Medical Necessity Expert Witnesses

Medical necessity 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 medical necessity. The medical necessity expert witness listings on this page are typically from fields/areas of expertise such as: Brain Injury Medicine, Critical Care Medicine, Emergency Medicine, Family Medicine, Hospitalist, Insurance, Internal Medicine, Medical Billing, Medical Management, Occupational Therapy, Pain Management - Medicine, Pediatric Neurology, Physical Medicine & Rehab, Physical Therapy, and Pulmonary Critical Care Medicine.

Allison Weiner-Lasher, DPT, OTR/L www.ExpertWitnessPTOT.com

Alabama
Physical Therapy, Occupational Therapy - Nursing homes, rehab hospitals, pediatrics, geriatrics, protocols, falls, sexual assault, training, wound care, orthopedics surgical, pressure sores, transfers, restraints, fall risk assessment, supervision, functional capacity evaluation, FCE, medical necessity, billing, oncology
Licensed physical and occupational therapist. 20+ years of clinical experience including: adults, pediatrics, nursing homes, inpatient and outpatient. Several years teaching experience. 6+ years expert witness experience. Significant supervisory experience of physical therapy and occupational therapy assistants and aids. Pediatric Physical Therapy (PT) experience includes autism spectrum disorders, Angelman’s syndrome, Fragile X syndrome, and Cerebral Palsy. Adult Physical Therapy (PT) experience includes patients with physical therapy deficits after oncology diagnoses and treatments, arthroscopic/arthroplasty surgeries of the shoulder, knee, hip and ankle, rotator cuff repairs, shoulder replacements, post-operative cervical, thoracic and lumbar spine surgeries, back pain syndromes, hand injuries/tendon repairs, ankle injuries/fractures, carpal tunnel repair, Dequervains syndrome, lumbar and cervical spine injuries, neurological diagnoses, knee, hip, and ankle injuries and foot con...

Shishir Shah, DO, CWS, ABPM

SCOTTSDALE, Arizona
Wound Care, Medical Management - bedsores, skin injuries, surgical wounds, burns, pressure ulcers, venous ulcers, hyperbaric oxygen, infections, nursing home, medical devices, telemedicine, scar, qui tam, medical necessity, fraud, patents, medical devices, medical director, decubitus ulcers, diabetic ulcers, regenerative medicine
Award-winning wound care physician in active clinical practice. Wound care clinical, safety ,and leadership experience in acute care, skilled nursing (nursing homes), rehabilitation, and home health settings. Certified Wound Specialist (CWS) with additional Board Certifications in Hyperbaric Medicine and Family Practice. Has served as the medical director of several wound programs. Over twenty years of medical necessity/utilization review and expert witness experience. Midwestern University Medical School faculty. Significant private equity, medical device, startup, and consulting experience. Undergraduate degree in aeronautical engineering, Rensselaer Polytechnic Institute. Deposition and trial experience in multiple states. Over 85,000 wound encounters. Key roles have included medical director oversight of several level 1 hospital trauma wound programs, 5 community hospital wound programs, and over 15 SNF/LTACHs. Co-implemented one of the largest wound care/hyperbaric clinical de...

Thomas Baird McIlraith, MD, SFHM, CLHM Baird Medical Consulting

Davis, California
Hospitalist, Internal Medicine - Hospitalist, Hospital Medicine, Internal Medicine, Infections, Pneumonia, Electrolyte abnormalities, Hypertension, Diabetes, Heart Disease, Sepsis, Shock, Falls, Stroke, Medical Necessity, InterQual, Milliman Care Guidelines (MCG)
Dr. McIlraith received his BS, and MD from the University of Wisconsin; and completed Internal Medicine Residency at the McGaw Medical Center of Northwestern University in 1999. In 2000, he was made the head of the hospitalist division in the South Sacramento Kaiser Permanente. He became the Chairman of Hospital Medicine at Mercy Medical Group in 2004. In the subsequent 12 years he grew the department from 12 to 84 hospitalists. He was elected to the MMG board of directors in 2009, and served as Treasurer from 2011 through 2016. Dr. McIlraith has been providing expert opinion services to defense and plaintiff clients since 2011. He has served on the The Doctors Company Hospital Medicine Advisory Board. Dr. McIlraith joined NAIP (now SHM) as a charter member in 1998 and has been active ever since. He was in the inaugural FHM class in 2009, the inaugural SFHM class in 2010, and the inaugural CLHM class in 2013. He was the 2016 recipient of the SHM Award of Excellence.

