Coding Expert Witnesses

Novato, California

Medical Billing, Insurance - MBR, Medical Billing Review, Usual and customary fees, UCR, Billing analysis, Medical Claims, Healthcare claims, Commercial claims, Hospital claims, Hospital billing, Workers compensation, Veteran Claims, MVA, MVC, Motor vehicle accident, PI case, Personal injury, coding, Medical insurance, Insurance payable

As a medical billing company owner, I'm a billing and claim specialist with 30+ years of experience assisting clinics, ASC's, and medical offices with their insurance claims, follow up, and revenue cycles. Specialties include chiro, acupuncture, orthopedic, psychiatry, psychology, urology, cosmetic surgery, pulmonary, podiatry, transgender, and many others. Experienced with commercial, Workers Comp, VA claims, liens, and MVA's. Experienced with HCFA 1500's, UB-04's, MS-DRG codes, LOA's, DME, and HCPCS. As an Expert Witness, I have analyzed 200+ cases to establish Usual and Customary fees, Howell numbers, payable averages, and have deposition and trial experience.

San Francisco, California

Ophthalmology, Optometry - Cataract, Glaucoma, Diabetic Retinopathy, eye, vision, eye injury, eye injuries, retina, macula, eye surgery, vision loss, patent, antitrust, eyedrops, pharmaceuticals, coding, reimbursement

DR. ANDREW CALMAN, a full-time, board-certified comprehensive ophthalmologist with an active surgical practice, has served as an expert witness in over 300 cases including patent, antitrust, injury, class action, and malpractice cases, including some of the largest judgments and settlements in ophthalmology. Yet he brings the same detailed analysis, diligence, energy, accessibility, and authenticity to all his cases, large and small. For detailed information, including cases, clients, and retaining attorneys, please visit www.andrewcalmanmd.com As Past President of the California Academy of Eye Physicians and Surgeons, and Associate Clinical Professor at UC-San Francisco, Dr. Andrew Calman brings comprehensive expertise in eye diseases, injuries and surgery, as well as outstanding availability and responsiveness. Attorneys have repeatedly praised Dr. Calman's deposition and courtroom skills. Most cases have settled favorably after his expert report or deposition. Dr. Calman is als...

Melbourne, Florida

Medical Coding, Ophthalmology - Surgeon, Coder, Auditor, Fair and Reasonable Value, Medical Coding, Physician Coding, Ophthalmology Coding, Optometry Coding, Reimbursement, Eye Care, Coding, Medicare, Healthcare Fraud, Audits, False Claims Act, National Correct Coding Initiative, Bundling

ABOUT: Highly experienced expert witness with 100+ cases in medical coding, reimbursement, and compliance across the entire medical spectrum, providing services for both plaintiff and defense. Board-certified practicing physician and surgeon, Certified Coding Specialist (Physician-based), and Certified Professional Medical Auditor. Awarded graduate of Cornell University’s College of Engineering (B.S.) and the University of Michigan Medical School (M.D.), with postgraduate specialty training at Johns Hopkins Hospital and the University of California, San Francisco. Master-level graduate (M.B.A.) of the University of Central Florida, College of Business Administration. Chairman of the Ophthalmology Section at Holmes Regional Medical Center in Melbourne, Florida. Assistant professor at the University of Central Florida, College of Medicine. Extensive committee involvement, including American Medical Association’s CPT Advisory Committee and the Florida Medicare Carrier Advisory Com...

Newbury, New Hampshire

Medical Billing, Medical Coding - ALL STATES, Medical Billing, Coding, Usual and customary, reasonable and customary, DRG, CPT, ICD-10, ICD-9, medical necessity, fees, fee schedule, billing

Mark L Friedman MD FACEP FACP is currently Chief Medical Officer Emeritus of First Stop Health. He is an emergency physician emeritus at St Vincent’s Hospital in Bridgeport, CT. He was formerly Associate Professor of Emergency Medicine at the Frank Netter School of Medicine, Chief of Emergency Medicine at St Elizabeth's Hospital of Boston, Assistant Professor of Medicine at Tufts University School of Medicine, Assistant Clinical Professor of Emergency Medicine at the University of Illinois, and Adjunct Professor of Public Health at Benedictine University. Dr. Friedman is an expert in DRG claims analysis and medical cost containment. He has helped design programs to prevent medical errors as well as malpractice litigation. He has served as an advisor to government on medical billing fraud and abuse and developed two companies that perform audits for the Medicare RAC. Dr. Friedman is the author of articles and books on medically related topics. Dr Friedman specializes in expert op...

