Medical Coding Expert Witnesses
Start Medical Coding Expert Search
What is a medical coding expert witness?
Medical coding expert witness candidates typically have years of experience in healthcare administration, medical billing, medical record review, healthcare compliance, and/or are a Certified Professional Medical Auditor (CPMA), Certified Coding Specialist – Physician-based (CCS-P), or Certified Professional Coder (CPC). Oftentimes medical coding expert witnesses have a higher education degree (MBA or PhD) and associated with a health information industry organization such as the American Academy of Professional Coders (AAPC), the American Health Information Management Association (AHIMA), the Healthcare Billing & Management Association (HBMA), or the Medical Association of Billers (MAB).
What types of cases require a medical coding expert witness?
Litigation support matters requiring an expert in medical coding include medical malpractice cases and healthcare fraud.
Medical coding is an important component of medical billing. It involves an analysis of statements by a physician or other health care provider, and the assignment of standard codes using a classification system. A medical coder needs to understand medical terminology, anatomy and physiology, clinical procedures, diseases, injuries, the legal and ethical aspects of health information, health data standards, as well as the classification conventions.
Medical coding expert witness case examples
Example cases that Cahn Litigation Services has searched for medical billing expert witnesses have encompassed:
- Current Procedural Terminology (CPT codes),
- Medicare fraud,
- Medicaid medical bill reimbursement,
- neurology medical records,
- life care plan payers,
- Usual, Customary, and Reasonable (UCR) medical service fees,
- International Classification of Diseases (e.g., ICD-9, ICD-10-CM),
- health insurance companies reimbursement procedures,
- medical cost and medical necessity assessment as a result of a personal injury,
- clinical documentation auditing in Florida,
- Medicare and Medicaid fee schedule and medical bill reviews,
- HIPAA matters,
- Medicare Set-Aside law,
- electronic health records (EHR) breach,
- independent medical examination (IME) methodology, and
- legal nurse testimony in a medical malpractice suit.
What litigation support work might a medical coding expert witness be expected to perform?
Expert witness services by a medical coding specialist could include documentation analyses, research and authoring expert reports, providing expert opinions, deposition testimony, and courtroom testimony. In addition, a law firm may seek a coding specialist for pre-litigation consultant work. In a high-profile case, or litigation involving a significant financial stake, the lead attorney may request a medical coding or medical billing expert with prior expert testimony experience.
Cahn Litigation Services has the experience required to turn a search for a medical coding expert witness around quickly, providing the right balance of expertise and testimony experience. On behalf of a plaintiff or defendant, the firm has an earned reputation for providing experts with the right balance of expertise and testimony experience to support each unique project.
Related Disciplines
Medical Coding 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 Medical Coding experts known by Cahn Litigation Services. These bios are provided to give lawyers a sense of the Medical Coding 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.
Start Medical Coding Expert SearchExpert 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
Start Medical Coding Expert SearchExpert 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.
Start Medical Coding Expert SearchExpert Witness #262519
This expert is the President & CEO of a firm providing detailed medical coding and billing compliance reviews/audits, operational assessments, investigations, and forensic analyses. This expert also provides litigation support in a consulting and expert capacity. Case work frequently pertains to allegations of improper and/or fraudulent medical coding and/or billing. This expert has provided services to firms specializing in Qui Tam matters. Clients have included government agencies, some of the largest insurance carriers in the United States, and nationally-recognized law firms. This expert's coding and medical records career spans many years, including work at medical centers, an insurance company, and a consultancy.
Urology is an area this expert is well-acquainted with, both from the standpoint of in-office procedures and surgical interventions. This expert's firm conducted a very large external audit for a multi-state provider, and also worked on a matter with the Department of Justice. Both cases included an analysis of studies routinely performed to address urinary retention, incontinence, and other types of studies and procedures. Multiple times this expert has worked in collaboration with a well-regarded urologist. This expert holds a BS in Health Information Management, is a Registered Health Information Administrator, a Certified Fraud Examiner, and an Accredited Healthcare Fraud Investigator.
Start Medical Coding Expert SearchExpert Witness #262528
This expert has extensive experience in auditing, coding, and billing for many practice areas, including urology, oncology, hematology, internal medicine, endocrinology, neurology, hospital medicine, critical care and other practice areas. This expert is a nationally known speaker and educator with credentials from the two most recognized organizations in the field of medical coding training and certification: the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). In addition to being a Certified Professional Coder, this expert is also a Certified Risk Adjustment Coder, a Certified Coding Specialist, and an approved Coding Trainer for AHIMA. This expert has been published in the national publication AAPC Healthcare Business Monthly Magazine and is a frequent expert contributor to industry publications.
This expert founded a national consulting firm specializing in coding and compliance advisory solutions. This expert has developed and designed instructor-led and web-based training in medical coding, billing, and compliance. This expert has served as an expert witness and has worked on many litigation matters.
Start Medical Coding Expert SearchExpert 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).
Start Medical Coding Expert SearchExpert Witness #268329
This medical records and coding expert holds a BS and credentials as an RN, CRNA, and CCS-P, and has over 40 years of experience involving coding and billing for medical charges for hospital services and physician groups. This expert has experience in medical billing litigation and medical billing consulting.
