Managed Care Expert Witnesses
Start Managed Care Expert Search
What is a managed care expert witness?
Managed care expert witness candidates typically have backgrounds as a physician, legal nurse consultant, specialized medical expert, and/or in the health insurance industry. In a high-profile case, or litigation involving a significant financial stake, legal counsel may request an expert with prior expert testimony experience. The expertise of a managed care expert witness will provide credibility to enable the jury to consider the evidence with the weight it deserves.
What types of cases require a managed care expert witness?
Litigation support matters requiring a managed care expert witness often involve medical malpractice cases, personal injury, managed care health plan disputes, standards of care, pain management, or medical billing.
According to the National Center for Biotechnology Information, U.S. National Library of Medicine, managed care programs are:
Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as health maintenance organizations and preferred provider organizations.
What litigation support work might a managed care expert witness be expected to perform?
Expert witness services by a subject matter expert in managed care could include dispute resolution, research and authoring expert reports, providing expert opinions, deposition testimony, and courtroom testimony.
Cahn Litigation Services has the experience required to turn a search for a managed care expert witness around quickly, providing the right balance of expertise and testimony experience.
Related Disciplines
Managed Care 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 Managed Care experts known by Cahn Litigation Services. These bios are provided to give lawyers a sense of the Managed Care landscape.
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.
Start Managed Care Expert SearchExpert Witness #250690
This expert has been in the health care IT field for many years and has been actively been involved in EHR implementations. This expert has been involved in over 200 Hospital implementations and has worked with over 26,000 physicians on their EHR decisions and implementations. This expert has also been involved in over 150 replacements of older or discontinued healthcare specific applications, and has been evaluating EHR products and publishing a report with 3,000+ functionality. This expert has extensive experience in health care redesign and organizational restructuring along with a comprehensive background in start-up and replacement of multi-facility health information platforms, including financial, clinical, managed care and decision support systems. This expert tracks industry trends, conducts member surveys, publishes case studies, assesses best practices, and performs benchmarking studies, and evaluates over 70 product categories within healthcare that are offered by more than 500 software, RCM, and Value Based Reimbursement (VBR) vendors that are in the care Coordination and Population Health Marketplace. This expert specializes in the evaluation, selection, and ranking of vendors in the VBR, RCM, HIE, and PMS/EHR hospital and physician healthcare marketplace. Annually this expert publishes a detailed report on VBR, HIE, and PMS/EHR software product functional, usability, and company viability. This evaluation decision tool has been used by more than 25,000 physicians, more than 20 ACOs/IPAs, and over 200 Hospitals. Additionally, this expert has conducted more than 400 PMS/EHR searches, selections, and contract negotiations for small physician offices to large IPA.
This expert provides independent advisory and consultative services designed to assist physicians and hospitals in evaluating and selecting technology to enable the creation of a digital medical office of the future. For Hospital clients, this expert conducts operational reviews, technology selections, and assists in development of long range plans. This expert has extensive prior litigation experience including deposition and courtroom testimony.
Start Managed Care Expert SearchExpert Witness #247616
This COPD/pharma development expert holds an MD, FCCP, MBA, and CPE and is a clinical pulmonologist with Board Certifications in Pulmonary Disease and Internal Medicine. This expert opened a pulmonary disease, Critical Care Medicine, and Sleep Medicine practice that eventually grew to a number of offices, a number of sleep labs, dozens of employees, and over 5 providers.
This expert has diagnosed and managed thousands of patients with COPD. While this expert has no history of working on patent cases, this expert has testified as a pulmonary disease expert hundreds of times in Pulmonary/Critical Care/Sleep Medicine and product liability cases. This expert also has clinical trial experience.
Start Managed Care 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 Managed Care Expert SearchExpert 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.
Start Managed Care Expert SearchExpert Witness #294677
This mental health facility standard of care expert holds an MSW, is an LCSW, and has over a decade of experience as a Licensed Clinical Social Worker and Certified Eating Disorder Specialist & Supervisor. This expert specializes in treating eating disorders, acute and complex trauma, substance abuse, obsessive compulsive disorder, and depressive and anxiety disorders. Experience includes providing intensive therapy at inpatient and outpatient treatment centers for eating disorders, mental health, and substance abuse. This expert is also a former director of a large and prominent adult eating disorder treatment center. This expert holds a Masters in Social Work from a prestigious university and a B.A. in Psychology from a well-regarded university.
As a program director at a residential treatment center for a number of years, this expert ensured the facility's compliance with California requirements for licensure as a residential treatment center through the Joint Commission, including a thorough understanding of quality of care, patient and staff safety from physical and emotional perspectives, HR management, patient, staff, and facility vulnerabilities, health department requirements, record-keeping protocols and requirements, patient rights, and emergency protocols. This expert managed staffing and oversight of facility staff, including floor staff, doctors, nurses, dietitians, and therapists. This expert has been licensed with the state of California and approved for supervision of AMFT, APCC, and ASWs for over 5 years. This expert has worked as an expert witness in matters related to mental health facility record keeping and compliance with standards of care, particularly in residential treatment.
This expert is an experienced expert witness and litigation consultant.
Start Managed Care 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 Managed Care Expert SearchExpert Witness #297916
This property management expert has broad experience maintaining and managing commercial property, including office buildings and retail centers. This expert has managed office buildings for over 25 years and a retail center for over 5 years, has owned a number of office buildings, and understands building maintenance and management requirements.
This expert currently works on numerous assignments involving appraisal, brokerage, property management standard of care, and valuation services. This expert is a seasoned expert witness.
Start Managed Care Expert Search