Utilization Review Expert Witnesses

Phoenix, Arizona

Chiropractic, Acupuncturist - Personal Injury, Chiropractic IME, Medical Records Review, Utilization Review, Plaintiff or Defense

1983 graduate of Palmer College of Chiropractic (Davenport), AZ Chiropractic License #3884 issued in 1984. 41 years in active solo practice (and currently) using chiropractic manipulation, physical medicine modalities and acupuncture. Former Medical Director of FCQA. 35 years as a Clinical Advisor for BCBSAZ doing chiropractic UR/UM, peer review and med. necessity determinations. Former member of BCBSAZ Medical Appeals and Professional Standards Committees. Vetted by URAC to make med. necessity/investigational determinations on chiropractic and non-chiropractic medical appeals. 30 years (and current) as a member of the BCBSAZ Credentialing/Clinical Quality Management Committees. Currently working for American Health Holdings, Inc. doing UR and preauthorization of PT/Chiropractic services. Currently doing IMEs for ISG, Inc.

Napa, California

Medical Management, Risk Management - Medical Quality/Risk Management, Hospital and Medical Management, Hospital Compliance, Medical Compliance, HIPAA, Grievance and Appeals, Managed Care, Joint Commission, CMS, Utilization Review, Patient Safety, Hospital Governance

Dr. Geni Bennetts is an experienced physician executive in healthcare and a Certified Physician Executive. She has served as a hospital subspecialist and as Chair of that division. Additionally, she has chaired hospital care management and managed care compliance, as well as serving as the chair of hospital risk management. Dr. Bennetts is the founder and principal of Resolve Healthcare Consulting. She also held the roles of Vice Chair, Chair of the Asset/Liability Committee, and then Chair of a Bank Board, the last position being held for five years. She has been an examiner for the California Department of Managed Health Care and has reviewed over 40 health plans for Quality, Utilization, Grievance and Appeals, and Access and Availability. She has consulted for a number of health plans and has held positions in health plans, hospitals, and IPAs as consulting interim CMOs, Medical Directors, and Advisors. For the past 15 years, Dr. Bennetts has consulted in the following areas o...

Port Richey, Florida

Life Care Planning, Physical Medicine & Rehab - Life Care Planning, Medical Cost Projection, Utilization Review, IME, Personal Injury, Auto Accident, Trucking Accident, Pain Management, PMR, Disability, Workers Compensation, Trauma, TBI, Premise Liability, Plaintiff, Defense, Medical Summary, Demands, Medical Expert, Brain Injury

With a successful 30-year career as a partner at one of the most preferred spine and pain practices in Florida, Dr. Kenneth Botwin has expanded his expertise in medical expert testimony. Dr. Botwin is board-certified in Pain Management & Rehabilitation, Electrodiagnostic Medicine, and Medical Specialties in Pain Management. He is a Certified Life Care Planner and Certified Physician Life Care Planner providing the most elite standard of Future Medical Care and Costing. Dr. Botwin is a published author with over 30 publications relating to his field. He currently serves on the Editorial Advisory Board for the Pain Physician Journal. Dr. Botwin’s experience and exponential knowledge in permanent injury, regenerative medicine, worker’s compensation, and minimally invasive procedures make him the most appropriate expert in personal injury, workers compensation, and premise liability cases. Dr. Botwin provides expert witness testimony for both plaintiff and defense following the m...

Kildeer, Illinois

Internal Medicine, Hospitalist - Outpatient Internal Medicine, Hospital Medicine, Nursing Home Medicine, Nursing Home Medical Director, Hospice Medical Director, Utilization Review, Geriatrics, Family Medicine Residency, Medical Education

I have 30 years of experience as a practicing internist and hospitalist. I have 10 years of experience in academic medicine when I was clinical faculty teaching family practice residency physicians in both outpatient internal medicine and inpatient hospital medicine. I won the Gold Apple Teaching award almost every year I was clinical faculty even though I'm an internist teaching in a family practice residency program. I'm an expert in the clinical scope of expertise of outpatient internal medicine, family medicine, and hospital medicine. I also have extensive experience in nursing home medicine and hospice care as I have been medical director for 4 skilled nursing facilities and 2 hospice agencies. I also have experience with hospital utilization review as a medical advisor for Centegra Health Systems. I left my teaching position over 10 years ago to establish a hospitalist programs in 2 different hospital settings. I am now in private practice with both an outpatient practice...

Silver Spring, Maryland

Medical Management, Long Term Care - Home Healthcare, Managed Care, Transitional Care Management, Medical Necessity Determination, Long-Term Care Planning, Evidence-Based Care Guidelines Expert, Patient-Centered Care Expert, Geriatric Services, Utilization Review, Medical Valuation, Infectious Disease

Vera Dvorak, MD, has broad and extensive experience in a continuum of care, with over 40 years working in diverse healthcare settings including home health services, palliative care, and hospice. She has also served as medical director in all of these areas. Dr. Dvorak has been a practicing physician, a managed care executive, a strategic member of corporate leadership, and vice president and medical director of hospital-based care coordination. She has been in charge of the appeals department in various managed care organizations; and is the founder of transitional care management for one of the largest healthcare systems in Northern Virginia. Dr. Dvorak’s focus has been on medical necessity determination, appropriate discharge disposition with defined short and long-term care needs. She has been a proponent of consistently applying evidence-based care guidelines to support clinical decision-making on a case-by-case basis and across the continuum of care to maximize the potenti...

