Medical Billing Expert Witnesses in Colorado

Medical Billing, HIPAA - 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...

Medical Billing, Fraud - 60-Day Rule, Hospice, Corrective Action Plan, Cost Report, Coding, Statistical Sampling, Overpayment, Skilled Nursing, Home Health, FCA, Medicare, Hospital, Physician, False Claim, Physician Contract, Compliance Training, Anti-Kickback, Laboratory Billing, Medical Necessity, Clinical Documentation

Mr. Loria has 53 years of healthcare (HC) regulatory compliance, M&A, Medicare reimbursement and appeals, hospital pricing, managed care contracting and litigation support. Extensive expert witness experience before the Provider Reimbursement Review Board, ALJ proceedings, civil and criminal litigation, and mediation and arbitration proceedings. Mr. Loria has represented hospitals, nursing facilities, home health, hospice, reference laboratory, physician groups, and other providers in Medicare appeals and controversies. During his career he has managed more than 2,000 Medicare disputes and other investigations. He was a Partner in the SW Regional HC practice of PwC. Prior to joining PwC as a Partner, he was the National Director of the Regulatory practice at EY for 10 years. He founded Loria Associates in 2002 and serves as CEO and Managing Director. He has consistently served HC clients on a nation-wide basis and delivered excellent results based on his unique qualifications a...

Medical Billing, Medical Coding - 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

Parker, Colorado

Medical Billing, Medical Coding - 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...

Colorado

Medical Billing, HIPAA - 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...