Medical Billing Expert Witnesses
The SEAK Expert Witness Directory contains a comprehensive list of medical billing expert witnesses who testify, consult and provide litigation support on medical billing and related issues. Medical billing expert witnesses and consultants on this page may form expert opinions, draft expert witness reports, and provide expert witness testimony at deposition and trial. The issues and subjects these medical billing expert witnesses testify regarding may include: Medical Billing, Medical Coding, Medical Necessity, Medicare, Pain Management, Coding, Qui Tam, Revenue Cycle Management, Ucr, Amputation, Case Management, Causation, Chronic Pain, Disability Evaluation, and Hospital Billing.
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Lance S. Loria, CPA, LFACHE, FAAMA
National Expert in Medicare Regulatory Matters
Loria Associates, LLC
Medical Billing, Fraud
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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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Joe Carnes
Medical Billing Expert Witness
Medsurity Experts
Medical Billing, Medical Coding
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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
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Joe Carnes
Medical Billing Expert Witness
Medsurity Experts
Birmingham, Alabama
Medical Billing, Medical Coding
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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
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Wilfred L Hynes, MD
Award Winning, Harvard Trained Pain Physician
Tufts Medical Center
Alabama
Pain Management - Medicine
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Pain management, pain medicine, chronic pain, spine injections, steroid injections, opiates, complex regional pain syndrome, CRPS, RSD, nerve injury, epidural hematoma, failed back syndrome, facet injections, radiofrequency ablation, billing fraud, medical billing, personal injury
Award-Winning, Harvard Trained Pain Management Physician in active clinical practice. Tufts Faculty (2005-Present). Harvard Faculty (1997-2005). Double Board Certified (Anesthesia and Pain Management). 10+ years experience Medical Director, Tufts. Opiate Management Committee, Tufts Medical Center (2014-Present). Boston College - Scholar of the College/Gasson Scholar. Experienced expert witness at both deposition and trial. Forensic experience includes medical malpractice, workers’ compensation, criminal matters, national opiate litigation, and health care fraud
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Douglas L Constant, MD
Pain Management- Medicine and IME
360 Orthopedics
Alabama
Pain Management - Medicine, Independent Medical Examinations
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Pain Management, spinal cord stimulator, nerve injury, RSD, Reflex Sympathetic Dystrophy, radiofrequency ablation, injections, complex regional pain syndrome, CRPS, opioids, causalgia, nerve block, neuropathic pain, failed back syndrome, IME, medical billing, billing fraud, disability evaluation
Award Winning, Harvard Trained Pain Physician.
Active clinical practice.
Provided pain management treatment to WNBA players, the MLS, the Boston Red Sox and the Pittsburgh Pirates.
Castle Connolly Top Doctor, Pain Management, since 2015. Chosen by his peers and recognized as "Top Doctor" in the Sarasota area since 2017.
U.S. Naval Academy graduate. Former United States Marine Corps Officer with deployments to Sarajevo, Mogadishu, and Kuwait.
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Paul Saiz, MD, FAAOS, CIME
Spine surgery and coding expert
3 Crosses Orthopedic Spine
Arizona
Spine Surgery & Spine Care, Medical Coding
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Spine fusion, Spine tumors, Spine trauma, Laminectomy, Discectomy, Total disk replacement, Decompression, Dural tear, Pedicle screws, Independent medical examinations, IME, Causation, Medical coding, Medical billing, Medical necessity, Spinal abscess, Disability evaluation, Workers Comp, MVA
Board Certified in Orthopedic Surgery and Spine Surgery in active clinical practice. Fellowship trained in both spinal reconstructive surgery and musculoskeletal oncology and reconstruction. 20+ years clinical experience in spine surgery. Well-experienced public speaker. Special expertise in spinal care coding and medical necessity. New Mexico State Team Physician. Experienced expert witness, certified independent medical examiner, and medical necessity peer reviewer. Licensed in New Mexico, Texas and Arizona. Co-vice chair North American Spine Society Coding Committee.
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Doreen R Casuto, RN, MRA, CRRN, CCM
Life Care Planning Expert with 40 years experience
Rehabilitation Care Coordination
Arizona
Life Care Planning, Medical Billing
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Rehabilitation Nursing, Nursing Assessment, Case Management, Benefit Administration, Special Needs Trust, Care Coordination, Spinal Cord Injury, Traumatic Brain Injury, Cerebral Palsy, Neuromuscular Disorders, Amputation, Accessibility, Medical Billing, Benefit Application
50 years of experience in rehabilitation nursing, providing patient care, education and coordination of services. 35 years as an independent case manager working with catastrophically injured. Evaluated patients, assisted physicians in planning and coordinating the rehabilitation needs of patients with spinal cord, brain injuries, stroke and neuromuscular illnesses. Prior to founding RCC she was the Director of Physical Rehabilitation Nursing at Grossmont Hospital in San Diego, Rehabilitation Nurse Coordinator at Methodist Hospital in Indianapolis and Rehab Nursing Workshop Coordinator at Ohio State University. Doreen is currently an Adjunct Professor with San Diego State’s School of Nursing as well as a former board member of the Brain Injury Association of California (BIACAL), the San Diego Brain Injury Foundation (SDBIF) and Jewish Family Services of San Diego.
In 1989, Doreen Casuto decided to start a small company with a unique goal. Doreen had recently left Grossmont Hospit...
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Michele Elmore, MSN, RN, SANE-A
Pediatrics - Forensic Nurse - SANE-A
Justice Forensics
Fort Smith, Arkansas
Legal Nurse Consulting, Nurse
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Pediatrics, Medical chart review, Acute hospital care, Long term care, Adolescent, Sexual Assault, Analysis, Neonatal, Medical billing, Report writing, Abuse, Review, Infant, Medical coding, Wrongful death, Expert witness, Intensive care, Adult
CERTIFIED * EXPERIENCED * SPECIALIZED * INTEGRATED * COMPASSIONATE
CERTIFIED: Board Certified MSN, RN, SANE-A
EXPERIENCED: Justice Forensics offers over 33 years in professional nursing practice, 10 years of experience on the nursing faculty at the University of Arkansas. Current Director at Large for the Arkansas Forensic Nursing Association, 10 years Clinical and Didactic pediatric Instructor at the Fort Smith campus, and experience in: acute care hospitals, pediatrics, neonatal intensive care, Infant and pediatric ICU, special care nursery, OB/post-partum, and long-term pediatric care. Our team also has over 20 years of medical billing and coding.