Salem, Massachusetts

Hospital Administration, Life Care Planning - Certified Case Manager, CCM, Hospital Case Management, Care Coordination, Utilization Review, Discharge Planning, Post-Acute Care, Resource Utilization, Transition Planning, Regulatory Compliance, Patient Safety, Readmission Reduction, Patient Outcome, Skilled Nursing Facility Transitions

With over 40 years of nursing experience and more than 25 years in case management leadership, Lee Ann Baldini brings an exceptional depth of knowledge in coordinating and optimizing patient care transitions. As Director of Case Management at a major medical center, she oversees comprehensive case management services, ensuring compliance, efficient resource use, and quality outcomes across campuses. Her strategic approach to discharge planning and interdisciplinary collaboration has resulted in reduced readmission rates, improved patient satisfaction, and streamlined transitions to post-acute care. Lee Ann's expertise as a Certified Case Manager (CCM) and extensive background in clinical nursing make her a highly qualified expert witness for cases related to care coordination, discharge planning, and hospital utilization management. Case Work Includes: · Case Management Operations and Policy Implementation · Hospital Utilization Review and Resource Allocation · Discharge Plannin...

Cambridge, Massachusetts

Artificial Intelligence, Health Informatics - Healthcare AI, Bad Faith Denials, Insurance Denials, HIPAA, Machine Learning, Prior Authorization, Agentic AI, Clinical Decision Support, FDA, RAG, LLM Hallucinations, Generative AI, Utilization Review, EEOC, AI Ethics, Algorithmic Bias, AI Governance, AI Fraud, Daubert, ChatGPT

AI expert witness with 15+ years building, deploying, and auditing 100+ production AI systems. Rare combination of practitioner, scholar, and researcher - the expert opposing counsel can't dismiss as "just an academic" or "just an engineer." Most AI experts fall into one category: academics who've never shipped production code, or engineers who can't write a defensible report. I've done both - built AI systems at Harvard Medical School, Apple, and federal agencies while publishing award-winning peer-reviewed research on AI ethics and large language models. This dual foundation creates opinions that survive Daubert challenges and cross-examination. Technical expertise spans multiple domains, including healthcare AI and insurance bad faith litigation, including prior authorization algorithms, utilization management systems, AI-driven claim denials, and clinical decision support failures. Deep experience with LLM hallucinations and defective outputs including GPT, Claude, and Llama fa...

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...

Houston, Texas

Internal Medicine, Hospitalist - Internal Medicine, Hospitalist, Telemedicine, Insurance companies, Geriatrics, Primary care, Utilization review, Intensive care

Dr. Chinemerem Ugorji, MD, FACP Board Certified Internal Medicine Physician | Expert Medical Witness Dr. Chinemerem Ugorji is a board-certified Internal Medicine physician with over a decade of active clinical practice in acute care settings, including critical access hospitals, Level II trauma centers, tertiary hospitals, and telemedicine platforms across the United States. She brings a rare combination of frontline patient-care experience and physician level utilization management expertise, making her particularly well-suited for medical-legal matters involving standard of care, medical necessity, telemedicine practices, fraud investigations, and billing and coding disputes. Dr. Ugorji currently practices clinical medicine as a hospitalist and acute telemedicine physician, managing complex medical conditions, high acuity admissions, ICU escalations, and multidisciplinary care coordination. Her hands on experience includes inpatient admissions, observation versus inpatient deter...

Waunakee, Wisconsin

Nurse Practitioner, Long Term Care - primary care, internal medicine, infectious disease, standard of care, failure to diagnose, failure to treat, delayed diagnosis, medical negligence, medical malpractice, long-term care, documentation review, utilization review, insurance review, hiv, infectious disease, PrEP, sexually transmitted infections, antiretroviral therapy

Amy Pease, MSN, ANP-BC, AAHIVS Primary Care & Healthcare Systems Consultant Infectious Disease | Long-Term Care | Insurance & Documentation Review Licensed Advanced Practice Nurse Prescriber – Wisconsin Amy Pease is an Adult Nurse Practitioner with more than 25 years of clinical experience in internal medicine, primary care, infectious disease, and healthcare systems across inpatient, outpatient, and long-term care settings. She is board certified by the American Nurses Credentialing Center (ANCC) and is a Certified HIV Specialist (AAHIVS). She holds a Bachelor of Science in Nursing and a Master of Science in Nursing (Adult Nurse Practitioner emphasis) from the University of Wisconsin–Madison. Ms. Pease currently manages approximately 700 active patients and has overseen care for more than 5,000 patients receiving HIV pre-exposure prophylaxis (PrEP) throughout her career. Her clinical practice includes complex chronic disease management, infectious disease care, STI diagnosis and t...