demand forecasting, bankruptcy, discrimination, certificate of need feasibility analyses, and fraud and abuse issues. This expert has assisted in cases in Federal District Courts, State Courts, Tax Court, Bankruptcy Court, and arbitrations, involving complex economic, legal, financial, valuation, and related issues across a broad spectrum of provider entities in the healthcare industry.

  
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• Expert Witness #293285

  This electronic medical records expert is a registered nurse who holds an M.Sc. in Health Informatics, a BSN, and a CSA credential, with over 15 years of healthcare informatics and technology experience. This expert's clinical and informatics background supports review of records for continuity of care.

  This expert has worked as a consulting witness on over 40 cases related to electronic medical records. This expert has worked in healthcare and healthcare informatics for many years, including clinical settings such as intensive care, rapid response, hospice, and home care. In healthcare informatics, this expert has held roles including RN, system analyst, project management, and leadership while working with multiple electronic medical record systems.

  This expert reviews cases from multiple points of view with attention to detail and finding answers. This expert can educate legal teams on healthcare, standards of care, electronic medical records, and healthcare information technology, while offering questions informed by experience. This expert can also organize and summarize electronic medical records as requested.

  
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• Expert Witness #296675

  This healthcare policy and cost analysis expert is an attorney with an MPH who specializes in healthcare policy and regulatory matters, with a focus on healthcare cost analysis and payment structures. This expert holds a Master's degree and JD from a well-regarded university and is pursuing a Ph.D. from a public university. This expert has held pivotal roles with healthcare plans, helping shape key healthcare provider policies, and has also served in a healthcare counsel role for a congressional committee, followed by senior lobbying roles with a prominent healthcare professional association.

  This expert has experience evaluating claim practices, contractual obligations, and the use of statistical sampling in large-scale claim disputes. This expert's work includes assessing whether sampling methodologies are appropriate in light of denial patterns and applicable contractual and regulatory frameworks, as well as supporting claim documentation review and categorization.

  This expert has experience as an expert witness and litigation consultant.

  
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• Expert 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.

  
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• Expert 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.

  
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