SPECIALIZED: Pediatric and neonatal care. Forensic Nurse Examiner, SANE-A, with expertise in sexual abuse and assault, anogenital findings, injury interpretation for sexual contact and sexual assault, forensic evidence collection, chain of custody compliance and analysis, forensic photography, and medical records.
INTEGRATED: O...
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Carol Moreali, RN, MSN
Inpatient and Post Hospital Care Management Expert
HealthTrack
Carmel, California
Nurse, Medical Management
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Inpatient and Post Hospital Care Coordination, Assessment of Inpatient Hospital Practices, Nurse Practice, Nursing Assessment, Medical Chart Documentation and Chart Review, Medical Billing, Benefit Administration, Benefit Application, and Medical Claim Review and Appeals
Ms Moreali has enjoyed 50 years of medical experience in Nursing providing patient care covering areas in critical care, case management, education and coordination of services, medical consulting, quality and regulatory management. Expertise in chart review/ analysis and documentation.
She also had over 40 years expertise in independent consulting, development of disease management programs, and with inpatient care coordination teams consisting of Hospitalists, RN, RN Case Manager, and Social Services. Working with large Integrated Healthcare Systems and singular hospital organizations.
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Brett Halloran, MD, SFHM
Hospitalist, Medical Billing, Medical Necessity
Napa, California
Hospitalist, Medical Billing
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Wernicke Encephalopathy, Stroke, Hospital Transfers, Heart attack, Falls, Delirium, Pulmonary embolism, Alcohol withdrawal, Hospital transfers, Pneumonia, Medication side effects, UTI, Renal failure, Medical Billing, Medical Necessity , Abdominal pain, Bed sores, C Diff, Sepsis
Nationally recognized and awarded for contributions to the field of hospital medicine. Extensive experience in medical necessity as a physician advisor.
Dr. Halloran is board certified in internal medicine and in active practice as a hospitalist in Northern California at a referral center hospital with high severity of illness. He listens to patients and specializes in complex, challenging cases. He also serves as regional medical director for utilization management.
Dr. Halloran is an expert in medical billing and medical necessity. He has served as UM medical director and physician advisor for a large regional health care entity. In that capacity, he has reviewed thousands of charts for medical necessity.
In addition to more than 15 years of clinical experience at the bedside as a hospitalist and many years as medical director, Dr. Halloran has 10+ years of experience as an expert. Dr Halloran has served as an expert in hundreds of cases, with particular expertise in commun...
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Erika Browning, BSN, RN, CCM, CLCP
Life Care Planning Expert
EB Medical Planning
Vista, California
Life Care Planning, Medical Billing
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Traumatic Brain Injury, Spinal Cord Injury, Multiple Trauma, Burn Injury, Pain Management, Chronic Illness, Chronic pain, Chronic Regional Pain Syndrome, Catastrophic Injury, Amputation Injury, Crush Injury, Life Care Plan Rebuttal, Life Care Plan
Erika Browning, BSN, RN, CCM, CLCP, is the founder and CEO of EB Medical Planning, a company that provides life care plans, life care plan rebuttals, medical record reviews, medical bill reviews, and future medical cost projections. Ms. Browning has been a Registered Nurse for 15 plus years. She graduated from Georgetown University with a Bachelor of Science in Nursing in 2011. She has extensive clinical experience in ER and ICU settings. Ms. Browning transitioned to nurse case management in 2018 where she manages, coordinates, and assesses the healthcare needs for catastrophically injured patients. She is a Certified Case Manager and a Certified Life Care Planner.
Ms. Browning has extensive experience with brain injuries, spinal cord injuries, burns, multiple trauma, orthopedic injuries, chronic pain, and amputations. She has deposition experience and has given presentations on life care planning to various organizations. She primarily works in California, but is available...
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Thomas Peatman, MD
Orthopedic Surgeon and Expert Witness
California
Orthopedic Surgery, Sports Medicine
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Hip, Knee, Shoulder, Trauma, Spine Surgery & Spine Care, Orthopedics Non Surgical, Independent Medical Examinations, Causation, Disability evaluation, Impairment Evaluation, Medical Coding, Medical billing, Workers’ Compensation, Motor Vehicle Accident, Patents, MVA
Board-Certified orthopedic surgeon in clinical practice. Additional sub-specialty Certification in Sports Medicine.
Have performed over 8,000 joint replacements, hip, knee and shoulder arthroscopies and open surgeries. After developing a hand tremor, I now focus on the non-operative management of orthopedic disease and trauma.
Former Team Physician for the Oakland Athletics. United States Navy veteran.
I have been participating in expert witness work for 15+ years. I perform complex case reviews with or without an exam, as well as provide clarity to simpler incidents. I am timely and prioritize scheduling exams, depositions and court appearances. My reports provide compelling. I have given testimony in 12 trials.
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Doreen R Casuto, RN, MRA, CRRN, CCM
Life Care Planning Expert with 40 years experience
Rehabilitation Care Coordination
San Diego, California
Life Care Planning, Medical Billing
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Rehabilitation Nursing, Nursing Assessment, Case Management, Benefit Administration, Special Needs Trust, Care Coordination, Spinal Cord Injury, Traumatic Brain Injury, Cerebral Palsy, Neuromuscular Disorders, Amputation, Accessibility, Medical Billing, Benefit Application
50 years of experience in rehabilitation nursing, providing patient care, education and coordination of services. 35 years as an independent case manager working with catastrophically injured. Evaluated patients, assisted physicians in planning and coordinating the rehabilitation needs of patients with spinal cord, brain injuries, stroke and neuromuscular illnesses. Prior to founding RCC she was the Director of Physical Rehabilitation Nursing at Grossmont Hospital in San Diego, Rehabilitation Nurse Coordinator at Methodist Hospital in Indianapolis and Rehab Nursing Workshop Coordinator at Ohio State University. Doreen is currently an Adjunct Professor with San Diego State’s School of Nursing as well as a former board member of the Brain Injury Association of California (BIACAL), the San Diego Brain Injury Foundation (SDBIF) and Jewish Family Services of San Diego.
In 1989, Doreen Casuto decided to start a small company with a unique goal. Doreen had recently left Grossmont Hospit...
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Paul D Wagner, MD, FACP
Board Certified Internist, Medical Director, CMO
Paul D. Wagner MD Inc.
