Medicare Expert Witnesses
Medicare 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 medicare. The medicare expert witness listings on this page are typically from fields/areas of expertise such as: Family Medicine, Fraud, Geriatric Psychiatry, Geriatrics, Health Informatics, Insurance, Long Term Care, Marketing, Medical Billing, Medical Coding, Nursing Home Administration, Nursing Homes, Ophthalmology, Pharmaceutical Regulation, and Preventive Medicine.
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Elliott M. Stein, MD
Geriatric Psychiatrist - Estates/UI, NH/ALF Cases
Mill Valley, California
Psychiatry, Geriatric Psychiatry
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Contested wills and trusts, Testamentary capacity, Undue Influence, Geriatric Psychiatry, Elders & Elderly, Dementia, Alzheimer's Disease, Nursing Homes, Assisted Living, Medicare, Geriatric decision making capacity competency, Medical Documentation and Coding, Depression, Anxiety, Stress, Psychosis
Providing legal and forensic consultation on legal issues pertaining to the elderly and their mental, emotional, behavioral and cognitive functioning, including contested inheritance, undue influence and financial elder abuse, and dementia and related issues in nursing homes, memory care and assisted living facilities.
Clinical Professor (Voluntary), Psychiatry, University of California San Francisco;
Psychiatric Consultant, San Francisco Towers life care community 2021- Present.
Consultant in Geriatric Psychiatry, San Francisco Veterans Administration Medical Center 2021 - 2023.
Previously, Director of Psychiatry, Jewish Home of San Francisco, 2010 – 2020.
Previously in private practice of Adult and Geriatric Psychiatry, 1977 – 2010, in Miami and Miami Beach, Florida.
Board Certified, Geriatric Psychiatry and General Psychiatry, by the American Board of Psychiatry and Neurology.
Distinguished Life Fellow, American Psychiatric Association.
Distinguished Fellow, American A...
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John J Hosier
Biotechnology & Pharmaceutical Marketing and Sales
John Hosier Healthcare Consulting, LLC
California
Marketing, Pharmaceutical Regulation
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Bio-similar drugs, Biotech & Pharma Marketing, Operations, Branded Promotion, CNS Products, Medicare, Oncology Products, Pharma Commercialization, Pharmaceutical Contracting & Pricing, Pharmaceutical Launch, Pharma Marketing, Pharma Sales, Specialty Pharma, DTC, Commercially Reasonable Efforts, CRE
Mr. Hosier is a strategic advisor to the life sciences industry drawing on nearly 30 years of sales, marketing and managed markets experience in commercial healthcare organizations. He has provided insights to small molecule & biotechnology companies across multiple therapeutic areas but has maintained a heavy concentration in oncology and specialty pharmaceuticals. He has led brand launch; corporate, franchise, and strategic brand planning; commercial integration; organizational design; and operational effectiveness from multiple perspectives (as the client, as the independent consultant, and as an agency lead). Mr. Hosier’s firm has architected the launch of rare disease and oncology business units for multiple pharmaceutical clients (large and small); led development of the managed markets, trade, and distribution strategy for the launch of new chemical entities (NCEs) and 505(b)2 assets for various organizations; advised on commercially reasonable effort (CRE); and provided c...
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Tiana Thompson, NHA, MBA
Experienced Nursing Home Administrator Expert
Expert Consulting Services
Montclair, California
Nursing Home Administration, Long Term Care
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Wound Care, Nutrition, Abuse, Medicare Compliance, Behavioral Health, Infection Control, Health Services Management, Elder Care, Neglect, Memory Care, Dementia/Alzheimer's, Regulatory Compliance, Nursing Home Finance, Quality Assurance, Subacute Care, Medicare
A dynamic healthcare executive with a rich background in senior living, skilled nursing, and behavioral health management, Tiana Thompson brings substantial expertise in operations, compliance, and turnaround strategies for healthcare facilities. As VP of Operations for “We Care” Psychology Affiliates and a seasoned healthcare consultant, she manages multi-state behavioral health practices and provides expert witness services in nursing home litigation. Her leadership in skilled nursing and assisted living facilities has consistently resulted in improved star ratings, regulatory compliance, and financial health. Known for her strategic approach, Tiana excels in staff development, budgeting, and fostering positive work environments.
Case Work Includes:
Skilled Nursing and Assisted Living Operations
Behavioral Health Program Management for Senior Living
Expert Witness in Nursing Home and Assisted Living Litigation
Regulatory Compliance (Medicare, Medicaid, CMS, OBRA, OSHA)
Financial ...
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David Martinez
Medical Billing & UCR Reimbursement Expert Witness
Accurate Billing Investigators, Inc.
