Expert No. 316501 – NV
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Expertise Description: C.F.E., F.A.C.F.E.I., D.A.B.F.E., C.M.I.-II, F.H.F.M.A. - Expert in health care consulting with more than 40 years experience in the health care industry. Experience includes: medicare and other regulatory compliance audits, medical necessity and documentation audits, audit protocol, and patient accounting systems and billing activities. Additional experience performing valuation analyses and risk assessments. Certified Fraud Examiner (C.F.E.). Fellow, American College of Forensic Examiners (F.A.C.F.E.I.). Diplomate of American Board of Forensic Examiners (D.A.B.F.E.). Certified Medical Investigator-Level II (C.M.I.-II). Fellow, Healthcare Financial Management Association (F.H.F.M.A.). Almost 25 years expert witness experience. Consultations, depositions, and courtroom testimony.
Areas of Expertise:
Representative Litigation Experience:
- Fraud investigations.
- Multidisciplinary expert witness services.
- Parallel ZPIC, RAC, and MAC audit services.
- Witness interviews.
- Damage and over and under payment calculations
Representative Consulting Services and/or Projects:
- ED operation risk assessment.
- E/M Tool Review and Revision.
- Coding Hotline.
- ICD-10 Training: physician documentation, training other trainers.
- Nurse auditor services.
- Education programs.
- Clinical informatics support.
- ZPIC, RAC, and MAC risk assessments.
- Billing compliance audits.
- Compliance plan review, audits, updates, and training.
- Small provider compliance officer outsourcing.
Licenses & Certifications:
| Certificate, Executive Graduate Program in Health Care Financial Management, Univ. of CO, Boulder |
| Certified Fraud Examiner, Association of Certified Fraud Examiners |
| Diplomate, American Board of Forensic Examiners |
| Certified Medical Investigator - Level II, American College of Forensic Examiners |
| Healthcare Financial Management Association, Healthcare Financial Management Association |
Education:
| Degree | Subject | Institution | |
|---|---|---|---|
| BA | Government | California State University, Sacramento | |
| AA | Business Administration | Sacramento City College |
Professional Appointment/Association Affiliations:
- California UB-82 Committee
- Healthcare Financial Management Association
- Nevada Association of Hospitals and Health Systems
- Health Care Fraud Committee