Shawn Uraine, M.D.

Loma Linda, California
Pain Management - Medicine, Physical Medicine & Rehab - Spinal Cord Stimulator, Opioid, Facet, Epidural, Pill Mill, Complex Regional Pain Syndrome, CRPS, Opioid Overdose, Radiofrequency Ablation, Medical Necessity, Medical Billing, Independent Medical Examination, IME, spinal cord injury, neuromodulation, fluoroscopy, fraud, platelet rich plasma
Double-board certified physician (physical medicine & rehabilitation and pain medicine). Full-time clinical practice. Assistant professor, Loma Linda University School of Medicine. Experienced expert witness and independent medical examiner – has reviewed over one hundred cases and testified at deposition on numerous occasions.

Felicia A. Pixler, MD F.P. Medical Consulting PLLC

Tampa, Florida
Hospitalist, Medical Billing - disability, Diabetes, congestive heart failure, Kidney Disease, Sepsis, Stroke, COPD/Asthma, Medication Errors, COVID-19, coronavirus, pressure sores, wound care, DVT, deep vein thrombosis, handoffs, medical necessity, healthcare fraud, telemedicine
Board-Certified Internal Medicine Physician with 10+ years experience as a Hospitalist & Telemedicine Hospitalist. Active clinical practice. Significant experience drafting medico-legal reports and providing medical necessity and disability opinions. Additional conditions commonly treated include: electrolyte abnormalities, hypertension, heart disease, congestive heart failure, cardiac arrhythmias, acute respiratory failure, sepsis, stroke , medication errors, deep vein thrombosis, skin and soft skin infections, delirium, cirrhosis, gastrointestinal bleed, and Covid -19 complications.

Stephen Broomes, MD

Douglasville, Georgia
Hospitalist, Medical Billing - Internal Medicine, PE, Pulmonary Embolism, Pneumonia, COVID-19, infection, pressure sores, decubitus ulcers, medical necessity, healthcare fraud, qui tam, sepsis, falls, stroke, DVT, Deep Vein Thrombosis, hypoglycemia, hand offs, Nurse Practitioner & PA Supervision, Disability Evaluation, bleeds
Cleveland Clinic trained hospitalist in active clinical practice. Board certified in internal medicine with a practice focus on hospital medicine. 20+ years of clinical experience. Experienced expert witness at both deposition and trial. Vast medical necessity, UR (utilization review) and disability file review experience – has reviewed in excess of 2,000 charts. Conducted over 1,700 Veterans Benefits Administration (VBA) Disability Reviews. Also experienced in UDT (Urine Drug Testing Analysis) and IMEs (Independent Medical Examinations).

Gregory E. Jones, MD

Douglasville , Georgia
Hospitalist, Internal Medicine - COVID-19, decubitus ulcers, medical necessity, DVT, deep vein thrombosis, PE, pulmonary embolism, sepsis, septic shock, medical necessity, standard of care, respiratory failure, heart failure, heart disease, stroke, peri-operative management
Dr. Jones is board certified in the specialty of Internal Medicine by the American Board of Internal Medicine. He has over 10 years of experience in Hospital Medicine. He is licensed in GA, SC, and TN. He received his medical degree from Morehouse School of Medicine and completed his residency training at the Medical University of South Carolina. He continues to practice as a Hospitalist in Georgia.

Glenda E Flemister, MD, FACP, FCCP Medical Health Solutions.us

Frankfort, Illinois
Pulmonary Critical Care Medicine, Critical Care Medicine - Medical Management, Medical Utilization & Location of Care, Fraud & Abuse, Compliance, Medical Necessity, Medical Devices, Pharmacy Management, Genomics & Personalized Health, Insurance Reviews of Plan Benefits, Insurance Clinical Policy Reviews, Long Term Acute Care & Long Term Care,
Triple Board Certified physician executive/consultant, (Board Certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine), with vast experience in medical necessity and utilization review. Over 12 years of experience in national insurance and payer companies. Has served as Medical Director for Aetna, Blue Cross Blue Shield Association, and interim CEO for Next Level Health Partners. Consultation services to companies and manufactures in various areas, (pharmacy, genomics, medical devices, medical management, utilization, etc.), regarding healthcare medical necessity, compliance and educational issues. Fraud and Abuse. Government plans: Medicare & Medicaid. Private insurers all plans: HMO, PPO, Specialty networks. Expert reviews and medical litigation support performed. Sub-specialty medical reviews in Pulmonary and Critical Care Medicine. Current license: Illinois; New Mexico; Oklahoma; Kentucky; New Mexico ...