California
Medical Billing, Insurance
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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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Karl E. Steinberg, MD, CMD, HMDC, HEC-C
Geriatrics, Nursing Homes, Hospice/Palliative
Stone Mountain Medical Associates, Inc.
Oceanside, California
Geriatrics, Nursing Homes
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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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Robert D. Zitsman, LNHA, MBA, NHA
Experienced Nursing Home Administrator
Expert Consulting Services
San Diego, California
Nursing Home Administration, Long Term Care
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Wound Care, staffing analysis, nursing home, malpractice, Healthcare administration, Skilled Nursing Facility Management, CMS Survey Compliance, Patient Care Quality Improvement, Post-Acute Care Services, Dementia, Regulatory Compliance, Medicare, Healthcare Leadership, Nursing Home Expert
Robert D. Zitsman, LNHA, MBA, NHA, has over thirty-five years of experience in healthcare administration, focusing on promoting excellent, evidence-based patient care outcomes and creating positive experiences for patients, residents, families, and staff. His extensive career spans the continuum of care from critical care to long-term care, including inpatient acute rehab, post-acute rehab, dementia care, assisted living, and entry fee model continuing care retirement communities (CCRCs). Robert has consistently maintained substantial compliance with CMS surveys for over twenty years.
Currently, Robert serves as the Administrator at Community Memorial Hospital-Ojai’s Continuing Care Center, a 75-bed skilled nursing facility. He has held numerous leadership positions, including Interim Administrator at Community Hospital of the Monterey Peninsula and Administrator at Escondido Post Acute Rehab, overseeing operations at facilities with up to 180 beds. His role at Life Care Services a...
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L. Neal Freeman, MD, MBA, CCS-P, CPMA
Physician/Surgeon + Medical Coding/Auditing Expert
Coding and Physician Reimbursement Analysts, Inc.
Melbourne, Florida
Medical Coding, Ophthalmology
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Surgeon, Coder, Auditor, Fair and Reasonable Value, Medical Coding, Physician Coding, Ophthalmology Coding, Optometry Coding, Reimbursement, Eye Care, Coding, Medicare, Healthcare Fraud, Audits, False Claims Act, National Correct Coding Initiative, Bundling
ABOUT:
Highly experienced expert witness with 100+ cases in medical coding, reimbursement, and compliance across the entire medical spectrum, providing services for both plaintiff and defense. Board-certified practicing physician and surgeon, Certified Coding Specialist (Physician-based), and Certified Professional Medical Auditor.
Awarded graduate of Cornell University’s College of Engineering (B.S.) and the University of Michigan Medical School (M.D.), with postgraduate specialty training at Johns Hopkins Hospital and the University of California, San Francisco. Master-level graduate (M.B.A.) of the University of Central Florida, College of Business Administration.
Chairman of the Ophthalmology Section at Holmes Regional Medical Center in Melbourne, Florida. Assistant professor at the University of Central Florida, College of Medicine.
Extensive committee involvement, including American Medical Association’s CPT Advisory Committee and the Florida Medicare Carrier Advisory Com...
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Marsha S Diamond, CPC, COC, CCS, CPMA
Medical Auditing, Billing, and Coding Expert
Orlando, Florida
Medical Billing, Medical Coding
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CPC, CPMA, COC, CCS, medical coding, medical billing, medical auditing, Qui tam, AAPC, CIA, IRO, Medicare, Inspector General, Medical, UCR, Usual Customary and Reasonable, Electronic Medical Records, EMR, Compliance
Ms. Diamond is an experienced coding, billing, and auditing professional who is available for consultation in medical practice auditing, billing, coding, compliance, litigation, reimbursement, and revenue cycle issues when requested by medical providers, their management, or their legal counsel.
She is a Certified Professional Coder (CPC) and Certified Outpatient Coder (COC) by the American Association of Professional Coders (AAPC), with her initial certifications over 30 years ago. She has served as a member of the AAPC National Advisory Board, has been a Fellow of the AAPC, and has served as President of the Greater Orlando Chapter of AAPC. She is a Certified Professional Medical Auditor (CPMA) by the AAPC. For 18 years, she led billing and coding for a university multi-specialty medical practice of over 400 physicians. She has 20 years of experience as a medical auditor with a company that provided medical auditing services for medical practices, hospitals, and commercial me...
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Cassandre Voltaire
Physician & Wound Care Expert Witness
WoundFit LLC
Lexington, Massachusetts
Wound Care, Urgent Care Medicine
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Wound Care, Pressure Injury Prevention, Pressure Ulcer Management, Nursing Standard of Care, Skilled Nursing Facility, Long-Term Care, Hospital-Acquired Pressure Ulcers, Diabetic Foot Ulcer Care, Medicare, Amputation Prevention, Debridement Standard of Care, Home Health Wound Care
Cassandre Voltaire, DO,ABWMS is a board-certified family medicine physician and certified wound care specialist with over six years of clinical experience managing complex wounds in skilled nursing, long-term care, and outpatient settings. Dr. Voltaire has a proven track record in preventing, identifying, and treating pressure injuries, diabetic foot ulcers, venous leg ulcers, and other chronic wounds.
