Medical Billing Expert Witnesses

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What is a medical billing expert witness?

Medical billing expert witness candidates have years of experience in healthcare administration, medical coding, and/or provider compliance with training as a Certified Professional Medical Auditor (CPMA) or Certified Professional Coder. Health insurance billing expert witnesses have extensive HIPAA knowledge specific to insurance billing practices. Physician billing expert witnesses and medical insurance billing expert witnesses may work in tandem, combining their expertise. Medical bill review expert witnesses have an advanced degree and associated with an organization such as the American Academy of Professional Coders (AAPC) or the Healthcare Billing & Management Association (HBMA).

What types of cases require a medical billing expert witness?

Example litigation support matters requiring an expert in medical billing include medical malpractice cases, personal injury, healthcare fraud, and health insurance fraud.

Medical billing involves filing claims with health insurance organizations to receive payment for services rendered. Medical coding is an important component of medical billing and involves an analysis of medical provider statements and the assignment of standard codes using a classification system.

Medical billing expert witness case examples

Example cases that Cahn Litigation Services has searched for medical billing expert witnesses for have encompassed:

• Current Procedural Terminology (CPT codes),
• Medicare fraud,
• Medicaid medical bill reimbursement,
• neurology medical records,
• life care plan payers,
• International Classification of Diseases (e.g., ICD-9, ICD-10-CM),
• Certified Life Care Planner (CLCP) qualifications,
• insurance companies reimbursement for medical services,
• medical cost and medical necessity assessment as a result of a personal injury,
• clinical documentation auditing,
• Medicare and Medicaid fee schedule and medical bill reviews,
• HIPAA matters,
• Medicare Set-Aside law,
• electronic health records (EHR) breach,
• false claims act matters (Qui tam),
• independent medical examination (IME) methodology, and
• medical malpractice.

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

Expert witness services by a subject matter expert in medical billing could include research and authoring expert reports, providing expert opinions, deposition testimony, and trial testimony. In a high-profile case, or litigation involving a significant financial stake, the lead attorney may request a medical billing or medical coding expert with prior expert testimony experience.

Cahn Litigation Services has the experience required to turn a search for a medical billing 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.

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Medical Billing 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 Medical Billing experts known by Cahn Litigation Services. These bios are provided to give lawyers a sense of the Medical Billing 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 #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.

  
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• Expert 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.

  
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• Expert Witness #262604

  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.

  
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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 #263905

  This expert serves as Senior Manager and leads the Forensic Investigation group of a highly successful, International consultancy. This expert brings to the table many years of experience, with expertise in economic damage analysis and quantification, and other financial issues, including damage quantifications and analyses, fraud and forensic accounting investigations, forensic accounting analyses, and ethics and compliance reviews. This expert’s case experience encompasses a broad array of industries including automotive, aviation, biotechnology, cellular, chemicals, consumer products, energy, financial securities, healthcare, HVAC, information technology, internet, medical products, military, network security, online learning, optical, pharmaceuticals, semiconductors, sporting goods, supercomputers, and telecommunications.

  This expert previously spent years with an Internal Audit Investigations team at a Fortune 500 manufacturing company, handling damage calculations and recoveries from fraudulent billing schemes, employee misconduct investigations, and highly sensitive senior/executive level employee investigations. This expert’s prior experience also includes positions at large international companies in the life sciences and financial services sectors, providing internal investigation, internal audit, and financial reporting control services. This expert’s experience includes discovery, deposition and trial assistance, calculation of economic damages, forensic accounting analyses in litigation and non-litigation matters, as well as other dispute forums, and advising clients related to internal fraud preventative and detective controls.

  
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