San Diego, California
Internal Medicine, Long Term Care
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Hypertension management, Failure to diagnose, Diabetes management, Cognitive impairment/dementia management, Preventive screening management, Hyperlipidemia management, Medical coding, eClinicalWorks Subject Matter Expert, Certified Medical Director, Medical billing, Primary Care
Board certified Internist for 30 years. Founder of San Diego Medical Group. eClinicalWorks subject matter expert for all aspects of primary care, documentation, billing and coding. Over 20 years of experience as Chief Medical Officer and Certified Medical Director at a Veterans Home of California overseeing the delivery of healthcare services for ambulatory and long term care resident veterans. Many years as a medical expert witness including records review, depositions, arbitration and court testimony.
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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
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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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Debbie Noonkester
Medical Billing Company Owner - Expert Witness
Novato, California
Medical Billing, Insurance
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MBR, Medical Billing Review, Usual and customary fees, UCR, Billing analysis, Medical Claims, Healthcare claims, Commercial claims, Hospital claims, Hospital billing, Workers compensation, Veteran Claims, MVA, MVC, Motor vehicle accident, PI case, Personal injury, coding, Medical insurance, Insurance payable
As a medical billing company owner, I'm a billing and claim specialist with 30+ years of experience assisting clinics, ASC's, and medical offices with their insurance claims, follow up, and revenue cycles. Specialties include chiro, acupuncture, orthopedic, psychiatry, psychology, urology, cosmetic surgery, pulmonary, podiatry, transgender, and many others. Experienced with commercial, Workers Comp, VA claims, liens, and MVA's. Experienced with HCFA 1500's, UB-04's, MS-DRG codes, LOA's, DME, and HCPCS. As an Expert Witness, I have analyzed 200+ cases to establish Usual and Customary fees, Howell numbers, payable averages, and have deposition and trial experience.
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Roberto Contreras II, MD, CLCP
California Life Care Planning Association
Seal Beach, California
Life Care Planning, Internal Medicine
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medical billing, life care planner, hospitalist, medical devices, medical management, medical coding, legal medicine, legal nurse consulting, nurse practitioner, obstetrics and gynecology, addiction medicine, family medicine, general practice, gynecology, consultative examinations
The California Life Care Planning Association was created by experts in the field of Life Care Planning, with more than 30 years of experience working in the health care industry. All of our professionals are Certified Life Care Planners, as well as active medical practitioners dedicated to assessing lifetime cost of care for individuals with catastrophic injuries/illness. What sets us apart from many other Life Care Planning organizations and individuals is that all of our Life Care Planners have active direct experience with patient care. We hold ourselves to a higher standard and hold all of our affiliates to that same higher standard. Whether it be plaintiff, defense , or any other client, our methodology is transparent and consistent.
Given the healthcare backgrounds of our founders, all Life Care Plans and services are overseen by a Physician. Similar to a hospital setting, many of our services go through "rounding" with senior partners and physicians to make sure we are keep...
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Douglas L Constant, MD
Pain Management- Medicine and IME
360 Orthopedics
California
Pain Management - Medicine, Independent Medical Examinations
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Pain Management, spinal cord stimulator, nerve injury, RSD, Reflex Sympathetic Dystrophy, radiofrequency ablation, injections, complex regional pain syndrome, CRPS, opioids, causalgia, nerve block, neuropathic pain, failed back syndrome, IME, medical billing, billing fraud, disability evaluation
Award Winning, Harvard Trained Pain Physician.
Active clinical practice.
Provided pain management treatment to WNBA players, the MLS, the Boston Red Sox and the Pittsburgh Pirates.
Castle Connolly Top Doctor, Pain Management, since 2015. Chosen by his peers and recognized as "Top Doctor" in the Sarasota area since 2017.
U.S. Naval Academy graduate. Former United States Marine Corps Officer with deployments to Sarajevo, Mogadishu, and Kuwait.
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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Richard F Lacy, MHA, CPC, FMC
Medical Coding and Reasonable Value Expert
Transparency Healthcare
Parker, Colorado
Medical Billing, Medical Coding
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Reasonable Value of Medical Services, Payment Disputes, Future Cost of Care, Managed Care, Reimbursement Rate Expert, Contract Rate Negotiations, Medical Claims Analysis, Cost Projections
I am the founder of Transparency Healthcare, LLC and serve as an independent medical billing and coding expert. I hold a Master of Health Care Administration (MHA) from Trinity University and a Bachelor’s degree in Psychology from Southern Methodist University. I am a Certified Professional Coder (CPC) through the American Academy of Professional Coders and a Certified Forensic Medical Coder through the Association of Forensic Medical Coders, and I maintain active involvement in multiple professional organizations related to medical billing, coding, and claims analysis.
Throughout my career, I have worked extensively with complex healthcare data, large claims datasets, and multiple healthcare information systems to support financial analysis, contract evaluation, and operational improvement. My expertise includes reimbursement methodologies, managed care contracting, utilization analysis, and medical coding compliance. As an expert consultant, I have prepared numerous reports addr...
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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Marjorie Hackett-Wallace, CFE, RHIA, CHC, CPIP, CPC, CPMA, CDEO, AAPC Fellow
Healthcare Coding and Documentation Professional
Integrity Medical Billing Consultant
New Britain, Connecticut
Medical Billing, Medical Coding
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Medical Records Review, Provider Documentation, Medicaid/Medicare, State Regulations/Statutes, Federal Regulations/Statutes, Regulatory Compliance, Healthcare Fraud Investigation, Data Analysis, Data Mining, Payment Integrity, False Claims Act, Fraud Waste and Abuse, Provider Billing Verification
I provide expert witness services in healthcare billing, coding, and clinical documentation, supported by over 19 years of industry experience across provider, payer, and compliance environments. My work focuses on the evaluation of medical records, coding accuracy, documentation integrity, and regulatory compliance, including alignment with federal, state and commercial payer requirements.
I hold a Master of Legal Studies in Health Law, which strengthens my ability to analyze healthcare documentation within legal and regulatory frameworks and to clearly articulate findings in both written reports and testimony. I maintain multiple nationally recognized certifications, including Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Documentation Expert Outpatient (CDEO), Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), and Registered Health Information Administrator (RHIA).
My expertise includes auditing evaluation an...
