Prior Authorization Expert Witnesses

Cambridge, Massachusetts

Artificial Intelligence, Health Informatics - Healthcare AI, Bad Faith Denials, Insurance Denials, HIPAA, Machine Learning, Prior Authorization, Agentic AI, Clinical Decision Support, FDA, RAG, LLM Hallucinations, Generative AI, Utilization Review, EEOC, AI Ethics, Algorithmic Bias, AI Governance, AI Fraud, Daubert, ChatGPT

AI expert witness with 15+ years building, deploying, and auditing 100+ production AI systems. Rare combination of practitioner, scholar, and researcher - the expert opposing counsel can't dismiss as "just an academic" or "just an engineer." Most AI experts fall into one category: academics who've never shipped production code, or engineers who can't write a defensible report. I've done both - built AI systems at Harvard Medical School, Apple, and federal agencies while publishing award-winning peer-reviewed research on AI ethics and large language models. This dual foundation creates opinions that survive Daubert challenges and cross-examination. Technical expertise spans multiple domains, including healthcare AI and insurance bad faith litigation, including prior authorization algorithms, utilization management systems, AI-driven claim denials, and clinical decision support failures. Deep experience with LLM hallucinations and defective outputs including GPT, Claude, and Llama fa...

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...

Houston, Texas

Pharmacist, Toxicology - Pharmacy, Retail, Clinical Pharmacist, Prior Authorization, Pharmacology, Overdose, Immunization, Vaccines, Medication Therapy Management, Medication Error, Dispensing Error, Standard of Care, Drug-Drug Interactions, Adverse Drug Events, Prescribing Error, Administration Error, High Risk Medications, Geriatrics/Peds Pharmacotherapy

I am a licensed Pharmacist (PharmD, RPh) with extensive experience across retail pharmacy operations, clinical review, and medication utilization management. I have experience in prior authorization and clinical review role, where I have evaluated medical necessity, guideline adherence, and regulatory compliance for a broad range of therapeutic classes. My professional background includes years of hands-on experience as a Staff Pharmacist and Pharmacist-in-Charge, overseeing prescription verification, medication safety, controlled substance management, immunization services, staff supervision, workflow optimization, and compliance with state and federal pharmacy regulations. This role required direct accountability for patient safety and documentation accuracy. I hold active pharmacist licensure and maintain certifications in immunization delivery, basic life support (BLS), and medication therapy management principles. My training includes clinical documentation review, prior auth...