Seth P Womack, MD, FAAEM

Louisiana
Emergency Medicine, Medical Management - Airway Management, Central Line Placement, Myocardial Infarction, Heart Attack, Stroke, Appendicitis, epidural abscess, aortic dissection, Pulmonary Embolism, Testicular Torsion, Ectopic Pregnancy, Medical Necessity, pediatric emergency, head trauma, billing, cost analysis, emergency trauma, trauma
Board Certified in Emergency Medicine by the American Board of Emergency Medicine. Full time practitioner of emergency medicine. Has work experience at a level 1 trauma center and its associated freestanding emergency room. Recognized by the American Academy of Emergency Medicine as having expertise in pediatric, trauma, neurological, and cardiac resuscitation. ATLS, ACLS, BLS, and PALS certified. ATLS course instructor. Completion of The Difficult Airway Course: Emergency™. Undergraduate Degree, Magna Cum Laude, in biomedical engineering. Licensed in Louisiana and Texas. Completed multiple SEAK expert witness training courses. Experienced flight physician. Skilled in utilization of video laryngoscopy for emergency airway management and in bedside ultrasound procedures.

Wilfred L Hynes, MD Tufts Medical Center

Boston, Massachusetts
Pain Management - Medicine - Chronic pain, spine injections, steroid injections, opiates, CRPS, RSD, NECC, nerve injury, cauda equina, sacral fractures, failed back syndrome, facet injections, radiofrequency ablation, overdose, billing fraud, medical billing, personal injury, medical necessity
Award-Winning, Harvard Trained Pain Management Physician in active clinical practice. Tufts Faculty (2005-Present). Harvard Faculty (1997-2005). Double Board Certified (Anesthesia and Pain Management). 10+ years experience Medical Director, Tufts. Opiate Management Committee, Tufts Medical Center (2014-Present). Boston College - Scholar of the College/Gasson Scholar. Experienced expert witness at both deposition and trial. Forensic experience includes medical malpractice, workers’ compensation, criminal matters, and health care fraud

Brian Woodruff, MD

East Grand Rapids, Michigan
Pediatric Neurology, Brain Injury Medicine - Child Neurology, Hypoxic ischemic encephalopathy, HIE, cerebral palsy, stroke, hypoxic brain injury, seizures, life expectancy, medical necessity, timing of injury, perinatal/birth asphyxia, concussions, headaches, intracranial hemorrhage, epilepsy, head trauma, developmental delay
Board-certified pediatric neurologist in active clinical practice. Michigan and Wisconsin trained. Award-winning teacher. Michigan State University – College of Human Medicine school faculty. Extensive expert witness experience – testified in over 100 cases.

Dan Laird, M.D., J.D. Flamingo Medical Clinic

Las Vegas, Nevada
Pain Management - Medicine, Family Medicine - telemedicine, primary care, opioids, overdose, benzodiazepines, respiratory depression, apnea, pain management, pain medicine, pain relief, overdose, prescribing, medical necessity, oxycodone, hydrocodone, morphine, hydromorphone, gabapentin, sleep apnea, hypoxia, anoxic brain damage, analgesia
Dr. Laird has more than 25 years of experience as a primary care and pain management physician. He has extensive experience safely prescribing opioids and is familiar with the consequences of not only over-prescribing, but also under-prescribing of opioids. Dr. Laird holds expertise in anesthesiology and the pharmacology of opioids, benzodiazepines, sedatives, hypnotics, and other sedating medications. He is also intimately familiar with how these medications interact to cause respiratory depression, airway obstruction, apnea, and overdose. Dr. Laird is familiar with the legal and medical issues related to allegations of overprescribing opioids. He is familiar with the standard of care with regard to urine drug testing (UDS) and the pros and cons of the same. Dr. Laird has expertise in the medical and legal aspects of addiction, physical and psychological dependence, withdrawal, diversion, misuse, and the management of opioid addiction. Though Dr. Laird is trained as both a physic...