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BETH MORGAN, CPC, MCS-P
Medical Bill Reviews
Medical Bill Consultants, LLC
Somers, Connecticut
Medical Coding, Medical Billing
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CPT codes, Bill & Coding, Compliance, Accounts Receivable Reduction, Bill Review, Personal Injury Bill Reduction, UCR pricing, Bill Analaysis
Beth Morgan, President & CEO, is a Certified Professional Coder (CPC) and Compliance Specialist (MCS-P) since 2004. Over the past 20 years she has worked in several areas of the medical profession doing billing and coding for all sorts of providers. Her knowledge and expertise has enabled her to not only reduce provider’s accounts receivables but medical bills by 51%. She has access to a broad base of insurance company policy information, and is an information contributor, to radio and TV shows as well as magazine articles.
Medical Bill Detectives reviews medical bills for errors and overcharges, reducing them down to Usual Reasonable and Customary charges, for negotiating discounts on medical bills. We are able to review bills for all 50 states.
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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, Medical Billing
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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, Florida Tort Reform Act, Medical Billing, Ophthalmology
ABOUT:
Highly experienced expert witness with 150+ 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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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Douglas L Constant, MD
Pain Management- Medicine and IME
360 Orthopedics
Sarasota, Florida
Pain Management - Medicine, Independent Medical Examinations
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Pain Management, spinal cord stimulator, nerve injury, RSD, Reflex Sympathetic Dystrophy, radiofrequency ablation, injections, complex regional pain syndrome, CRPS, opioids, causalgia, nerve block, neuropathic pain, failed back syndrome, IME, medical billing, billing fraud, disability evaluation
Award Winning, Harvard Trained Pain Physician.
Active clinical practice.
Provided pain management treatment to WNBA players, the MLS, the Boston Red Sox and the Pittsburgh Pirates.
Castle Connolly Top Doctor, Pain Management, since 2015. Chosen by his peers and recognized as "Top Doctor" in the Sarasota area since 2017.
U.S. Naval Academy graduate. Former United States Marine Corps Officer with deployments to Sarajevo, Mogadishu, and Kuwait.
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Marsha S Diamond, CPC, COC, CCS, CPMA
Medical Auditing, Billing, and Coding Expert
Orlando, Florida
Medical Billing, Medical Coding
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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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Misty Coffman, RN, MSCC, CNLCP
Nurse Life Care Plan Expert Witness - Experienced
National Life Care Planning Experts, LLC
Atlanta, Georgia
Life Care Planning, Medical Billing
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Life Care Plan, Life Care Planner, Nurse Expert, Nurse, LCP, TBI, Brain Injury, Amputation, Cerebral Palsy, Birth Injuries, Life Care Plans, Damage Assessments, Medical Bill Reviews, Medical Bill Review, Life Care Plan Rebuttal, Motor Vehicle Accidents, Medical Malpractice, Catastrophic Claims, Accidents, Injuries
Misty Coffman, RN, MSCC, CNLCP is a highly experienced Nurse Life Care Planning expert witness with nearly four decades of nursing practice and extensive deposition and trial experience. She brings exceptional credibility, leadership, and real-world clinical depth to complex personal injury, medical malpractice, and catastrophic injury cases.
She has been a Registered Nurse for 37 years and served as President of the American Association of Nurse Life Care Planners (AAANLCP) in 2024, following her tenure as an Executive Board Member from 2022–2024. Her national leadership role reflects peer-recognized expertise and a deep command of life care planning standards and methodology.
Her clinical and administrative background spans a broad range of healthcare settings, including orthopedic nursing, medical-surgical nursing, occupational health, long-term and skilled nursing care, medical billing, and healthcare compliance. She has held senior leadership roles such as Director of Nursing...
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Daniel Batteiger, PT, DPT
Fishers, Indiana
Physical Therapy, Geriatrics
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Falls with Injury, Standard of Care, Medical Necessity, Surgical Protocols, Medical Malpractice, Negligence, Medical Billing, Nursing Home Rehabilitation, Fraud, Geriatrics, Home Health, Joint Replacements, Rotator Cuff Repair, Pressure sores
Dr. Batteiger has been a practicing physical therapist since 2016 with a background treating geriatric, post-operative, neurologic, musculoskeletal, and athletic patients. He is currently studying for the Geriatric Clinical Specialist certification, exam date in early 2026.
Following graduation, he began working at a level II trauma center that held the Joint Commission certification as a Primary Stroke Center and provided physical therapy to patients after neurological diagnoses including stroke, spinal cord injury, traumatic brain injury, and dementia. Provided orientation training for safe patient handling and proper use of mechanical lifts for new employees. He also piloted a program in the emergency department, including providing evaluations and collecting/analyzing data to present to upper management in order to establish efficacy of physical therapy in optimizing patient placement in collaboration with the medical team.
He transitioned to Montefiore Hospital in New Rochell...
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Khalida S. Burton
Hospital and Physician Medical Billing Expert
Kohler HealthCare Consulting, Inc
Woodstock, Maryland
Medical Billing
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Medical Billing, Skilled Nursing Facility, Acute Care Hospital, Inpatient Reimbursement, Outpatient Reimbursement, Insurance Contracts, Payer Contracts, Physician Reimbursement
Khalida S. Burton, MBA, FHFMA, CRCE, CRCR, is a Director with Kohler HealthCare Consulting and has over 25 years of revenue cycle, finance and reimbursement, compliance and internal audit, corporate integrity agreement, and independent review organization support, due diligence, and litigation support. Ms. Burton’s revenue cycle experience includes front-end patient access (registration, insurance verification, etc.), charge master, charge capture and compliance, and back-end patient financial services (pre-billing, billing, collections, cash posting and reconciliation, denial management, etc.). Ms. Burton has experience working with medical practices, hospitals, large health systems, faculty practice plans, continuing care retirement communities, skilled nursing facilities, home health agencies, medical device manufacturers/suppliers, and law firms. Clients benefit from her in-depth understanding of healthcare regulations, revenue cycle, reimbursement, managed care contracting, bu...
