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Expertise Description

I have more than 20 years experience in the Healthcare system with expertise providing opinions in civil and criminal matters of health care claims reimbursement, billing and coding, fraud, ICD-10, HIPAA Privacy and Security, Meaningful Use, the Affordable Care Act, and usual customary and reasonable medical costs. I have experience with electronic health records, medical and dental claims, and patient’s duty to mitigate costs. My work involves self-insured employers, hospital systems, health plans (insurance) and healthcare IT firms. My education includes: USC - business, UCI - computer science & economics, Stanford Medical School in bioinformatics, computational biology and biomathematics. I have prior expert witness experience with consultation, deposition, and courtroom testimony.

Areas of Expertise


Relevant Experiences

I have provided testimony in State and federal court regarding Usual Customary and reasonable cost of care.

I have prior experience in and am a published author re prior Auth for medication and medical procedures. My testimony has never been excluded.

Industry best practices and guidelines for determining economic value and medical necessity (which may be based on the diagnosis of a licensed medical professional or retained medical expert provided to me as a precursor to rendering my opinion) as determined in payor medical policies and coverage determinations


Education

Degree Subject Institution
B.S. Business Administration University of Southern California
A.A. Statistics; Economics; Computer Science University of California at Irvine

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