Allison Weiner-Lasher, DPT, OTR/L www.ExpertWitnessPTOT.com

Glen Rock , New Jersey
Physical Therapy, Occupational Therapy - Nursing homes, rehab hospitals, pediatrics, geriatrics, protocols, falls, sexual assault, training, wound care, orthopedics surgical, pressure sores, transfers, restraints, fall risk assessment, supervision, functional capacity evaluation, FCE, medical necessity, billing, oncology
Licensed physical and occupational therapist. 20+ years of clinical experience including: adults, pediatrics, nursing homes, inpatient and outpatient. Several years teaching experience. 6+ years expert witness experience. Significant supervisory experience of physical therapy and occupational therapy assistants and aids. Pediatric Physical Therapy (PT) experience includes autism spectrum disorders, Angelman’s syndrome, Fragile X syndrome, and Cerebral Palsy. Adult Physical Therapy (PT) experience includes patients with physical therapy deficits after oncology diagnoses and treatments, arthroscopic/arthroplasty surgeries of the shoulder, knee, hip and ankle, rotator cuff repairs, shoulder replacements, post-operative cervical, thoracic and lumbar spine surgeries, back pain syndromes, hand injuries/tendon repairs, ankle injuries/fractures, carpal tunnel repair, Dequervains syndrome, lumbar and cervical spine injuries, neurological diagnoses, knee, hip, and ankle injuries and foot con...

Allison Weiner-Lasher, DPT, OTR/L www.ExpertWitnessPTOT.com

New York
Physical Therapy, Occupational Therapy - Nursing homes, rehab hospitals, pediatrics, geriatrics, protocols, falls, sexual assault, training, wound care, orthopedics surgical, pressure sores, transfers, restraints, fall risk assessment, supervision, functional capacity evaluation, FCE, medical necessity, billing, oncology
Licensed physical and occupational therapist. 20+ years of clinical experience including: adults, pediatrics, nursing homes, inpatient and outpatient. Several years teaching experience. 6+ years expert witness experience. Significant supervisory experience of physical therapy and occupational therapy assistants and aids. Pediatric Physical Therapy (PT) experience includes autism spectrum disorders, Angelman’s syndrome, Fragile X syndrome, and Cerebral Palsy. Adult Physical Therapy (PT) experience includes patients with physical therapy deficits after oncology diagnoses and treatments, arthroscopic/arthroplasty surgeries of the shoulder, knee, hip and ankle, rotator cuff repairs, shoulder replacements, post-operative cervical, thoracic and lumbar spine surgeries, back pain syndromes, hand injuries/tendon repairs, ankle injuries/fractures, carpal tunnel repair, Dequervains syndrome, lumbar and cervical spine injuries, neurological diagnoses, knee, hip, and ankle injuries and foot con...

Colleen K Greene, PT, DPT, WCS, CLT-LANA

Holly Springs, North Carolina
Physical Therapy - Pelvic Floor Rehab, Lymphedema, Oncology, Orthopedics, Neurology, Geriatrics, Falls Risk Assessment, Safety, Medical Necessity, Medical Record Review, PT Assistant/Aide Misuse, PT Standards of Care/Scope of Practice, Documentation, Independent PT Evaluation, HIPAA, Medicare/caid Guidelines
Board-Certified Women's Health Clinical Specialist (WCS) since 2009, Certified Lymphedema Therapist through the Lymphology Association of North American (CLT-LANA), Dr. Greene has over 18 years of clinical practice experience in both outpatient and acute care settings and is a practicing physical therapist at Duke University Medical Center. She has advanced expertise in musculoskeletal pelvic floor dysfunction, pre-and post-partum rehabilitation, and complex lymphedema populations. She was a postdoctorate residency mentor for several years, instructing physical therapists in the specialty of women's health. She has expertise in acute care rehabilitation in post-operative populations, such as spinal fusions, external fixations, amputations, total joint replacement, fractures, and falls. She also has extensive experience with traumatic brain injury, dementia, stroke, neurological disorders due to multiple sclerosis, seizures, Parkinson's disease, ALS, Lewy Body Dementia, neuropathy, b...

