Expertise DescriptionI 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
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 regarding prior Authorization for medication and medical procedures.
I have given testimony regarding emergency and urgent care. I have given testimony in the form of expert reports, depositions and testimony at trial regarding ambulatory care fees – (Urgent care is ambulatory care and uses the same standardized billing codes and reimbursement including HCPCS and CPT codes). I have been retained on over 20 cases involving ambulatory care. I have served as an expert in Federal court on false claims act cases for relators (‘whistleblower’), and defendants. I have extensive training in coding and billing.
I have given opinions on orthopedic surgery procedures including wrist surgery where the Usual Customary and Reasonable cost of care (UCR) is involved.
I have recent training and experience in toxicology Urology and pathology. I have given testimony in Federal and State Court including recent work for the US Department of Justice my testimony has never been excluded.
I’m experienced impair provider disputes and helps get results for several plaintiff’s disputing reimbursement with Blue Cross Blue Shield plans throughout the U.S..
I have analyzed Hospital profit and loss data, costs, revenue models and assessed business plans for many healthcare providers.
|B.S.||Business Administration||University of Southern California|
|A.A.||Statistics; Economics; Computer Science||University of California at Irvine|