False Claim Expert Witnesses

Lone Tree, Colorado

Appraisal & Valuation, Business Valuation - Healthcare Valuation, Physician Compensation, FMV, Stark, Anti-Kickback, Physician Strategy, Physician Alignment, Value-Based Care, ACO, CIN, Hospital Strategy, Provider Compensation, APP Compensation, False Claim, Doctor Pay, Healthcare Business Value, Healthcare Appraiser, Commercially Reasonable, Pay for Performance, Economic Damages

Jim leads InHealth’s work related to structuring, implementing, and valuing provider integration models for clinic-based specialties and navigating the transition to participation in advanced value-based contracting models. Jim is a frequent presenter and author on matters pertaining to physician alignment models, provider compensation, and healthcare valuation. He also possesses extensive experience serving as an expert in disputes and investigations involving physician compensation, healthcare business valuation, and other healthcare valuation matters. Jim offers InHealth’s clients guidance in designing provider integration models that ensure alignment with their organization’s operational and financial goals, as well as optimize the organization’s performance in value-based payment programs. He assists organizations in developing the strategies and entities needed for participation in advanced value-based contracting programs, including Value-Based Enterprises, Accountable Care ...

Montgomery, Texas

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...