In addition to direct patient care, she has extensive experience in medical chart review, utilization management, and applying standards of care to evaluate the quality and appropriateness of clinical decisions. This background gives her a precise, evidence-based approach to identifying lapses in wound prevention, documentation, and treatment-making her a valuable resource in pressure ulcer and wound care litigation.
Dr. Voltaire offers expert opinions on nursing and physician roles in wound care, standards of care in acute, post-acute, and home health settings, and the preventabili...
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John J Hosier
Biotechnology & Pharmaceutical Marketing and Sales
John Hosier Healthcare Consulting, LLC
West New York, New Jersey
Marketing, Pharmaceutical Regulation
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Bio-similar drugs, Biotech & Pharma Marketing, Operations, Branded Promotion, CNS Products, Medicare, Oncology Products, Pharma Commercialization, Pharmaceutical Contracting & Pricing, Pharmaceutical Launch, Pharma Marketing, Pharma Sales, Specialty Pharma, DTC, Commercially Reasonable Efforts, CRE
Mr. Hosier is a strategic advisor to the life sciences industry drawing on nearly 30 years of sales, marketing and managed markets experience in commercial healthcare organizations. He has provided insights to small molecule & biotechnology companies across multiple therapeutic areas but has maintained a heavy concentration in oncology and specialty pharmaceuticals. He has led brand launch; corporate, franchise, and strategic brand planning; commercial integration; organizational design; and operational effectiveness from multiple perspectives (as the client, as the independent consultant, and as an agency lead). Mr. Hosier’s firm has architected the launch of rare disease and oncology business units for multiple pharmaceutical clients (large and small); led development of the managed markets, trade, and distribution strategy for the launch of new chemical entities (NCEs) and 505(b)2 assets for various organizations; advised on commercially reasonable effort (CRE); and provided c...
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John J Hosier
Biotechnology & Pharmaceutical Marketing and Sales
John Hosier Healthcare Consulting, LLC
New York
Marketing, Pharmaceutical Regulation
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Bio-similar drugs, Biotech & Pharma Marketing, Operations, Branded Promotion, CNS Products, Medicare, Oncology Products, Pharma Commercialization, Pharmaceutical Contracting & Pricing, Pharmaceutical Launch, Pharma Marketing, Pharma Sales, Specialty Pharma, DTC, Commercially Reasonable Efforts, CRE
Mr. Hosier is a strategic advisor to the life sciences industry drawing on nearly 30 years of sales, marketing and managed markets experience in commercial healthcare organizations. He has provided insights to small molecule & biotechnology companies across multiple therapeutic areas but has maintained a heavy concentration in oncology and specialty pharmaceuticals. He has led brand launch; corporate, franchise, and strategic brand planning; commercial integration; organizational design; and operational effectiveness from multiple perspectives (as the client, as the independent consultant, and as an agency lead). Mr. Hosier’s firm has architected the launch of rare disease and oncology business units for multiple pharmaceutical clients (large and small); led development of the managed markets, trade, and distribution strategy for the launch of new chemical entities (NCEs) and 505(b)2 assets for various organizations; advised on commercially reasonable effort (CRE); and provided c...
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John J Hosier
Biotechnology & Pharmaceutical Marketing and Sales
John Hosier Healthcare Consulting, LLC
Pennsylvania
Marketing, Pharmaceutical Regulation
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Bio-similar drugs, Biotech & Pharma Marketing, Operations, Branded Promotion, CNS Products, Medicare, Oncology Products, Pharma Commercialization, Pharmaceutical Contracting & Pricing, Pharmaceutical Launch, Pharma Marketing, Pharma Sales, Specialty Pharma, DTC, Commercially Reasonable Efforts, CRE
Mr. Hosier is a strategic advisor to the life sciences industry drawing on nearly 30 years of sales, marketing and managed markets experience in commercial healthcare organizations. He has provided insights to small molecule & biotechnology companies across multiple therapeutic areas but has maintained a heavy concentration in oncology and specialty pharmaceuticals. He has led brand launch; corporate, franchise, and strategic brand planning; commercial integration; organizational design; and operational effectiveness from multiple perspectives (as the client, as the independent consultant, and as an agency lead). Mr. Hosier’s firm has architected the launch of rare disease and oncology business units for multiple pharmaceutical clients (large and small); led development of the managed markets, trade, and distribution strategy for the launch of new chemical entities (NCEs) and 505(b)2 assets for various organizations; advised on commercially reasonable effort (CRE); and provided c...
