ForensisGroup Medical Fraud Expert Witnesses are responsible for investigating, collecting, researching, and analyzing billing data to detect fraudulent, abusive, or wasteful activities and practices.
Our experts have in-depth knowledge of healthcare coding conventions, fraud schemes, general areas of vulnerability, reimbursement methodologies as well as laws and regulations in this area to find suspicious patterns in claims data and other materials.
They conduct independent investigations, use data analysis techniques to detect issues with Medicare and insurance claim data, and reviews information in standard claims processing system files, such as claims histories and provider files to determine provider billing patterns and to detect potential fraudulent or abusive billing practices or vulnerabilities. They also participate in audits and provide support for matters at hearings, appeals, and before administrative law judges (ALJ).
Our experienced medical fraud experts work in the healthcare industry providing opinions in matters of health care claims reimbursement, billing and coding, and fraud. They also have experience with electronic health records, medical claims, hospital billing systems, and health insurance plans.
If you are unable to find the right Medical Fraud expert witness, please contact our office. We will work with you to find the right expert for your case. We also provide an initial case consultation with our experts before they are retained at no cost. Our experts do not pay a fee to be listed, allowing us to select experts based only on a rigorous screening process. Let ForensisGroup match you with a highly qualified Medical Fraud expert witness today.
With more than 25 years experience in healthcare fraud investigations, I have expertise in conducting comprehensive audits and investigations for fraud, waste, abuse, and error (erroneous coding) for Medicaid, Medicare Advantage, and commercial products. I have prior experience offering my services as a healthcare fraud investigation expert witness.
I am an experienced healthcare management expert witness. I have specialized for over 35 years in general medical data audit support services, data analytics (predictive), data assessments and strategy support, internal control audits, compliance, risk, and vulnerability assessments for patients, providers, payers, plan sponsors and other indirect and direct support vendors within the healthcare industry. I have additional experience in denial management services, third party audits, metrics, medical software architecture and integration analysis and health record integrity that are essential to sustain revenue, billing and clinical integrity. I have prior experience offering consultations, deposition, and courtroom testimony as a healthcare management expert witness.
I have spent more than 15 years as a medical billing expert witness. I also have over 20 years experience in Medical Billing and Coding with expertise in medical record audits and reviews, compliance plan requirements, corporate integrity agreement (CIA), due diligence, independent review organization (IRO), Medicare and Medicaid fraud and abuse investigation, and physicians at teaching hospitals (PATH) initiatives.
I have over 40 years experience as a professional nurse. My areas of expertise include review and summary of medical records, assessment of damages and liability, medical bill review, and audits related to organizational compliance. I have experience in elderly care, elder abuse, personal injury, professional negligence, and product liability issues. I have more than 20 years expert witness experience with consultations, deposition, and courtroom testimony.