Managed Care Expert Witnesses

Managed care expert witnesses and consultants listed here may be able to form expert opinions, draft expert witness reports, provide expert witness testimony at deposition and/or trial as or serve as consulting (non-testifying) experts on managed care. The managed care expert witness listings on this page are typically from fields/areas of expertise such as: Family Medicine, Geriatrics, HMO, Hospital Administration, Insurance, Long Term Care, Medical Billing, Medical Coding, Medical Management, Nursing Homes, Occupational Medicine, Preventive Medicine, Public Health, and Risk Management.

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David Martinez

Medical Billing & UCR Reimbursement Expert Witness

Accurate Billing Investigators, Inc.

California
Medical Billing, Insurance - Managed Care, HMO, PPO, Medicare, Medicaid, Reasonable Value, Audit, Hospital, ERISA, Usual and Customary, Reimbursement Disputes, Claims Denials, Athena Billing, Out-of-Network, Balance Billing, Fee Schedule Analysis, Expert Testimony, Medical Necessity, Multi-State, Healthcare Reimbursement
I have over 35 years of experience in medical billing, reimbursement, and managed care systems, with expertise spanning provider operations, payer methodologies, and claims adjudication practices. My work focuses on evaluating medical billing accuracy, reimbursement methodologies, usual and customary charges, and payer denial practices. Practice includes multi-state reimbursement analysis, with extensive experience in California managed care systems, including HMO, IPA, and risk-based reimbursement structures, as well as Medicare Advantage and national payer methodologies. I have served in multiple roles, including claims examiner, billing manager, revenue cycle executive, and founder of a national medical billing and audit firm. This multidisciplinary experience allows me to analyze disputes from both the provider and payer perspectives. Experience includes analyzing billing system workflows and claims processing issues across platforms such as Athenahealth. My expert work includ...
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Geni A Bennetts, MD MA FAAP FACMQ CHCQM CPE

Hospital, Managed Care, Compliance, HIPAA Expert

Resolve Healthcare Consulting

Napa, California
Medical Management, Risk Management - Medical Quality/Risk Management, Hospital and Medical Management, Hospital Compliance, Medical Compliance, HIPAA, Grievance and Appeals, Managed Care, Joint Commission, CMS, Utilization Review, Patient Safety, Hospital Governance
Dr. Geni Bennetts is an experienced physician executive in healthcare and a Certified Physician Executive. She has served as a hospital subspecialist and as Chair of that division. Additionally, she has chaired hospital care management and managed care compliance, as well as serving as the chair of hospital risk management. Dr. Bennetts is the founder and principal of Resolve Healthcare Consulting. She also held the roles of Vice Chair, Chair of the Asset/Liability Committee, and then Chair of a Bank Board, the last position being held for five years. She has been an examiner for the California Department of Managed Health Care and has reviewed over 40 health plans for Quality, Utilization, Grievance and Appeals, and Access and Availability. She has consulted for a number of health plans and has held positions in health plans, hospitals, and IPAs as consulting interim CMOs, Medical Directors, and Advisors. For the past 15 years, Dr. Bennetts has consulted in the following areas o...
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Karl E. Steinberg, MD, CMD, HMDC, HEC-C

Geriatrics, Nursing Homes, Hospice/Palliative

Stone Mountain Medical Associates, Inc.

Oceanside, California
Geriatrics, Nursing Homes - Nursing Home - Skilled Nursing Facility, Hospice - End-of-Life Care, Palliative Care, Home Health, Assisted Living, Regulatory, Decubitus, Pressure Ulcers, Falls, Dementia - Alzheimer's, Medicare, Medicaid, Managed Care - HMO, Life Care Planning, Personal Injury, Family Medicine, Addiction Medicine, Bioethics
Experienced Expert, 250+ depositions, 25+ trials. Speedy and Objective Records Reviews (plaintiff/defense); Standard of Care, Causation and Damages Opinions, including Life Expectancy and Future Care Costs, Regulatory Actions; Comprehensive Report Writing. References Available on Request. In clinical practice of post-acute and long-term care medicine, Geriatrics & Hospice in San Diego area since 1992; Chief Medical Officer, Bio-Pacific Admin Services (nursing facility management company); Chief Medical Officer, Beecan Health; Delegate, AMA and California Medical Association House of Delegates; Chair, CMA Council on Ethical, Legal & Judicial Affairs; Chair, CMA Administrative Medicine Forum; Clinical Faculty UCSD School of Medicine and Family Medicine Dept., Affiliate Faculty, California State University's Shiley Haynes Institute for Palliative Care (San Marcos), Past President of CALTCM, Past President of PALTmed (Post-Acute & Long-Term Care Medical Association, previously AMDA,...
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Bernard J Katz, MD, MBA

