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Medicare Expert Witnesses

Medicare 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. The medicare expert witness listings on this page are typically from fields/areas of expertise such as: Family Medicine, Fraud, Geriatric Psychiatry, Geriatrics, Health Informatics, Hospice and Palliative Care, Insurance, Long Term Care, Marketing, Medical Billing, Medical Coding, Medical Management, Nursing Home Administration, Nursing Homes, and Ophthalmology.

Michael F. Arrigo

Health Informatics
Electronic Health Records
ICD-10 Healthcare Coding

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Robert D. Zitsman, LNHA, MBA, NHA

Experienced Nursing Home Administrator

Expert Consulting Services

San Diego, California

Nursing Home Administration, Long Term Care - Wound Care, staffing analysis, nursing home, malpractice, Healthcare administration, Skilled Nursing Facility Management, CMS Survey Compliance, Patient Care Quality Improvement, Post-Acute Care Services, Dementia, Regulatory Compliance, Medicare, Healthcare Leadership, Nursing Home Expert

Robert D. Zitsman, LNHA, MBA, NHA, has over thirty-five years of experience in healthcare administration, focusing on promoting excellent, evidence-based patient care outcomes and creating positive experiences for patients, residents, families, and staff. His extensive career spans the continuum of care from critical care to long-term care, including inpatient acute rehab, post-acute rehab, dementia care, assisted living, and entry fee model continuing care retirement communities (CCRCs). Robert has consistently maintained substantial compliance with CMS surveys for over twenty years. Currently, Robert serves as the Administrator at Community Memorial Hospital-Ojai’s Continuing Care Center, a 75-bed skilled nursing facility. He has held numerous leadership positions, including Interim Administrator at Community Hospital of the Monterey Peninsula and Administrator at Escondido Post Acute Rehab, overseeing operations at facilities with up to 180 beds. His role at Life Care Services a...

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David Martinez, CPC, CMRS, CCA, CCS, CCE, CHP, CCO

Medical Billing & UCR Reimbursement Expert Witness

Accurate Billing Investigators, Inc.

California

Medical Billing, Insurance - Managed Care, HMO, PPO, Medicare, Medicaid, Reasonable Value, Audit, Hospital, ERISA, Usual and Customary, Reimbursement Disputes, Claims Denials, Athena Billing, Out-of-Network, Balance Billing, Fee Schedule Analysis, Expert Testimony, Medical Necessity, Multi-State, Healthcare Reimbursement

I have over 35 years of experience in medical billing, reimbursement, and managed care systems, with expertise spanning provider operations, payer methodologies, and claims adjudication practices. My work focuses on evaluating medical billing accuracy, reimbursement methodologies, usual and customary charges, and payer denial practices. Practice includes multi-state reimbursement analysis, with extensive experience in California managed care systems, including HMO, IPA, and risk-based reimbursement structures, as well as Medicare Advantage and national payer methodologies. I have served in multiple roles, including claims examiner, billing manager, revenue cycle executive, and founder of a national medical billing and audit firm. This multidisciplinary experience allows me to analyze disputes from both the provider and payer perspectives. Experience includes analyzing billing system workflows and claims processing issues across platforms such as Athenahealth. My expert work includ...

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Elliott M. Stein, MD

Geriatric Psychiatrist - Estates/UI, NH/ALF Cases

Mill Valley, California

Psychiatry, Geriatric Psychiatry - Contested wills and trusts, Testamentary capacity, Undue Influence, Geriatric Psychiatry, Elders & Elderly, Dementia, Alzheimer's Disease, Nursing Homes, Assisted Living, Medicare, Geriatric decision making capacity competency, Medical Documentation and Coding, Depression, Anxiety, Stress, Psychosis

Providing legal and forensic consultation on legal issues pertaining to the elderly and their mental, emotional, behavioral and cognitive functioning, including contested inheritance, undue influence and financial elder abuse, and dementia and related issues in nursing homes, memory care and assisted living facilities. Clinical Professor (Voluntary), Psychiatry, University of California San Francisco; Psychiatric Consultant, San Francisco Towers life care community 2021- Present. Consultant in Geriatric Psychiatry, San Francisco Veterans Administration Medical Center 2021 - 2023. Previously, Director of Psychiatry, Jewish Home of San Francisco, 2010 – 2020. Previously in private practice of Adult and Geriatric Psychiatry, 1977 – 2010, in Miami and Miami Beach, Florida. Board Certified, Geriatric Psychiatry and General Psychiatry, by the American Board of Psychiatry and Neurology. Distinguished Life Fellow, American Psychiatric Association. Distinguished Fellow, American A...

