Health Care Fraud

A health care fraud expert witness typically has a background as a physician, legal nurse consultant, medical billing professional, and/or in the healthcare insurance industry or health law.

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 a medical expert witness include a medical malpractice case, Medicare fraud, managed care health plan disputes, standards of care, medical negligence, and fraudulent claims. Expert witness services by a subject matter expert in health care fraud could include dispute resolution, an expert report, expert opinion, deposition testimony and expert witness testimony in the courtroom. In a high-profile case, or litigation involving a significant financial stake, the lead attorney may request a professional with prior expert testimony experience.

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.

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Health Care Fraud Expert Witness - Sample 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 Health Care Fraud experts known by Cahn Litigation Services. These bios are provided to give attorneys a sense of the Health Care Fraud landscape.


Expert Witness #257855

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.


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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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