Physician Advisor Expert Witnesses

Parker, Colorado

Pediatric Critical Care Medicine, Pediatrics - Bioethics, Patient advocate, Parental rights, Physician Advisor, Medical Ethics

Monique Robles MD, MS, is a board-certified physician, specializing in both pediatrics and pediatric critical care medicine. She received her Doctorate of Medicine from the University of Texas Southwestern Medical School, Dallas, Texas. She completed a pediatric residency, chief residency, and pediatric critical care fellowship at Children’s Medical Center, Dallas, Texas (2001-2008). Dr. Robles has served in many pediatric centers throughout the country, providing medical, surgical, cardiac, and trauma care. Dr. Robles received a Certificate in Health Care Ethics from the National Catholic Bioethics Center and completed a Master of Science degree in Bioethics in 2018 at the University of Mary, Bismarck, North Dakota. She is an unwavering advocate for the dignity of the patient. Dr. Robles is available for case reviews, consultations, and expert testimony.

Roseville, Minnesota

Hospitalist, Medical Coding - clinical validation, DRG validation, inpatient versus observation, hospital reimbursement, physician advisor, CDI, diagnosis denial, documentation adequacy, utilization management, auditor denials, AKI, malnutrition, acute respiratory failure, encephalopathy, sepsis, CDI query compliance, level of care, DRG reassignment

Matthew K. Turner, MD, CCDS is a board-certified internal medicine physician, actively practicing hospitalist, and physician advisor who serves as system medical director for clinical documentation integrity (CDI) in a large integrated health system. His work centers on clinical validation, DRG validation, documentation adequacy, level-of-care determinations, and payer or auditor disputes involving hospital reimbursement. Since 2020, Dr. Turner’s work has included both CDI and utilization management physician-level review. In his CDI leadership roles, he has performed more than 500 physician-level clinical validation reviews involving provider-disputed queries, escalations, and prospective query appropriateness consultations; reviewed more than 100 auditor-initiated diagnosis denials since 2022 in which denial of a specific diagnosis typically resulted in DRG reassignment and reduced reimbursement; and prepared written clinical justifications and participated in peer-to-peer discus...

Webster Groves, Missouri

Hospital Administration, Family Medicine - Physician Advisor, Expert Witness, Medical-Legal Consultant, Standard of Care Analysis, Medical Necessity, Utilization Review (UR), Denial Management, Peer Review, Clinical Documentation Integrity (CDI), Medicare Two-Midnight Rule, CMS Regulations, Inpatient status, Urgent Care, Telemedicine, Observation Unit

I am Dr. Alexander Kim, DO, MBA, FAAFP, CHCQM-PHYADV, ACPA-C , a dually board-certified physician in Family Medicine (ABFM and AOBFP) dedicated to providing objective, evidence-based analysis for complex medical-legal cases. My expertise is built upon extensive experience in clinical practice, healthcare operations, and utilization management, making me a valuable resource for attorneys. I hold specialized credentials, including certification in Healthcare Quality and Management (CHCQM-PHYADV) and Certified Expertise in Physician Advising, Utilization Review (UR), and Clinical Documentation Integrity (ACPA-C) , which inform my deep understanding of Medical Necessity and Regulatory Compliance. Specifically, I evaluate cases involving Inpatient vs. Observation Status, Admission/Discharge Criteria, the application of InterQual/Milliman standards , and adherence to CMS Regulations, including the Medicare Two-Midnight Rule. My background encompasses serving as a Physician Advisor to majo...

Buffalo, New York

Hospitalist, Internal Medicine - Perioperative Medicine, Stroke, Seizure, Sepsis, Physician Advisor, Pneumonia, COPD, Asthma, Shock, Respiratory Failure, Renal Failure, Congestive Heart Failure, Acute Coronary Syndrome, Atrial fibrillation, Pulmonary Embolism, DVT, Liver Failure, Electrolyte-Acid-Base abnormality, GI Bleed, Spinal Cord Injury

Award winning Board Certified Internal Medicine Hospitalist Physician, Associate Chief Medical Officer (Hospital Administration) at a Level 1 Trauma Academic Medical Center. Extensive leadership experience as the Director of 45 FTE Hospitalist Group and the Associate Chief of Internal Medicine. Director of Physician Advisor program, perform utilization review, medical necessity determination, denial appeals, well versed with MCG and Interqual criteria. Hospital Administration pertaining to quality reviews, mortality reviews, policy reviews, credentialing and performance review of medical dental staff. President Elect of Medical Dental Staff. Committee Involvement: Medical Executive Committee, Credentialing Committee, P&T (Pharmacy & Therapeutics) Committee, Utilization Review Committee, Patient Safety Indicator (PSI QAPI) Committee, Quality Steering Committee, Leadership Council, Chiefs of Service. Graduated with Prelim General Surgery Residency at Saint Joseph Mercy Oakland Ho...