Frank L Brown, Jr, MD, FACP, FRSM, FCP(E)

Bluffton, South Carolina
Medical Management, Insurance - Accountable Care Organizations (ACO), Health Insurance, Grievances, Pharmacology, Provider Credentialing, Medical Management, Medical Necessity, Medicare, Medicaid, Healthcare Fraud & Abuse, Medical Billing & Coding, Medical Utilization, Utilization Review, Qui Tam
Senior physician executive in the health insurance industry, with licensure in Kentucky, North Carolina, Pennsylvania, and Virginia. Certified as Health Insurance Executive. National insurance companies worked for include Oxford Healthplans, Blue Cross & Blue Shield, Wellpoint, Anthem, and Cigna. Responsibilities have included case management, fraud and abuse, physician credentialing, peer review, physician grievances & appeals, patient grievance & appeals, and patient safety. Board-certified in both internal medicine, and emergency medicine. Holder of multiple patents. Experienced public speaker. Chief Medical Correspondent WVGB-FM in Beaufort, South Carolina. Yale-educated, NIH trained. Conducted over 5,000 physician credentialing reviews; over 5,000 medical necessity/utilization management reviews; patient & physician appeals, & hearings; and over 2,000 committee and in-person patient grievance & appeal reviews. Served as an Examiner for the Malcolm Baldrige National Quality...

Seth P Womack, MD, FAAEM

Tyler, Texas
Emergency Medicine, Medical Management - Airway Management, Central Line Placement, Myocardial Infarction, Heart Attack, Stroke, Appendicitis, epidural abscess, aortic dissection, Pulmonary Embolism, Testicular Torsion, Ectopic Pregnancy, Medical Necessity, pediatric emergency, head trauma, billing, cost analysis, emergency trauma, trauma
Board Certified in Emergency Medicine by the American Board of Emergency Medicine. Full time practitioner of emergency medicine. Has work experience at a level 1 trauma center and its associated freestanding emergency room. Recognized by the American Academy of Emergency Medicine as having expertise in pediatric, trauma, neurological, and cardiac resuscitation. ATLS, ACLS, BLS, and PALS certified. ATLS course instructor. Completion of The Difficult Airway Course: Emergency™. Undergraduate Degree, Magna Cum Laude, in biomedical engineering. Licensed in Louisiana and Texas. Completed multiple SEAK expert witness training courses. Experienced flight physician. Skilled in utilization of video laryngoscopy for emergency airway management and in bedside ultrasound procedures.

Karla Lacayo, MD Alteon Health

Vienna, Virginia
Emergency Medicine - Heart Attack, Stroke, Sepsis, Airway Management, Abdominal Aortic Aneurysm, Pulmonary Embolism, Aortic Dissection, Ectopic Pregnancy, Ovarian Torsion, Testicular Torsion, Appendicitis, Orthopedic Injuries, Medical Necessity, EMTALA, Medical Malpractice, Risk Management
Board Certified in Emergency Medicine by the American Board of Emergency Medicine (ABEM). Fellow of the American College of Emergency Physicians (FACEP). 13 years of experience in Adult and Pediatric Emergency Medicine. Practices full time in a mid-sized community hospital, supervises physician extenders. Worked as the sole provider in free-standing Emergency Department. Expert in standard of care in Emergency Medicine. Can assist with case review, expert witness testimony, opinions on medical malpractice and negligence. Medical Director for the Emergency Department, Vice Chief of Staff for the Hospital. Serves on Credentials Committee, Quality Committee, Sepsis Committee, and Peer Review Committee. Graduated cum laude from Dartmouth College, completed medical school at Northwestern University, and Emergency Medicine Residency at George Washington University. Licensed in Virginia. Fluent in Spanish.

Seth P Womack, MD, FAAEM

Wisconsin
Emergency Medicine, Medical Management - Airway Management, Central Line Placement, Myocardial Infarction, Heart Attack, Stroke, Appendicitis, epidural abscess, aortic dissection, Pulmonary Embolism, Testicular Torsion, Ectopic Pregnancy, Medical Necessity, pediatric emergency, head trauma, billing, cost analysis, emergency trauma, trauma
Board Certified in Emergency Medicine by the American Board of Emergency Medicine. Full time practitioner of emergency medicine. Has work experience at a level 1 trauma center and its associated freestanding emergency room. Recognized by the American Academy of Emergency Medicine as having expertise in pediatric, trauma, neurological, and cardiac resuscitation. ATLS, ACLS, BLS, and PALS certified. ATLS course instructor. Completion of The Difficult Airway Course: Emergency™. Undergraduate Degree, Magna Cum Laude, in biomedical engineering. Licensed in Louisiana and Texas. Completed multiple SEAK expert witness training courses. Experienced flight physician. Skilled in utilization of video laryngoscopy for emergency airway management and in bedside ultrasound procedures.