UCLA Health

Santa Monica, California
Family Medicine, Geriatrics - family medicine, primary care, general medicine, urgent care, managed care, utilization management
I have vast experience providing medical legal expertise for both medical defense as well as plaintiff counsels. I also serve as an expert for the medical board of California. I have been in clinical practice for 34 years in the Los Angeles area, 21 years in private/group practice and 13 years in outpatient family medicine in a community practice affiliated with UCLA. I also serve as medical director for the UCLA primary care network, and am involved in clinical operations as well as quality improvement activities for the primary care physicians. The network includes primary care offices as well as urgent care locations and also incorporates telehealth services. While I no longer provide inpatient care, I do maintain hospital privileges at 2 community hospitals and follow my patients closely upon hospital discharge. I have vast experience in managed care, providing utilization review for health plan beneficiaries under HMO insurance. My clinical practice includes pediatrics, ad...
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Richard F Lacy, MHA, CPC, FMC

Medical Coding and Reasonable Value Expert

Transparency Healthcare

Parker, Colorado
Medical Billing, Medical Coding - Reasonable Value of Medical Services, Payment Disputes, Future Cost of Care, Managed Care, Reimbursement Rate Expert, Contract Rate Negotiations, Medical Claims Analysis, Cost Projections
I am the founder of Transparency Healthcare, LLC and serve as an independent medical billing and coding expert. I hold a Master of Health Care Administration (MHA) from Trinity University and a Bachelor’s degree in Psychology from Southern Methodist University. I am a Certified Professional Coder (CPC) through the American Academy of Professional Coders and a Certified Forensic Medical Coder through the Association of Forensic Medical Coders, and I maintain active involvement in multiple professional organizations related to medical billing, coding, and claims analysis. Throughout my career, I have worked extensively with complex healthcare data, large claims datasets, and multiple healthcare information systems to support financial analysis, contract evaluation, and operational improvement. My expertise includes reimbursement methodologies, managed care contracting, utilization analysis, and medical coding compliance. As an expert consultant, I have prepared numerous reports addr...
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Sarita M Massey, MD, MPH, FACOG

Catalyst Health and Equity Solutions LLC

Chicago, Illinois
Public Health, Hospital Administration - medical necessity, utilization management, Insurance clinical policy reviews, managed care, obstetrics, gynecology
Board Certified Obstetrician and Gynecologist with more than 3 decades of experience in healthcare. Experience with peer review including 10 years on State Medical Disciplinary Board. More than a decade of experience as Medical Director on provider and payor side, authoring policies and procedures, performing medical necessity review with specialization in prior authorization.
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Vera Dvorak, MD

TD&P Consulting Inc.

Silver Spring, Maryland
Medical Management, Long Term Care - Home Healthcare, Managed Care, Transitional Care Management, Medical Necessity Determination, Long-Term Care Planning, Evidence-Based Care Guidelines Expert, Patient-Centered Care Expert, Geriatric Services, Utilization Review, Medical Valuation, Infectious Disease
Vera Dvorak, MD, has broad and extensive experience in a continuum of care, with over 40 years working in diverse healthcare settings including home health services, palliative care, and hospice. She has also served as medical director in all of these areas. Dr. Dvorak has been a practicing physician, a managed care executive, a strategic member of corporate leadership, and vice president and medical director of hospital-based care coordination. She has been in charge of the appeals department in various managed care organizations; and is the founder of transitional care management for one of the largest healthcare systems in Northern Virginia. Dr. Dvorak’s focus has been on medical necessity determination, appropriate discharge disposition with defined short and long-term care needs. She has been a proponent of consistently applying evidence-based care guidelines to support clinical decision-making on a case-by-case basis and across the continuum of care to maximize the potenti...
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Richard F Lacy, MHA, CPC, FMC

