Medical Coding Expert Witnesses

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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.

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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.

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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.

  
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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 #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.

  
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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 #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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