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John J Hosier

Pharmaceutical & Biotechnology Marketing and Sales

John Hosier Healthcare Consulting, LLC

California

Marketing, Pharmaceutical Regulation - Bio-similar drugs, Biotech & Pharma Marketing, Operations, Promotion, CNS Products, Medicare, Launch delay, Pharma Commercialization, Pharmaceutical Contracting & Pricing, Pharmaceutical Launch, Pharma Marketing, Pharma Sales, Specialty Pharma, DTC, Commercially Reasonable Efforts, CRE, Pharmaceuticals , Promotional compliance

Mr. Hosier is a strategic advisor to the life sciences industry drawing on 30 years of sales, marketing and managed markets experience in commercial healthcare organizations. He has provided insights to small molecule & biotechnology companies across multiple therapeutic areas but has maintained a heavy concentration in oncology and specialty pharmaceuticals. He has led brand launch; corporate, franchise, and strategic brand planning; commercial integration; organizational design; and operational effectiveness from multiple perspectives (as the client, as the independent consultant, and as an agency lead). Mr. Hosier’s firm has architected the launch of rare disease and oncology business units for multiple pharmaceutical clients (large and small); led development of the managed markets, trade, and distribution strategy for the launch of new chemical entities (NCEs) and 505(b)2 assets for various organizations; advised on commercially reasonable effort (CRE); and provided commerci...

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Tiana Thompson, NHA, MBA

Experienced Nursing Home Administrator Expert

Expert Consulting Services

Montclair, California

Nursing Home Administration, Long Term Care - Wound Care, Nutrition, Abuse, Medicare Compliance, Behavioral Health, Infection Control, Health Services Management, Elder Care, Neglect, Memory Care, Dementia/Alzheimer's, Regulatory Compliance, Nursing Home Finance, Quality Assurance, Subacute Care, Medicare

A dynamic healthcare executive with a rich background in senior living, skilled nursing, and behavioral health management, Tiana Thompson brings substantial expertise in operations, compliance, and turnaround strategies for healthcare facilities. As VP of Operations for “We Care” Psychology Affiliates and a seasoned healthcare consultant, she manages multi-state behavioral health practices and provides expert witness services in nursing home litigation. Her leadership in skilled nursing and assisted living facilities has consistently resulted in improved star ratings, regulatory compliance, and financial health. Known for her strategic approach, Tiana excels in staff development, budgeting, and fostering positive work environments. Case Work Includes: Skilled Nursing and Assisted Living Operations Behavioral Health Program Management for Senior Living Expert Witness in Nursing Home and Assisted Living Litigation Regulatory Compliance (Medicare, Medicaid, CMS, OBRA, OSHA) Financial ...

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Karl E. Steinberg, MD, CMD, HMDC, HEC-C

Geriatrics, Nursing Homes, Hospice/Palliative

Stone Mountain Medical Associates, Inc.

Oceanside, California

Geriatrics, Nursing Homes - Nursing Home - Skilled Nursing Facility, Hospice - End-of-Life Care, Palliative Care, Home Health, Assisted Living, Regulatory, Decubitus, Pressure Ulcers, Falls, Dementia - Alzheimer's, Medicare, Medicaid, Managed Care - HMO, Life Care Planning, Personal Injury, Family Medicine, Addiction Medicine, Bioethics

Experienced Expert, 250+ depositions, 25+ trials. Speedy and Objective Records Reviews (plaintiff/defense); Standard of Care, Causation and Damages Opinions, including Life Expectancy and Future Care Costs, Regulatory Actions; Comprehensive Report Writing. References Available on Request. In clinical practice of post-acute and long-term care medicine, Geriatrics & Hospice in San Diego area since 1992; Chief Medical Officer, Bio-Pacific Admin Services (nursing facility management company); Chief Medical Officer, Beecan Health; Delegate, AMA and California Medical Association House of Delegates; Chair, CMA Council on Ethical, Legal & Judicial Affairs; Chair, CMA Administrative Medicine Forum; Clinical Faculty UCSD School of Medicine and Family Medicine Dept., Affiliate Faculty, California State University's Shiley Haynes Institute for Palliative Care (San Marcos), Past President of CALTCM, Past President of PALTmed (Post-Acute & Long-Term Care Medical Association, previously AMDA,...