Medical Coding and Reasonable Value Expert

Transparency Healthcare

Missouri
Medical Billing, Medical Coding - Reasonable Value of Medical Services, Payment Disputes, Future Cost of Care, Managed Care, Reimbursement Rate Expert, Contract Rate Negotiations, Medical Claims Analysis, Cost Projections
I am the founder of Transparency Healthcare, LLC and serve as an independent medical billing and coding expert. I hold a Master of Health Care Administration (MHA) from Trinity University and a Bachelor’s degree in Psychology from Southern Methodist University. I am a Certified Professional Coder (CPC) through the American Academy of Professional Coders and a Certified Forensic Medical Coder through the Association of Forensic Medical Coders, and I maintain active involvement in multiple professional organizations related to medical billing, coding, and claims analysis. Throughout my career, I have worked extensively with complex healthcare data, large claims datasets, and multiple healthcare information systems to support financial analysis, contract evaluation, and operational improvement. My expertise includes reimbursement methodologies, managed care contracting, utilization analysis, and medical coding compliance. As an expert consultant, I have prepared numerous reports addr...
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Mary Mason, MD MBA FACP

Former CMO Fortune 25 Managed Care /Physician

Saint Louis, Missouri
Insurance, Medical Management - Medicaid, Managed Care, Medicare, Dual Eligible, Marketplace, Medical Policy, Utilization Management, Risk Management, Payer Operations, Quality Improvement, Regulatory Compliance, Expert Witness, Internal Medicine, Corporate Compliance, Medicare Advantage, Utilization Review, Access to Care, Population Health, Insurance
Physician executive, internist, MBA, and thought leader in managed care with 27 years of leadership experience across Medicaid, Medicare, Dual Eligible/D-SNP, Marketplace, utilization management, medical policy, quality performance, population health, and payer operations. Former Senior Vice President and Corporate Chief Medical Officer for Centene, a Fortune 25 healthcare enterprise, and Washington University faculty member with extensive experience in enterprise clinical strategy, risk management, and work with corporate lawyers, corporate compliance, and senior leadership on litigation-related matters, depositions, fair hearings, regulatory issues, medical affairs, and complex managed care operations Washington University faculty member, with appointments in the School of Medicine, School of Law, Olin Business School, and Brown School of Social Work. Board-certified internist, Fellow of the American College of Physicians, and Missouri-licensed physician. Earned an MD from Washin...
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James J. McCormick, M.D., M.B.A

Medicare Advantage Prior Auth Physician Expert

Yanceyville, North Carolina
HMO, Insurance - prior authorization, PA, Medicare Advantage, MA, Outpatient authorization, Inpatient authorization, Post Acute authorization, Appeals, documentation standards, managed care, helicopter transportation
As a physician leader, I have designed and implemented systems to ensure medical recordkeeping meet legal, reimbursement, and quality benchmarks. I spearheaded the development of a multi-state governance framework for both primary and specialty care groups, ensuring peer review, credentialing, quality assurance, and utilization management processes are rigorously structured and defensible. I also led the creation of an enterprise-wide Utilization Management Committee to meet CMS mandates. The committee is empowered to critically evaluate national clinical policies before adoption—aligning frontline utilization decisions with evidence-based standards. With decades of expanding leadership across diverse healthcare sectors, I bring a fair, balanced, and meticulously documented expert perspective to every case I consider. Tradewinds Healthcare Consulting, LLC 04/2025 - Present - Consulting Expert - Testifying Expert - Clinical case review Humana, Inc. 08/2023 - 04/2024...
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Kristin Devor, D.O.