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Richard A Parker, MD
Hospital Corporate Negligence
Care Dimensions hospice
Newton Highlands, Massachusetts
Hospital Administration, Hospice and Palliative Care
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Hospital Corporate Negligence, Hospital Liability, Hospital administration, Hospice care, Hospice fraud, healthcare fraud, Credentialing, Policies and procedures, Mental Health, Covid, sepsis, hemorrhage, medical billing, qui tam, medical necessity, DNR, end of life, hospital advertising
Highly experienced hospital corporate negligence, hospital credentialing and hospice expert witness. Reviewed over 800 cases and testified in 57 trials and depositions over 25 years. Trained at Dartmouth and Brown medical schools. Previous Assistant Professor appointment at Harvard Medical School. Practiced internal medicine for 24 years. Served as medical director and chief medical officer for Beth Israel Deaconess Physician Organization for 15 years in Boston. Former chief of medical services at Massachusetts Mental Health Center, Boston, MA and New England Deaconess Psychiatric unit. Former editor for Journal of the American Medical Association. Served as chief medical officer for Arcadia -- a data aggregation and analytics company providing population health services to large healthcare organizations. Currently practice in hospice for Care Dimensions hospice in Lincoln and Danvers, Mass. Experienced speaker and presenter.
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Wilfred L Hynes, MD
Award Winning, Harvard Trained Pain Physician
Tufts Medical Center
Boston, Massachusetts
Pain Management - Medicine
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Pain management, pain medicine, chronic pain, spine injections, steroid injections, opiates, complex regional pain syndrome, CRPS, RSD, nerve injury, epidural hematoma, failed back syndrome, facet injections, radiofrequency ablation, billing fraud, medical billing, personal injury
Award-Winning, Harvard Trained Pain Management Physician in active clinical practice. Tufts Faculty (2005-Present). Harvard Faculty (1997-2005). Double Board Certified (Anesthesia and Pain Management). 10+ years experience Medical Director, Tufts. Opiate Management Committee, Tufts Medical Center (2014-Present). Boston College - Scholar of the College/Gasson Scholar. Experienced expert witness at both deposition and trial. Forensic experience includes medical malpractice, workers’ compensation, criminal matters, national opiate litigation, and health care fraud
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Adam P Beck
Ophthalmology and Vitreoretinal Surgery Expert
Adam P Beck, M.D., Esq.
Andover, Massachusetts
Ophthalmology, Medical Billing
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Ophthalmology Expert Witness, Fraud & Abuse, Retina Surgery, Retinal Detachment, Cataract Surgery, Glaucoma, Macular Degeneration, Uveitis, Oculoplastics, Optometry, Ophthalmology Standard of Care, Eye Surgery, LASIK, Vision Loss, Medical Billing, Medical Coding, Insurance Billing Disputes, Medical Malpractice, Legal Malpractice
Adam P. Beck, M.D., Esq. is a board-certified ophthalmologist and attorney with extensive experience in clinical ophthalmology, vitreoretinal disease, medical billing, and medical-legal analysis. Dr. Beck is the President of New England Eye and Facial Specialists and has been in private practice since 2005, providing comprehensive ophthalmology care with particular expertise in vitreoretinal disease and retinal surgery.
Dr. Beck completed a vitreoretinal surgery fellowship at Massachusetts Eye and Ear Infirmary and previously served as a Clinical Instructor in Ophthalmology at Harvard Medical School, where he supervised residents and fellows in the diagnosis and management of complex ophthalmic disease.
In addition to his medical training, Dr. Beck earned a Juris Doctor, magna cum laude, from the Massachusetts School of Law and is admitted to the Massachusetts Bar and the United States District Court.
This dual background provides a unique perspective on issues involving stand...
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Richard F Lacy, MHA, CPC, FMC
Medical Coding and Reasonable Value Expert
Transparency Healthcare
Missouri
Medical Billing, Medical Coding
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Reasonable Value of Medical Services, Payment Disputes, Future Cost of Care, Managed Care, Reimbursement Rate Expert, Contract Rate Negotiations, Medical Claims Analysis, Cost Projections
I am the founder of Transparency Healthcare, LLC and serve as an independent medical billing and coding expert. I hold a Master of Health Care Administration (MHA) from Trinity University and a Bachelor’s degree in Psychology from Southern Methodist University. I am a Certified Professional Coder (CPC) through the American Academy of Professional Coders and a Certified Forensic Medical Coder through the Association of Forensic Medical Coders, and I maintain active involvement in multiple professional organizations related to medical billing, coding, and claims analysis.
Throughout my career, I have worked extensively with complex healthcare data, large claims datasets, and multiple healthcare information systems to support financial analysis, contract evaluation, and operational improvement. My expertise includes reimbursement methodologies, managed care contracting, utilization analysis, and medical coding compliance. As an expert consultant, I have prepared numerous reports addr...
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Daniel Laird, MD, JD, MFA
Medical Billing, Usual & Customary All Specialties
Flamingo Medical Clinic
Las Vegas, Nevada
Pain Management - Medicine, Medical Billing
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Usual and Customary Billing, Medically Necessary Billing, Causation, Anesthesiology, Opioids, Pain Management, Overdose, Medication Overdose, Addiction, Airway, Legal Medicine, Reasonable Medical Billing, Soft Tissue Injury, Pre-Existing Conditions, Obstructive Sleep Apnea, Oversedation, Respiratory Arrest, Cardiac Arrest, Code Blue
Expert has extensive experience in analysis of medical billing. Expert is able to determine whether medical and health care bills are usual, customary, reasonable, medically necessary, and related to the incident or accident in question. All specialties and all States and geographic locations. Expert has broad general medical experience including primary care, pain medicine, addiction medicine, surgery, critical care, perioperative medicine, etc. Special interest in opioids, benzodiazepines, sedation, anesthesiology, obstructive sleep apnea, oversedation, respiratory arrest, cardiac arrest, chronic pain, acute pain, and wrongful death. Expert also has experience in paramedical and ancillary medical billing including PT, laboratory, rehabilitation, diagnostic imaging, emergency medical services, ambulance, diagnostic testing, etc.
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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Victoria Morgan, FHFMA
Abacus Analytics
Reno, Nevada
Medical Billing, Medical Coding
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Medical Cost, Healthcare Finance, Revenue Cycle Management
EXPERIENCE:
Tahoe Forest Health District, Truckee, CA: June 2018 to Present – Director, Revenue Cycle Projects
Responsible for coordination of all revenue cycle functions for 2 hospitals, a cancer center, surgery center, skilled nursing facility, hospice and 150 providers in various clinics in 2 states. Provide management oversite to systems development, charge description master (Revenue Integrity), business office, health information management, patient registration, and customer service. Facility uses both EPIC Hospital Billing (HB) and EPIC Physician Billing (PB)
Abacus Analytics: Revenue Analyst/Expert Witness: June 2017 to Present
Working as in independent reviewer / expert witness on 3rd party liability medical cases.
Principal, Independent Revenue Cycle Consultant: 1991 - Present
Consulting projects involve interacting with internal staff in all facets of the revenue cycle.