Newcastle, Oklahoma

Emergency Medicine - Stroke, Sepsis, Cardiac arrest, Pulmonary embolism, fracture reduction, fracture, cardiopulmonary arrest, code, coding, neurologic deficits, CPR, ATLS, trauma, MVC, arthrocentesis, chest tube, central venous line, lumbar puncture, central line, intubation

I obtained my PhD in human physiology from Auburn University in 2008. While there I performed and published research regarding control and regulation of growth hormone and IGF-1 as well as regulation of the HPA axis. I obtained my medical degree from the University of Alabama at Birmingham in 2012 and subsequently completed Emergency Medicine residency there in 2015. I am Board Certified with the American Board of Emergency Medicine as of 2018. I have been a practicing emergency medicine attending physician since 2012. I am employed by a physician group in Norman, Oklahoma and am a member of the core faculty for the Emergency Medicine residency program affiliated with Oklahoma State University. I serve as the Research Director for the residency program. I opened a private medical spa in 2017 that I own and oversee that performs noninvasive cosmetic procedures, hormone replacement, medical weight loss, etc.

Montgomery, Texas

Medical Billing, Fraud - 60-Day Rule, Hospice, Corrective Action Plan, Cost Report, Coding, Statistical Sampling, Overpayment, Skilled Nursing, Home Health, FCA, Medicare, Hospital, Physician, False Claim, Physician Contract, Compliance Training, Anti-Kickback, Laboratory Billing, Medical Necessity, Clinical Documentation

Mr. Loria has 53 years of healthcare (HC) regulatory compliance, M&A, Medicare reimbursement and appeals, hospital pricing, managed care contracting and litigation support. Extensive expert witness experience before the Provider Reimbursement Review Board, ALJ proceedings, civil and criminal litigation, and mediation and arbitration proceedings. Mr. Loria has represented hospitals, nursing facilities, home health, hospice, reference laboratory, physician groups, and other providers in Medicare appeals and controversies. During his career he has managed more than 2,000 Medicare disputes and other investigations. He was a Partner in the SW Regional HC practice of PwC. Prior to joining PwC as a Partner, he was the National Director of the Regulatory practice at EY for 10 years. He founded Loria Associates in 2002 and serves as CEO and Managing Director. He has consistently served HC clients on a nation-wide basis and delivered excellent results based on his unique qualifications a...

ARLINGTON , Virginia

Ophthalmology, Plastic Surgery Within the Head and Neck - Lasik, cataract surgery, pterygium surgery, medical retina, glaucoma, corneal procedures, facial aesthetics, oculoplastics, trauma and injuries, blepharoplasty, laser treatments, optometry, malpractice cases, ophthalmology emergencies, retinal lasers, intravitreal retinal injections, IMEs, coding

I am a Board Certified Ophthalmologist who graduated with honors from a highly competitive 6 year BS-MD program. I have over 20 years of clinical experience in ophthalmology and am familiar and experienced in most clinical and surgical fields of ophthalmology including but not limited to Lasik/PRK, cataract surgery, ocular trauma, glaucoma treatment and surgery, corneal diseases and surgeries , pterygium surgeries, retinal lasers and intravitreal injections, facial aesthetics including botox and fillers, and oculoplastics. I have over 15 years experience with and enjoy doing chart reviews, serving as an expert witness, and performing independent and disability medical examinations. I have significant knowledge and experience in dealing with ocular trauma and surgical complication cases. I am well versed in ocular sequalae resulting from traumatic brain injuries. I am a clinical professor for premedical program at The George Washington University. I have served on both defens...

Adell, Wisconsin

Chiropractic, Medical Coding - Sports Medicine, Medical Malpractice, Chiropractic malpractice, motor vehicle accidents, motor vehicle collisions, independent medical examinations, legal medicine, physical therapy, coding, standard of care, scope of practice, insurance fraud, benefits, Taft- Hartley, personal injury, informed consent

Dr. Boll has extensive medicolegal experience and has been in practice since 1992. He has been retained nationwide for various cases. Dr. Boll assists numerous entities (law enforcement, law firms, insurance carriers, TPAs) as an Expert Witness, Consulting Witness, CPT and diagnostic coding issues, File Review, and Independent Medical Examinations, along with internal educational programs. He is a Certified Professional Coder (CPC) from AAPC and a Performance Enhancement Specialist (PES) from NASM. Dr. Boll has active licenses in both Wisconsin and Michigan. He continues to practice within his athletic training and conditioning facility, serving two school districts and consulting with professional racing sanctioning bodies regarding race weekend injury concerns. Dr. Boll was a former Chiropractic Services Director for an insurance company, where he assisted in writing guidelines, sitting on appeals panels, and establishing internal review and claims processing measures. He is...