Medical Billing Fraud Expert Witnesses

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

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...

Medical Billing, Medical Coding - Usual customary reasonable charges, damages, fraud, Over-billing statistical analysis, Electronic health records, clinical documentation, insurance coverage determinations, provider, biller, insurance disputes

Two decades of Medical Billing expertise in multiple care settings. 24-hour turnaround on billing consultations. Thorough analysis and reporting. Expert in analysis of contract rates compared to actual billed charges Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act fraud Usual Customary Reasonable (UCR), Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid,insurance, CRPS, EMTALA, HIPPA compliance

Newport Beach, California

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

Colorado

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

Florida

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

Louisiana

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

Nevada

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

New Jersey

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

New York

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

SAN ANTONIO, Texas

Medical Billing, Medical Coding - Pain Management, Orthopaedics, Anesthesia, UCR, Personal Injury, Chiropractic, Neurology, Fraud Waste Abuse, Unbundling, Fee Analysis, Physical Therapy, Radiology, Medical Record Auditing, Psychiatry, Up coding, Outpatient Hospital, Hospital Billing, Reasonable charges, Future Costs, Medical Billing Fraud

BEST-MED CONSULTING, LLC - Billing Expert Solutions of Texas. Highly Experienced Expert Witness 10 years –200 + cases. Multiple specialty expertise (Pain Management, Anesthesia, Physical Therapy, Chiropractic, Orthopedic, Radiology, Hospital) Trial and deposition experience. Certified Professional Coder and Medical Record Auditor 20+ Years. Healthcare Compliance experience for Health Plan and Large Health System. Experience in detecting Healthcare Fraud, Waste and Abuse former Special Investigation Unit Manager.

Texas

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...

Washington

Medical Billing, HIPAA - Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages

Summary of Qualifications National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings. Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling. DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement. Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT. Areas of Expertise Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act). Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...