National Expert in Medicare Regulatory Matters
Contact this Expert Witness
- Company: Loria Associates, LLC
- Phone: 936-693-2103
- Cell: 936-693-2103
Specialties & Experience of this Expert Witness
General Specialties:
Medical Billing and FraudKeywords/Search Terms:
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, AKS, Laboratory Billing, Medical Necessity, Clinical DocumentationEducation:
Bachelor of Science in Accounting, Stetson UniversityYears in Practice:
53Number of Times Deposed/Testified in Last 4 Yrs:
5Additional Information
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 and expertise. His broad base in financial management and auditing provides a sound foundation for almost any litigation dispute. His deep understanding of hospital and other provider operations provides unique insight into business issues uncommon for expert witnesses. Finally, his deep technical skills with Medicare regulatory and compliance, statistical sampling and Medicare billing yield an unbeatable advocate for client's facing government investigations and/or civil litigation. Mr. Loria is frequently the "difference" in a case due to his ability to research information that no one else in the case has any experience about. Mr. Loria is the author of the chapter "Cost Report Compliance" in the Compliance Professionals Manual published by the Health Care Compliance Association and Wolters Kluwer in 2006 which he has periodically updated, including most recently in November 2022. This chapter is the leading industry authority for cost report compliance. He has published more than 100 articles; delivered over 120 presentations to industry meetings, professional organizations and private groups; served as a book reviewer for HFM Journal; article editor for AAMA Executive; and served on numerous Boards and Committees of industry and professional societies. His knowledge, honors, Awards and distinguished accomplishments include the following: > Inducted into the Stetson University Accounting Hall of Fame (2022) > Earned a National Service Award from American College of Health Care Executives (ACHE) (2021) > Published his ACHE Fellowship Thesis as a book, "Divesting Physician Practices: Ethical, Business and Regulatory Challenges (2004) > Contributed to the Hospital Audit Guide, Third Edition, published by AICPA Subcommittee on Healthcare Matters (1979-80) > Represented the Association of Air Medical Services in the CMS Rule-Making process and designed the uniform ambulance fee schedule adopted in the regulations. > Founders Medal of Honor recipient from HFMA (2003) > Captain, United States Army Reserve (1972-1980)