Primary Care

Upper Arlington, Ohio
Family Medicine, Preventive Medicine - Primary Care, General Medicine, Failure to Diagnose, Cancer Screening, Standard of Care, Internal Medicine, Managed Care, Utilazation Management, Nutrition, Exercise counseling
Board Certified by American Board of Family Medicine. Full time clinical practice in adult Primary Care, 2013-present. Voted as Top Doctor in Columbus, OH 2022, 2023, 2024. Serving on Board of Directors for the largest physician owned Primary Care Organization in the U.S., 2020-present. Highly experienced in Standard of Care. Completion of SEAK Expert Witness Training 2023. Able to provide witness consultation services to both plaintiff and defense cases.
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David Martinez

Medical Billing & UCR Reimbursement Expert Witness

Accurate Billing Investigators, Inc.

McKinney, Texas
Medical Billing, Insurance - Managed Care, HMO, PPO, Medicare, Medicaid, Reasonable Value, Audit, Hospital, ERISA, Usual and Customary, Reimbursement Disputes, Claims Denials, Athena Billing, Out-of-Network, Balance Billing, Fee Schedule Analysis, Expert Testimony, Medical Necessity, Multi-State, Healthcare Reimbursement
I have over 35 years of experience in medical billing, reimbursement, and managed care systems, with expertise spanning provider operations, payer methodologies, and claims adjudication practices. My work focuses on evaluating medical billing accuracy, reimbursement methodologies, usual and customary charges, and payer denial practices. Practice includes multi-state reimbursement analysis, with extensive experience in California managed care systems, including HMO, IPA, and risk-based reimbursement structures, as well as Medicare Advantage and national payer methodologies. I have served in multiple roles, including claims examiner, billing manager, revenue cycle executive, and founder of a national medical billing and audit firm. This multidisciplinary experience allows me to analyze disputes from both the provider and payer perspectives. Experience includes analyzing billing system workflows and claims processing issues across platforms such as Athenahealth. My expert work includ...
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Richard F Lacy, MHA, CPC, FMC

Medical Coding and Reasonable Value Expert

Transparency Healthcare

Texas
Medical Billing, Medical Coding - Reasonable Value of Medical Services, Payment Disputes, Future Cost of Care, Managed Care, Reimbursement Rate Expert, Contract Rate Negotiations, Medical Claims Analysis, Cost Projections
I am the founder of Transparency Healthcare, LLC and serve as an independent medical billing and coding expert. I hold a Master of Health Care Administration (MHA) from Trinity University and a Bachelor’s degree in Psychology from Southern Methodist University. I am a Certified Professional Coder (CPC) through the American Academy of Professional Coders and a Certified Forensic Medical Coder through the Association of Forensic Medical Coders, and I maintain active involvement in multiple professional organizations related to medical billing, coding, and claims analysis. Throughout my career, I have worked extensively with complex healthcare data, large claims datasets, and multiple healthcare information systems to support financial analysis, contract evaluation, and operational improvement. My expertise includes reimbursement methodologies, managed care contracting, utilization analysis, and medical coding compliance. As an expert consultant, I have prepared numerous reports addr...
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Laura Suttin, MD, MBA, PCC

Family Medicine Physician - Peer Review Expert

San Antonio, Texas
Family Medicine, Occupational Medicine - primary care, outpatient medicine, preventive medicine, Medicare Advantage, geriatrics, chronic disease management, HCC coding, risk adjustment, managed care, chart review, peer review, medical record review, workers' compensation
I am a board-certified family physician with an active, unrestricted Texas medical license and over 20 years of clinical practice experience in primary care and outpatient medicine. With an MBA alongside my MD, and as a former healthcare executive, I bring both clinical depth and administrative perspective to every case evaluation — and I communicate my findings clearly, whether the audience is a legal team or a non-clinical decision-maker. Throughout my career, I have performed chart reviews and peer reviews across a broad range of primary care and outpatient clinical scenarios, with particular familiarity in chronic disease management, Medicare Advantage populations, preventive care standards, HCC coding accuracy, and medical necessity determinations. Beyond individual case review, I founded and led a physician peer review committee for over 10 years — completely redesigning the process from the ground up, establishing its standards and workflows, and guiding the committee throug...