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L. Neal Freeman, MD, MBA, CCS-P, CPMA

Physician/Surgeon + Medical Coding/Auditing Expert

Coding and Physician Reimbursement Analysts, Inc.

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...

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Marsha S Diamond, CPC, COC, CCS, CPMA

Medical Auditing, Billing, and Coding Expert

Orlando, Florida

Medical Billing, Medical Coding - CPC, CPMA, COC, CCS, medical coding, medical billing, medical auditing, Qui tam, AAPC, CIA, IRO, Medicare, Inspector General, Medical, UCR, Usual Customary and Reasonable, Electronic Medical Records, EMR, Compliance

Ms. Diamond is an experienced coding, billing, and auditing professional who is available for consultation in medical practice auditing, billing, coding, compliance, litigation, reimbursement, and revenue cycle issues when requested by medical providers, their management, or their legal counsel. She is a Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) by the American Association of Professional Coders (AAPC), with her initial certifications over 30 years ago. She has served as a member of the AAPC National Advisory Board, has been a Fellow of the AAPC, and has served as President of the Greater Orlando Chapter of AAPC. She is a Certified Professional Medical Auditor (CPMA) by the AAPC. For 18 years, she led billing and coding for a university multi-specialty medical practice of over 400 physicians. She has 20 years of experience as a medical auditor with a company that provided medical auditing services for medical practices, hospitals, and commercial me...

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Cassandre Voltaire, DO, ABWMS

Physician & Wound Care Expert Witness

WoundFit LLC

Lexington, Massachusetts

Wound Care, Urgent Care Medicine - Wound Care, Pressure Injury Prevention, Pressure Ulcer Management, Nursing Standard of Care, Skilled Nursing Facility, Long-Term Care, Hospital-Acquired Pressure Ulcers, Diabetic Foot Ulcer Care, Medicare, Amputation Prevention, Debridement Standard of Care, Home Health Wound Care, Nursing Home, Pressure Injury, Avoidable

Cassandre Voltaire, DO, ABWMS Wound Care Expert Witness | Pressure Ulcer Expert Witness | Diabetic Foot Ulcer Expert Cassandre Voltaire, DO, ABWMS is a double board-certified physician (Family Medicine and Wound Medicine & Surgery – ABWMS) and a highly sought-after wound care expert witness with deep clinical experience in long-term care, skilled nursing facilities, VA/domiciliary settings, and outpatient wound management. Dr. Voltaire specializes in the prevention, evaluation, and treatment of pressure injuries, diabetic foot ulcers, venous and vascular ulcers, post-surgical wounds, and other chronic non-healing wounds. She currently practices as Primary Care & Wound Care Physician at Soldiers’ Home in Chelsea (VA long-term care and domiciliary units) and has held dedicated wound care roles at Beth Israel Deaconess Medical Center and Skilled Wound Care across multiple long-term care facilities in Massachusetts. Her daily work includes advanced modalities such as sharp debridemen...

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Mary Mason, MD MBA FACP

Former CMO Fortune 25 Managed Care /Physician

Saint Louis, Missouri

Insurance, Medical Management - 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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John J Hosier

Pharmaceutical & Biotechnology Marketing and Sales

John Hosier Healthcare Consulting, LLC

West New York, New Jersey

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John J Hosier

Pharmaceutical & Biotechnology Marketing and Sales

John Hosier Healthcare Consulting, LLC

New York

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John J Hosier

Pharmaceutical & Biotechnology Marketing and Sales

John Hosier Healthcare Consulting, LLC

Pennsylvania

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Megan Smith, DO, MBA

Medical Qui Tam False Claims Expert Witness

MAS Medical Consulting, LLC

Aledo, Texas

Medical Billing, Medical Coding - Qui Tam, Health Insurance Fraud, Medical Necessity, Medicare Fraud, Medicare LCDs, Medicare, Commercial Insurance, Medicare NCDs, Medical Coding, Medicare Billing, Upcoding, Health Insurance Coding, Medicare Abuse, Commercial Insurance Fraud, Medical Policy

Dr. Smith is board certified in internal medicine with experience as a medical director in determining the medical necessity of procedures, post-acute care, admissions and billing & coding questions. Additionally, she has experience in serving as a consultant for pharmaceutical marketing research questions. She is licensed by the State of Texas Medical Board.

