Health care fraud expert witness candidates typically have backgrounds as physicians, legal nurse consultants, medical billing professionals, and may have experience in the healthcare insurance industry or health law. A damages expert, CPA, or forensic accounting professional may also be called in to assist. In a high-profile case, or litigation involving a significant financial stake, the lead attorney may request a professional with prior expert testimony experience.
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. Healthcare fraud encompasses health insurance fraud, drug fraud, and medical fraud. Damages from fraud can be recovered under the False Claims Act, most often under the qui tam provisions which rewards individuals for being “whistleblowers.” Fraudulent medical practice, also known as “quackery,” includes activities such as questionable diagnoses, questionable diagnostic tests, and untested or refuted treatments.
Example litigation support matters requiring healthcare fraud expert witnesses have included:
Expert witness services by a subject matter expert in healthcare fraud could include dispute resolution, an expert report, medical expert opinion, damages calculations, deposition testimony and expert witness testimony in the courtroom.
Representing the plaintiff or defendant, Cahn Litigation Services has the experience required to turn a search for a health care fraud subject matter expert around quickly and provide the right balance of expertise and testimony experience.
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 Health Care Fraud experts known by Cahn Litigation Services. These bios are provided to give lawyers a sense of the Health Care Fraud landscape.
This expert is the Principal of legal nurse consultancy providing comprehensive services including assessment, review, research and analysis for medical related cases. This expert serves attorneys and medical clients in the legal process from identification of merit to verdict, whether plaintiff or defense, with services related to Standards of Care, Medical Malpractice/Negligence, Health Care Fraud, Toxic Tort, Personal Injury, Risk Management and Workplace Culture.
As an educator, collaborator and strategist this expert renders informed professional opinions on the outcomes and delivery of health care. This expert has a quarter of a century of nursing and medical experience, which includes, but is not limited to, Medical Surgical, Intensive Care, Obstetrics and Women's Health, Renal Dialysis, Case Management, Education, Long-Term Care, Management and Leadership.
Specializing in Nursing Management and Leadership, this expert obtained an MS in Nursing, and s BS in Nursing, and a Nurse Legal Consultant Certificate. This expert has served in the role of Assistant Professor of Nursing and, among other certifications, holds an Advanced Cardiac Life Support, Neonatal Resuscitation, and Pediatric Life Support. Additionally, this expert has maintained Medical Surgical Board Certification.
This expert is a member of American Association of Legal Nurse Consultants, Sigma Theta Tau International Chi Omega Chapter, the National League for Nurses, a State Education Association, National Society for Leadership Success, Regional Economic Development Advisory Collaborative, and a Coalition of Nurses Leadership Committee. This expert has served on multiple ethics committees in health care, Presidents Council, Provost Council, and Shared Governance Chair.
This expert has been deposed and testified regarding standards of care and in nursing education regarding civil rights litigation. This expert has excellent communication skills and does not fear a court room setting.
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).
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
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.
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.
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.
This expert runs a legal investigations firm. Past assignments include contract work, where this expert performed medical fraud, waste and abuse detection across all claim types for Medicare and Medicaid claims processed. This work included utilizing data analysis techniques to detect aberrancies in Medicare claims data; and reviewing information in standard claims processing system files to determine provider billing patterns and detect fraudulent or abusive billing practices or vulnerabilities in Medicare policies. This expert ultimately developed potential Fraud Alerts and Program Vulnerabilities, and shared information on the investigations with other Medicare contractors, law enforcement, and other applicable stakeholders.
This expert has testimony experience.