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David Martinez
Medical Billing & UCR Reimbursement Expert Witness
Accurate Billing Investigators, Inc.
McKinney, Texas
Medical Billing, Insurance
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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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Sandra Guerra, MD, MPH
Exec Doctor: Public Health, Insurance & Medicine
San Antonio, Texas
Preventive Medicine, Family Medicine
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Health Insurance, Utilization Management, Government Contracts, Quality, Outbreak, Communicable Diseases, TRICARE, Medicare, Medicaid, HIV, LGBT care, Migrant Care, Non-profit or indigent care, Correctional facility care, Denial/Appeals, Academic health, Population health, Tuberculosis, Non-Profit
Executive Physician and former Chief Medical Officer with extensive leadership experience across public health, health insurance, complex health systems, government agencies, and nonprofit organizations. Brings deep clinical, administrative, and policy expertise to cases involving population health, disease prevention, standards of care, health plan operations, and organizational oversight.
Areas of Expertise
Public Health • Preventive Medicine • Family Medicine • Population Health • Health Insurance and Health Plan Operations • Clinical Oversight and Standards of Care • Utilization Management, Denials, Case and Disease Management • Outbreak and Contamination Response • Disaster Health • Clinical Quality Improvement and HEDIS Attainment • Accreditation and Certification • Clinical Safety • Provider Network Credentialing • Social Determinants of Health • Health Equity • Government Health Programs (Federal, State, Local) • Clinical Analytics, Metrics, AI and Predictive Analytics • Pub...
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Megan Smith, DO, MBA
Medical Qui Tam False Claims Expert Witness
MAS Medical Consulting, LLC
Aledo, Texas
Medical Billing, Medical Coding
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Qui Tam, Health Insurance Fraud, Medical Necessity, Medicare Fraud, Medicare LCDs, Medicare, Commercial Insurance, Medicare NCDs, Medical Coding, Medicare Billing, Upcoding, Health Insurance Coding, Medicare Abuse, Commercial Insurance Fraud, Medical Policy
Dr. Smith is board certified in internal medicine with experience as a medical director in determining the medical necessity of procedures, post-acute care, admissions and billing & coding questions. Additionally, she has experience in serving as a consultant for pharmaceutical marketing research questions. She is licensed by the State of Texas Medical Board.
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James E Alexander, Jr., MD
Specializes in Medicare Qui Tam False Claims Cases
Healthcare Compliance Management, LLC
Fort Worth, Texas
Medical Billing, Medical Coding
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Qui Tam, Health Insurance Fraud, Health Insurance Abuse, Medicare, Medicare Fraud, Medicare Abuse, Medical Policy, Medical Necessity in Medicare, Medicare LCDs, Medicare NCDs, Medicare Coding, Medicare Billing, Health Insurance Coding, Upcoding, Medical Devices, New Medical Technology
Completed SEAK Expert Witness Training. Experience working on 4 large qui tam cases. Retired Captain (O-6) United States Navy. Board Certified General Surgeon. Partner in Healthcare Compliance Management, LLC, a consulting firm incorporated in Texas. Dr. Alexander and his partners established HCM in early 2002 and since that time he has been involved in numerous healthcare compliance consulting projects for major pharmaceutical and medical device manufacturers, large and small hospitals, cancer centers, large and small physician groups, other consulting entities as a special consultant, and legal firms (both as a consultant and as an expert witness).
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Carol E Schultz
Health Actuary
White
Austin, Texas
Insurance, Health Informatics
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Actuary, Actuarial, Health Insurance, Medicare, Finance, Medigap, Medicare Advantage, Medicare Supplement
I am a health actuary with over 20 years of experience. I am a Fellow of the Society of Actuaries (FSA), and a member of the American Academy of Actuaries (MAAA). Most of my work experience is related to Medicare, but I know the general health insurance industry and can work on a variety of insurance-related topics. I am an excellent public speaker and writer. I can easily translate the complex topics of my work to a non-technical audience and have an approachable countenance. I worked for three major health insurance carriers for a total of 18 years before launching my own consultancy to work on a variety of health-related projects in 2024. I greatly enjoy the variety of projects I am exposed to as a consultant. I look forward to serving as an expert witness, as it will give me the opportunity to explore even more health insurance topics, and lend my expertise in legal cases. I am good at explaining technical concepts in reports, talking about the concepts of my work to peo...
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Lance S. Loria, CPA, LFACHE, FAAMA
National Expert in Medicare Regulatory Matters
Loria Associates, LLC
Montgomery, Texas
Medical Billing, Fraud
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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...