Typical projects include focusing on operational assessments and issues involving staff. Emphas...
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Mark L Friedman, MD, FACEP, FACP
Medical billing and coding expertise
Medical Directions LLC
Newbury, New Hampshire
Medical Billing, Medical Coding
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ALL STATES, Medical Billing, Coding, Usual and customary, reasonable and customary, DRG, CPT, ICD-10, ICD-9, medical necessity, fees, fee schedule, billing
Mark L Friedman MD FACEP FACP is currently Chief Medical Officer Emeritus of First Stop Health. He is an emergency physician emeritus at St Vincent’s Hospital in Bridgeport, CT. He was formerly Associate Professor of Emergency Medicine at the Frank Netter School of Medicine, Chief of Emergency Medicine at St Elizabeth's Hospital of Boston, Assistant Professor of Medicine at Tufts University School of Medicine, Assistant Clinical Professor of Emergency Medicine at the University of Illinois, and Adjunct Professor of Public Health at Benedictine University.
Dr. Friedman is an expert in DRG claims analysis and medical cost containment. He has helped design programs to prevent medical errors as well as malpractice litigation. He has served as an advisor to government on medical billing fraud and abuse and developed two companies that perform audits for the Medicare RAC. Dr. Friedman is the author of articles and books on medically related topics. Dr Friedman specializes in expert op...
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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Paul Saiz, MD, FAAOS, CIME
Spine surgery and coding expert
3 Crosses Orthopedic Spine
Las Cruces, New Mexico
Spine Surgery & Spine Care, Medical Coding
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Spine fusion, Spine tumors, Spine trauma, Laminectomy, Discectomy, Total disk replacement, Decompression, Dural tear, Pedicle screws, Independent medical examinations, IME, Causation, Medical coding, Medical billing, Medical necessity, Spinal abscess, Disability evaluation, Workers Comp, MVA
Board Certified in Orthopedic Surgery and Spine Surgery in active clinical practice. Fellowship trained in both spinal reconstructive surgery and musculoskeletal oncology and reconstruction. 20+ years clinical experience in spine surgery. Well-experienced public speaker. Special expertise in spinal care coding and medical necessity. New Mexico State Team Physician. Experienced expert witness, certified independent medical examiner, and medical necessity peer reviewer. Licensed in New Mexico, Texas and Arizona. Co-vice chair North American Spine Society Coding Committee.
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Douglas L Constant, MD
Pain Management- Medicine and IME
360 Orthopedics
New York
Pain Management - Medicine, Independent Medical Examinations
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Pain Management, spinal cord stimulator, nerve injury, RSD, Reflex Sympathetic Dystrophy, radiofrequency ablation, injections, complex regional pain syndrome, CRPS, opioids, causalgia, nerve block, neuropathic pain, failed back syndrome, IME, medical billing, billing fraud, disability evaluation
Award Winning, Harvard Trained Pain Physician.
Active clinical practice.
Provided pain management treatment to WNBA players, the MLS, the Boston Red Sox and the Pittsburgh Pirates.
Castle Connolly Top Doctor, Pain Management, since 2015. Chosen by his peers and recognized as "Top Doctor" in the Sarasota area since 2017.
U.S. Naval Academy graduate. Former United States Marine Corps Officer with deployments to Sarajevo, Mogadishu, and Kuwait.
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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Thomas Peatman, MD
Orthopedic Surgeon and Expert Witness
Bend, Oregon
Orthopedic Surgery, Sports Medicine
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Hip, Knee, Shoulder, Trauma, Spine Surgery & Spine Care, Orthopedics Non Surgical, Independent Medical Examinations, Causation, Disability evaluation, Impairment Evaluation, Medical Coding, Medical billing, Workers’ Compensation, Motor Vehicle Accident, Patents, MVA
Board-Certified orthopedic surgeon in clinical practice. Additional sub-specialty Certification in Sports Medicine.
Have performed over 8,000 joint replacements, hip, knee and shoulder arthroscopies and open surgeries. After developing a hand tremor, I now focus on the non-operative management of orthopedic disease and trauma.
Former Team Physician for the Oakland Athletics. United States Navy veteran.
I have been participating in expert witness work for 15+ years. I perform complex case reviews with or without an exam, as well as provide clarity to simpler incidents. I am timely and prioritize scheduling exams, depositions and court appearances. My reports provide compelling. I have given testimony in 12 trials.
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Paul Saiz, MD, FAAOS, CIME
Spine surgery and coding expert
3 Crosses Orthopedic Spine
Texas
Spine Surgery & Spine Care, Medical Coding
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Spine fusion, Spine tumors, Spine trauma, Laminectomy, Discectomy, Total disk replacement, Decompression, Dural tear, Pedicle screws, Independent medical examinations, IME, Causation, Medical coding, Medical billing, Medical necessity, Spinal abscess, Disability evaluation, Workers Comp, MVA
Board Certified in Orthopedic Surgery and Spine Surgery in active clinical practice. Fellowship trained in both spinal reconstructive surgery and musculoskeletal oncology and reconstruction. 20+ years clinical experience in spine surgery. Well-experienced public speaker. Special expertise in spinal care coding and medical necessity. New Mexico State Team Physician. Experienced expert witness, certified independent medical examiner, and medical necessity peer reviewer. Licensed in New Mexico, Texas and Arizona. Co-vice chair North American Spine Society Coding Committee.
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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
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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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Geoff Bretches
Expert Medical Billing - Coding & Reasonableness
Medical Equation
Austin, Texas
Medical Billing
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Revenue Cycle Management, Chargemaster Review, Collections Analysis, Medical Coding Review, Financial Analysis, Organizational Design and Review, Coding and Billing Operations, Budgeting, Insurance billing, Phantom charges, Unbundling Charges
With more than 22 years of experience in healthcare financial management, I bring a well-rounded perspective to medical billing reviews, coding accuracy, reimbursement audits and reasonable value determinations. My career spans management roles in hospital finance and revenue cycle operations and executive level leadership in private radiology and laboratory data analysis
My approach blends deep expertise with a commitment to integrity and clarity — whether reviewing complex billing files or providing Section 18.001 controverting affidavits. I specialize in analyzing the reasonableness of charges, identifying discrepancies and delivering precise objective insights that withstand legal scrutiny. I am available for depositions and trial testimony and willing to travel as needed.
For more details, a full CV or a list of prior testimony, please reach out.
