Medicare Advantage Expert Witnesses
Medicare advantage expert witnesses and consultants listed here may be able to form expert opinions, draft expert witness reports, provide expert witness testimony at deposition and/or trial as or serve as consulting (non-testifying) experts on medicare advantage. The medicare advantage expert witness listings on this page are typically from fields/areas of expertise such as: Family Medicine, Health Informatics, HIPAA, HMO, Insurance, Medical Billing, Medical Management, and Occupational Medicine.
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Newport Beach, California
Medical Billing, HIPAA
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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...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Colorado
Medical Billing, HIPAA
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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...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Florida
Medical Billing, HIPAA
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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...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Louisiana
Medical Billing, HIPAA
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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...
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Mary Mason, MD MBA FACP
Former CMO Fortune 25 Managed Care /Physician
Saint Louis, Missouri
Insurance, Medical Management
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Medicaid, Managed Care, Medicare, Dual Eligible, Marketplace, Medical Policy, Utilization Management, Risk Management, Payer Operations, Quality Improvement, Regulatory Compliance, Expert Witness, Internal Medicine, Corporate Compliance, Medicare Advantage, Utilization Review, Access to Care, Population Health, Insurance
Physician executive, internist, MBA, and thought leader in managed care with 27 years of leadership experience across Medicaid, Medicare, Dual Eligible/D-SNP, Marketplace, utilization management, medical policy, quality performance, population health, and payer operations. Former Senior Vice President and Corporate Chief Medical Officer for Centene, a Fortune 25 healthcare enterprise, and Washington University faculty member with extensive experience in enterprise clinical strategy, risk management, and work with corporate lawyers, corporate compliance, and senior leadership on litigation-related matters, depositions, fair hearings, regulatory issues, medical affairs, and complex managed care operations
Washington University faculty member, with appointments in the School of Medicine, School of Law, Olin Business School, and Brown School of Social Work. Board-certified internist, Fellow of the American College of Physicians, and Missouri-licensed physician. Earned an MD from Washin...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Nevada
Medical Billing, HIPAA
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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...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
New Jersey
Medical Billing, HIPAA
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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...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
New York
Medical Billing, HIPAA
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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...
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James J. McCormick, M.D., M.B.A
Medicare Advantage Prior Auth Physician Expert
Yanceyville, North Carolina
HMO, Insurance
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prior authorization, PA, Medicare Advantage, MA, Outpatient authorization, Inpatient authorization, Post Acute authorization, Appeals, documentation standards, managed care, helicopter transportation
As a physician leader, I have designed and implemented systems to ensure medical recordkeeping meet legal, reimbursement, and quality benchmarks. I spearheaded the development of a multi-state governance framework for both primary and specialty care groups, ensuring peer review, credentialing, quality assurance, and utilization management processes are rigorously structured and defensible. I also led the creation of an enterprise-wide Utilization Management Committee to meet CMS mandates. The committee is empowered to critically evaluate national clinical policies before adoption—aligning frontline utilization decisions with evidence-based standards. With decades of expanding leadership across diverse healthcare sectors, I bring a fair, balanced, and meticulously documented expert perspective to every case I consider.
Tradewinds Healthcare Consulting, LLC 04/2025 - Present
- Consulting Expert
- Testifying Expert
- Clinical case review
Humana, Inc. 08/2023 - 04/2024...
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Carol E Schultz, FSA, MAAA
Health Actuary
White Pine Actuarial Consulting
Austin, Texas
Insurance, Health Informatics
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Actuary, Actuarial, Health Insurance, Medicare, Finance, Medigap, Medicare Advantage, Medicare Supplement
I am a health actuary with over 20 years of experience. I am a Fellow of the Society of Actuaries (FSA), and a member of the American Academy of Actuaries (MAAA). Most of my work experience is related to Medicare, but I know the general health insurance industry and can work on a variety of insurance-related topics. I am an excellent public speaker and writer. I can easily translate the complex topics of my work to a non-technical audience and have an approachable countenance. I worked for three major health insurance carriers for a total of 18 years before launching my own consultancy to work on a variety of health-related projects in 2024. I greatly enjoy the variety of projects I am exposed to as a consultant. I look forward to serving as an expert witness, as it will give me the opportunity to explore even more health insurance topics, and lend my expertise in legal cases. I am good at explaining technical concepts in reports, talking about the concepts of my work to peo...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Texas
Medical Billing, HIPAA
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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...
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Laura Suttin, MD, MBA, PCC
Family Medicine Physician - Peer Review Expert
San Antonio, Texas
Family Medicine, Occupational Medicine
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primary care, outpatient medicine, preventive medicine, Medicare Advantage, geriatrics, chronic disease management, HCC coding, risk adjustment, managed care, chart review, peer review, medical record review, workers' compensation
I am a board-certified family physician with an active, unrestricted Texas medical license and over 20 years of clinical practice experience in primary care and outpatient medicine. With an MBA alongside my MD, and as a former healthcare executive, I bring both clinical depth and administrative perspective to every case evaluation — and I communicate my findings clearly, whether the audience is a legal team or a non-clinical decision-maker.
Throughout my career, I have performed chart reviews and peer reviews across a broad range of primary care and outpatient clinical scenarios, with particular familiarity in chronic disease management, Medicare Advantage populations, preventive care standards, HCC coding accuracy, and medical necessity determinations. Beyond individual case review, I founded and led a physician peer review committee for over 10 years — completely redesigning the process from the ground up, establishing its standards and workflows, and guiding the committee throug...
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Washington
Medical Billing, HIPAA
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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...