This expert's educational background includes a summa cum laude BS in Biology and Secondary Education from a university, Certified Registered Nurse Anesthetist training from a well-regarded university, and a Certified Coding Specialist credential from a professional health information management association. Evaluating medical care fees and coding requirements has been a daily activity for physicians, providers, and facilities managed by this expert's company.
This expert authored material in a professional legal nurse consulting textbook on principles and practices regarding the medical record and the concept of usual, customary, and reasonable aspects of medical charges. This expert is also an experienced expert witness and litigation consultant.
Start Medical Coding Expert SearchExpert Witness #278440
This healthcare contracts and Medicare billing expert has diverse experience in the healthcare industry, including senior reimbursement consulting, healthcare compliance leadership, billing compliance operations, and leadership of a compliance firm providing medical coding, litigation support, and compliance solutions to healthcare providers.
This expert completed a Bachelor of Science in Health Planning & Administration (HPA), studying Health/Health Care Administration/Management. This expert has obtained several certifications, including Certified Medical Cost Projection Specialist (CMCPS), Certified Professional Compliance Officer (CPCO) from a professional coding organization, and Certified Professional Coder (CPC) from a professional medical coding association.
Start Medical Coding Expert SearchExpert Witness #286273
This Medicare/Medicaid billing and regulatory expert has over 40 years' experience assisting medical practices with coding, regulatory, and reimbursement issues. Along with experienced health care attorneys, this expert helps physicians who are being audited by Medicare, Medicaid, and other payers. This expert also assists medical practices in developing reasonable and effective compliance initiatives to avoid audit risk. This expert has worked with hospitals and held a senior assistant executive leadership role with a state medical association, with major responsibilities that included conducting seminars to help physicians transition to Medicare's reimbursement system, RBRVS, and coding requirements during the mid-1980s and early 1990s.
This expert is an experienced expert witness and litigation consultant and has appeared as an expert witness on billing, coding, reimbursement, and other medical practice management issues.
Start Medical Coding Expert SearchExpert Witness #291169
This medical billing and coding expert holds CPC, CPMA, CPCO, and CPC-I credentials and is a Certified Professional Coder with over 30 years of experience across healthcare coding and reimbursement. This expert has in-depth knowledge of inpatient and outpatient billing, E/M coding and compliance, LTC billing, HCC coding, Medicare A and B, and Medicaid.
This expert is a certified professional coder, auditor, compliance officer, and instructor, and has served on a national advisory board for a professional medical coding association. This expert has experience reviewing medical necessity and testing-related billing issues in physician-practice contexts.
This expert is an experienced expert witness and litigation consultant.
Start Medical Coding Expert SearchExpert Witness #292785
This usual, customary and reasonable (UCR) expert holds an MBA and CHC, CPC, CPMA, CCS, and ICD-10 CM/PCS Trainer credentials, with over 20 years of experience in compliance, auditing, physician practice oversight, coding consulting, documentation requirements, billing, claim preparation, reimbursement, regulatory compliance, and CDM maintenance.
This expert has delivered training for physicians, managers, and billing staff across a broad range of healthcare coding and compliance topics. This expert has hands-on experience providing chart reviews for coding and compliance, with emphasis on E/M physician audits and education. A background in finance and compliance regulations has supported the design and implementation of coding reimbursement systems, compliance policies, and audit programs for physician practices.
This expert specializes in hospital pricing and charge master issues, healthcare fraud investigations, usual and customary analyses, charge analysis, reimbursement analyses, hospital and physician compliance, ICD-10 and E/M coding training, and audits.
This expert is an active speaker and author who has presented at numerous continuing medical education events, helping hospitals and physician practices identify and prevent healthcare fraud. This expert also consults on building and evaluating compliance programs, conducting compliance program risk analysis to assess effectiveness, and evaluating medical chart documentation.
Start Medical Coding Expert SearchExpert Witness #301115
This medical billing and coding expert holds a BSN and is an experienced Registered Nurse and Certified Professional Coder with over 15 years of clinical, case management, and life care planning expertise. This expert has a background spanning hospital care, research, rehabilitation, and medical review. This expert began in direct patient care and clinical research with pharmaceutical, biotechnology, and prominent medical institutions, later specializing in rehabilitation and life care planning by developing individualized care plans, performing cost analyses, and reviewing medical and billing records. This expert is a Certified Professional Coder, Medical Cost Projection Certified, and Certified Life Care Planner. The combination of clinical insight and analytical expertise supports work in nursing, medical cost analysis, and life care planning.
This expert has been a Registered Nurse for over 15 years and is certified in life care planning and medical coding. This expert has worked in the medical-legal field for over 5 years and has provided expert testimony for a number of years. In billing expert work, this expert reviews medical bills and records to determine reasonable charges, ensure accurate documentation, and assess correct coding for healthcare services. Although billing fraud investigations are not the primary specialty, the background in nursing, coding, and life care planning supports thorough and informed evaluation of billing charges and related medical records.
This expert is an experienced expert witness and litigation consultant.
Start Medical Coding Expert Search