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Helen Spaustat, CPC, CMPA, CRC, CHC
Expert Witness Medical Billing, Coding, UCR Fees
BEST-MED CONSULTING, LLC
SAN ANTONIO, Texas
Medical Billing, Medical Coding
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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.
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Misty Coffman, RN, MSCC, CNLCP
Nurse Life Care Plan Expert Witness - Experienced
National Life Care Planning Experts, LLC
Texas
Life Care Planning, Medical Billing
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Life Care Plan, Life Care Planner, Nurse Expert, Nurse, LCP, TBI, Brain Injury, Amputation, Cerebral Palsy, Birth Injuries, Life Care Plans, Damage Assessments, Medical Bill Reviews, Medical Bill Review, Life Care Plan Rebuttal, Motor Vehicle Accidents, Medical Malpractice, Catastrophic Claims, Accidents, Injuries
Misty Coffman, RN, MSCC, CNLCP is a highly experienced Nurse Life Care Planning expert witness with nearly four decades of nursing practice and extensive deposition and trial experience. She brings exceptional credibility, leadership, and real-world clinical depth to complex personal injury, medical malpractice, and catastrophic injury cases.
She has been a Registered Nurse for 37 years and served as President of the American Association of Nurse Life Care Planners (AAANLCP) in 2024, following her tenure as an Executive Board Member from 2022–2024. Her national leadership role reflects peer-recognized expertise and a deep command of life care planning standards and methodology.
Her clinical and administrative background spans a broad range of healthcare settings, including orthopedic nursing, medical-surgical nursing, occupational health, long-term and skilled nursing care, medical billing, and healthcare compliance. She has held senior leadership roles such as Director of Nursing...
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Dawn Espinoza, RN, MSN, CCM, CDMS, CNLCP, LNCC
Life Care Planner, Medical Billing
Dawn Espinoza Consulting, PLLC
Arlington, Texas
Life Care Planning, Medical Billing
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Case Management, Medical Cost Projection, Vocational Expert, Employability Expert, Nursing, Personal Injury, Property Liability, Workers Compensation, Brain Injury, Back Injury, Burns, Assault Injury, Trip Fall Injuries, Motor Vehicle Accident Injury, Chronic Pain, Spinal Cord Injury, Amputation, Whiplash, Concussion
A licensed Registered Nurse with over 30 years of experience. I have provided care for and developed treatment plans for a multitude of patients, including those patients experiencing orthopedic conditions that require inpatient and outpatient rehabilitation, patients with burn injuries, patients with spinal cord injuries, patients who have experienced with amputations, patients with visual impairments, and patients with acquired brain injuries.
I trained as and began working as a medical and vocational case manager in 2006, becoming certified in 2007. As a case manager, I perform assessment, planning, implementation, coordination of care, monitoring, evaluation, and outcomes management in a variety of practice settings. My work as a case manager included medical billing audit, utilization review, as well as appeals and denials of hospital services which included medical and procedural coding, medical necessity, and cost review.
In 2011, I became a certified disability management ...
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Marisa Yermakova
Expert Medical Billing - Coding & Reasonableness
Medical Equation
Austin, Texas
Medical Billing
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Revenue Cycle Management, Chargemaster Review, Collections Analysis, Medical Coding Review, Financial Analysis, Coding and Billing Operations, Budgeting, Insurance Billing, Phantom charges, Unbundling Charges, Claims Appeals, Payment Reconciliation
With more than 10 years of experience in healthcare reimbursement and revenue cycle analysis, I offer a specialized focus on benefit verification, claims appeals, payment reconciliation and trend analysis. My background includes in-depth research of payor policy stipulations, medical coding accuracy, and resolving discrepancies through direct communication with high-level insurance representatives.
I have led special projects to secure mass payments owed to providers, launched and optimized a practice management system for a multi-provider chiropractic group, and successfully advocated for countless beneficiaries denied medically necessary procedures. I am well-versed in state-specific billing laws and guidelines nationwide and bring a detail-oriented, compliance-driven approach to every case.
Available for depositions and trial testimony and willing to travel as needed. For a full CV or testimony list, please reach out directly.
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Bernice Zander
Medical Billing Expert Witness
Abacus Analytics
Austin, Texas
Medical Coding, Medical Billing
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UCR, Usual Customary Reasonable, Medical Billing Expert Witness, Medical Coding Expert Witness, Billing Expert Witness, Medical Coding Expert, Medical Billing Expert, AMA
BS, RHIT, CCS
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Douglas L Constant, MD
Pain Management- Medicine and IME
360 Orthopedics
Texas
Pain Management - Medicine, Independent Medical Examinations
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Pain Management, spinal cord stimulator, nerve injury, RSD, Reflex Sympathetic Dystrophy, radiofrequency ablation, injections, complex regional pain syndrome, CRPS, opioids, causalgia, nerve block, neuropathic pain, failed back syndrome, IME, medical billing, billing fraud, disability evaluation
Award Winning, Harvard Trained Pain Physician.
Active clinical practice.
Provided pain management treatment to WNBA players, the MLS, the Boston Red Sox and the Pittsburgh Pirates.
Castle Connolly Top Doctor, Pain Management, since 2015. Chosen by his peers and recognized as "Top Doctor" in the Sarasota area since 2017.
U.S. Naval Academy graduate. Former United States Marine Corps Officer with deployments to Sarajevo, Mogadishu, and Kuwait.
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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
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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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Nestor Bonilla
Healthcare Finance & UCR Billing Expert Witness
Eagle Pass, Texas
Medical Billing, Hospital Administration
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Healthcare Finance, Medical Billing, Usual Customary and Reasonable Charges, Revenue Cycle Management, Medical Cost Evaluation, Expert Witness Reports, Billing Reasonableness, Fee Schedule Compairson, Expert Rebuttal Reports, Medical Economics, Medical Charge Validation, Provider Charge Analysis, Medical Cost Benchmarking
I am a healthcare finance professional with over 18 years of experience in hospital finance, revenue cycle operations, and medical billing analysis. I currently serve as the Chief Executive Officer of Maverick County Hospital District (MCHD) in Eagle Pass, Texas, where I previously held the position of Chief Financial Officer for 11 years.
In addition to my executive leadership roles, I have been retained as an expert witness in legal cases involving the reasonableness of medical billing charges. My work includes providing opinions on past medical expenses, authoring rebuttal reports to challenge unsupported methodologies, and offering deposition testimony. I base my evaluations on actual billed charges, widely accepted industry standards, and a comprehensive understanding of how providers establish pricing.