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James E Alexander, Jr., MD

Specializes in Medicare Qui Tam False Claims Cases

Healthcare Compliance Management, LLC

Fort Worth, Texas

Medical Billing, Medical Coding - Qui Tam, Health Insurance Fraud, Health Insurance Abuse, Medicare, Medicare Fraud, Medicare Abuse, Medical Policy, Medical Necessity in Medicare, Medicare LCDs, Medicare NCDs, Medicare Coding, Medicare Billing, Health Insurance Coding, Upcoding, Medical Devices, New Medical Technology

Completed SEAK Expert Witness Training. Experience working on 4 large qui tam cases. Retired Captain (O-6) United States Navy. Board Certified General Surgeon. Partner in Healthcare Compliance Management, LLC, a consulting firm incorporated in Texas. Dr. Alexander and his partners established HCM in early 2002 and since that time he has been involved in numerous healthcare compliance consulting projects for major pharmaceutical and medical device manufacturers, large and small hospitals, cancer centers, large and small physician groups, other consulting entities as a special consultant, and legal firms (both as a consultant and as an expert witness).

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Sandra Guerra, MD, MPH

Exec Doctor: Public Health, Insurance & Medicine

San Antonio, Texas

Preventive Medicine, Family Medicine - Health Insurance, Utilization Management, Government Contracts, Quality, Outbreak, Communicable Diseases, TRICARE, Medicare, Medicaid, HIV, LGBT care, Migrant Care, Non-profit or indigent care, Correctional facility care, Denial/Appeals, Academic health, Population health, Tuberculosis, Non-Profit

Executive Physician and former Chief Medical Officer with extensive leadership experience across public health, health insurance, complex health systems, government agencies, and nonprofit organizations. Brings deep clinical, administrative, and policy expertise to cases involving population health, disease prevention, standards of care, health plan operations, and organizational oversight. Areas of Expertise Public Health • Preventive Medicine • Family Medicine • Population Health • Health Insurance and Health Plan Operations • Clinical Oversight and Standards of Care • Utilization Management, Denials, Case and Disease Management • Outbreak and Contamination Response • Disaster Health • Clinical Quality Improvement and HEDIS Attainment • Accreditation and Certification • Clinical Safety • Provider Network Credentialing • Social Determinants of Health • Health Equity • Government Health Programs (Federal, State, Local) • Clinical Analytics, Metrics, AI and Predictive Analytics • Pub...

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David Martinez, CPC, CMRS, CCA, CCS, CCE, CHP, CCO

Medical Billing & UCR Reimbursement Expert Witness

Accurate Billing Investigators, Inc.

McKinney, Texas

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Tiffany Richter, DO, HMDC

Hospice and Palliative Physician expert

Houston, Texas

Hospice and Palliative Care - Hospice, Palliative, LCD, Hospice eligibility, fraud, OIG, end-of-life, terminal, medicare, medicaid, compliance, CMS, hospice malpractice, medical record review, life expectancy determination, capacity, goals of care, standard of care, wrongful death

Dr. Tiffany Richter is a Hospice and Palliative Medicine & Family Medicine board certified physician with more than 17 years of experience in hospice and palliative care. Throughout her career, she has served in clinical, administrative, and executive leadership roles, including Hospice Medical Director and Chief Medical Officer, overseeing the delivery of care to thousands of patients across multiple states and diverse healthcare settings. Dr. Richter possesses extensive expertise in Medicare hospice eligibility, prognostication, hospice documentation, regulatory compliance, quality improvement and physician oversight. She has significant experience reviewing medical records, evaluating clinical decision-making, assessing hospice eligibility determinations, and interpreting Centers for Medicare & Medicaid Services (CMS) regulations and Local Coverage Determinations (LCDs). In addition to her clinical and leadership experience, Dr. Richter has participated in administrative and ...

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Lance S. Loria, CPA, LFACHE, FAAMA

National Expert in Medicare Regulatory Matters

Loria Associates, LLC

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...

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Carol E Schultz, FSA, MAAA

Health Actuary

White Pine Actuarial Consulting

Austin, Texas

Insurance, Health Informatics - 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...