I hold an MBA in Healthcare Management from the University of Texas at Tyler and a BBA in General Business from Sul Ross State University. I also earned an AAS in Computer Inf...
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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
Medical Billing, Insurance
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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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Mark S Sanders, MD FACS
Board Certified Orthopaedic Surgeon
Sanders Clinic for Orthopaedic Surgery and Sports Medicine
Houston, Texas
Orthopedic Surgery, Spine Surgery & Spine Care
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Medical Billing, Hospital Billing, Pain Management, Wound Care, Physical Therapy, Rehabilitation, Surgical Site Infection, Foot and Ankle Specialist, ACL, Osteotomy, Rotator Cuff, Hand/Wrist, Operating Room Procedures, Musculoskeletal Expert, Bunion correction
Certified by the American Board of Orthopaedic Surgery, Dr. Sanders also holds a Subspecialty Certificate in Orthopaedic Sports Medicine. He is a Fellow of the American Academy of Orthopaedic Surgeons and the American College of Surgeons. Dr. Sanders began his private Orthopaedic surgery practice in Houston in 1986 and maintains an office at the River Oaks Medical Tower in the heart of Houston’s Galleria area. He is a member of the American Orthopaedic Society for Sports Medicine (AOSSM), the Arthroscopy Association of North America (AANA) and the American Orthopaedic Foot & Ankle Society (AOFAS). Dr. Sanders champions advances in Orthopedic Sports Medicine and the treatment of complex fractures, malalignment, and joint degeneration. His research findings on the benefits of knee bracing in off road motorcyclists were recently published in the American Journal of Sports Medicine.
During his 45-year career in orthopedics, he has performed thousands of arthroscopic surgeries on sever...
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Richard F Lacy, MHA, CPC, FMC
Medical Coding and Reasonable Value Expert
Transparency Healthcare
Texas
Medical Billing, Medical Coding
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Reasonable Value of Medical Services, Payment Disputes, Future Cost of Care, Managed Care, Reimbursement Rate Expert, Contract Rate Negotiations, Medical Claims Analysis, Cost Projections
I am the founder of Transparency Healthcare, LLC and serve as an independent medical billing and coding expert. I hold a Master of Health Care Administration (MHA) from Trinity University and a Bachelor’s degree in Psychology from Southern Methodist University. I am a Certified Professional Coder (CPC) through the American Academy of Professional Coders and a Certified Forensic Medical Coder through the Association of Forensic Medical Coders, and I maintain active involvement in multiple professional organizations related to medical billing, coding, and claims analysis.
Throughout my career, I have worked extensively with complex healthcare data, large claims datasets, and multiple healthcare information systems to support financial analysis, contract evaluation, and operational improvement. My expertise includes reimbursement methodologies, managed care contracting, utilization analysis, and medical coding compliance. As an expert consultant, I have prepared numerous reports addr...
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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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Rhonda R Guitreau
Medical Billing Specialist - 40+ years experience
Medical Reimbursement Specialists
DALLAS, Texas
Medical Billing, Medical Coding
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Medical Bill Review, Reasonableness of Medical Bills, Forensic Bill Review, Medical Cost Analysis, Expert Witness for Deposition/Trial, UCR fee analysis, Medicare/Medicaid/Work Comp, Future Medical Expenses, Geographic Specific Provider market comparisons, Affidavits/Controverting affidavits
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Lance S. Loria, CPA, LFACHE, FAAMA
National Expert in Medicare Regulatory Matters
Loria Associates, LLC
Montgomery, Texas
Medical Billing, Fraud
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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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Avian Tisdale, MD, MBA, Paralegal
Experienced Physician Executive and Paralegal
DHM Consulting
Richmond, Texas
Pain Management - Medicine, Fraud
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Adoption, Arbitratilon, Mediation, Banking, Empolyment Law, Business Operations, Dispute Resolution, Document Examination, Failure Analysis, Health Informatics, HIPAA, Hospital Administration, Human Resources, Mangement, Medical Billing, Risk Management, Artificial Intelligence, Technology, School Safety, OSHA
Physician executive with over 20 years of clinical, administrative, and academic experience across hospitals, emergency departments, inpatient units, urgent care centers, and community health systems. Board-certified physician with deep expertise in medical staff management, quality improvement, and regulatory compliance. Dual-trained with a Paralegal certification and MBA in Finance, offering unique insight into how healthcare operations intersect with legal, financial, and risk domains.
Highly experienced in identifying deviations from clinical standards, assessing system-level failures, and providing objective, evidence-based opinions.
Independent, Licensed and Board Certified, Full-time Availability
AREAS OF EXPERTISE
Standards of Care
Emergency & Inpatient Pediatric Medicine
Hospital & Multi-Site System Administration
Medical Staff Credentialing & Supervision
Healthcare Compliance (HEDIS, NCQA, HRSA, FTCA)
HR Processes & Clinical Oversight
Value-Based Care & Quality Metrics
...
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Doreen R Casuto, RN, MRA, CRRN, CCM
Life Care Planning Expert with 40 years experience
Rehabilitation Care Coordination
Utah
Life Care Planning, Medical Billing
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Rehabilitation Nursing, Nursing Assessment, Case Management, Benefit Administration, Special Needs Trust, Care Coordination, Spinal Cord Injury, Traumatic Brain Injury, Cerebral Palsy, Neuromuscular Disorders, Amputation, Accessibility, Medical Billing, Benefit Application
50 years of experience in rehabilitation nursing, providing patient care, education and coordination of services. 35 years as an independent case manager working with catastrophically injured. Evaluated patients, assisted physicians in planning and coordinating the rehabilitation needs of patients with spinal cord, brain injuries, stroke and neuromuscular illnesses. Prior to founding RCC she was the Director of Physical Rehabilitation Nursing at Grossmont Hospital in San Diego, Rehabilitation Nurse Coordinator at Methodist Hospital in Indianapolis and Rehab Nursing Workshop Coordinator at Ohio State University. Doreen is currently an Adjunct Professor with San Diego State’s School of Nursing as well as a former board member of the Brain Injury Association of California (BIACAL), the San Diego Brain Injury Foundation (SDBIF) and Jewish Family Services of San Diego.
In 1989, Doreen Casuto decided to start a small company with a unique goal. Doreen had recently left Grossmont Hospit...
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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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
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