Medical Billing Expert Witnesses in California
The SEAK Expert Witness Directory contains a comprehensive list of medical billing expert witnesses who testify, consult and provide litigation support on medical billing and related issues. Medical billing expert witnesses and consultants on this page may form expert opinions, draft expert witness reports, and provide expert witness testimony at deposition and trial. The issues and subjects these medical billing expert witnesses testify regarding may include: Medical Billing, Medical Coding, Benefit Administration, Benefit Application, Case Management, Disability Evaluation, Hospital Transfers, Medicaid, Medical Necessity, Nursing Assessment, Pain Management, Spinal Cord Injury, Traumatic Brain Injury, Abdominal Pain, and Accessibility.
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Medical Billing, HIPAA
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Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages
Summary of Qualifications
National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings.
Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling.
DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement.
Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT.
Areas of Expertise
Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act).
Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...
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Lance S. Loria, CPA, LFACHE, FAAMA
National Expert in Medicare Regulatory Matters
Loria Associates, LLC
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...
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Joe Carnes
Medical Billing Expert Witness
Medsurity Experts
Medical Billing, Medical Coding
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Usual customary reasonable charges, damages, fraud, Over-billing statistical analysis, Electronic health records, clinical documentation, insurance coverage determinations, provider, biller, insurance disputes
Two decades of Medical Billing expertise in multiple care settings. 24-hour turnaround on billing consultations. Thorough analysis and reporting.
Expert in analysis of contract rates compared to actual billed charges
Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act fraud
Usual Customary Reasonable (UCR), Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid,insurance, CRPS, EMTALA, HIPPA compliance
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Paul D Wagner, MD, FACP
Board Certified Internist, Medical Director, CMO
Paul D. Wagner MD Inc.
San Diego, California
Internal Medicine, Long Term Care
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Hypertension management, Failure to diagnose, Diabetes management, Cognitive impairment/dementia management, Preventive screening management, Hyperlipidemia management, Medical coding, eClinicalWorks Subject Matter Expert, Certified Medical Director, Medical billing, Primary Care
Board certified Internist for 30 years. Founder of San Diego Medical Group. eClinicalWorks subject matter expert for all aspects of primary care, documentation, billing and coding. Over 20 years of experience as Chief Medical Officer and Certified Medical Director at a Veterans Home of California overseeing the delivery of healthcare services for ambulatory and long term care resident veterans. Many years as a medical expert witness including records review, depositions, arbitration and court testimony.
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Douglas L Constant, MD
Pain Management- Medicine and IME
360 Orthopedics
California
Pain Management - Medicine, Independent Medical Examinations
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Pain Management, spinal cord stimulator, nerve injury, RSD, Reflex Sympathetic Dystrophy, radiofrequency ablation, injections, complex regional pain syndrome, CRPS, opioids, causalgia, nerve block, neuropathic pain, failed back syndrome, IME, medical billing, billing fraud, disability evaluation
Award Winning, Harvard Trained Pain Physician.
Active clinical practice.
Provided pain management treatment to WNBA players, the MLS, the Boston Red Sox and the Pittsburgh Pirates.
Castle Connolly Top Doctor, Pain Management, since 2015. Chosen by his peers and recognized as "Top Doctor" in the Sarasota area since 2017.
U.S. Naval Academy graduate. Former United States Marine Corps Officer with deployments to Sarajevo, Mogadishu, and Kuwait.
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Doreen R Casuto, RN, MRA, CRRN, CCM
Life Care Planning Expert with 40 years experience
Rehabilitation Care Coordination
San Diego, California
Life Care Planning, Medical Billing
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Rehabilitation Nursing, Nursing Assessment, Case Management, Benefit Administration, Special Needs Trust, Care Coordination, Spinal Cord Injury, Traumatic Brain Injury, Cerebral Palsy, Neuromuscular Disorders, Amputation, Accessibility, Medical Billing, Benefit Application
50 years of experience in rehabilitation nursing, providing patient care, education and coordination of services. 35 years as an independent case manager working with catastrophically injured. Evaluated patients, assisted physicians in planning and coordinating the rehabilitation needs of patients with spinal cord, brain injuries, stroke and neuromuscular illnesses. Prior to founding RCC she was the Director of Physical Rehabilitation Nursing at Grossmont Hospital in San Diego, Rehabilitation Nurse Coordinator at Methodist Hospital in Indianapolis and Rehab Nursing Workshop Coordinator at Ohio State University. Doreen is currently an Adjunct Professor with San Diego State’s School of Nursing as well as a former board member of the Brain Injury Association of California (BIACAL), the San Diego Brain Injury Foundation (SDBIF) and Jewish Family Services of San Diego.
In 1989, Doreen Casuto decided to start a small company with a unique goal. Doreen had recently left Grossmont Hospit...
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David Martinez, CPC, CMRS, CCA, CCS, CCE, CHP, CCO
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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Roberto Contreras II, MD, CLCP
California Life Care Planning Association
Seal Beach, California
Life Care Planning, Internal Medicine
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medical billing, life care planner, hospitalist, medical devices, medical management, medical coding, legal medicine, legal nurse consulting, nurse practitioner, obstetrics and gynecology, addiction medicine, family medicine, general practice, gynecology, consultative examinations
The California Life Care Planning Association was created by experts in the field of Life Care Planning, with more than 30 years of experience working in the health care industry. All of our professionals are Certified Life Care Planners, as well as active medical practitioners dedicated to assessing lifetime cost of care for individuals with catastrophic injuries/illness. What sets us apart from many other Life Care Planning organizations and individuals is that all of our Life Care Planners have active direct experience with patient care. We hold ourselves to a higher standard and hold all of our affiliates to that same higher standard. Whether it be plaintiff, defense , or any other client, our methodology is transparent and consistent.
Given the healthcare backgrounds of our founders, all Life Care Plans and services are overseen by a Physician. Similar to a hospital setting, many of our services go through "rounding" with senior partners and physicians to make sure we are keep...
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Thomas Peatman, MD
Orthopedic Surgeon and Expert Witness
California
Orthopedic Surgery, Sports Medicine
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Hip, Knee, Shoulder, Trauma, Spine Surgery & Spine Care, Orthopedics Non Surgical, Independent Medical Examinations, Causation, Disability evaluation, Impairment Evaluation, Medical Coding, Medical billing, Workers’ Compensation, Motor Vehicle Accident, Patents, MVA
Board-Certified orthopedic surgeon in clinical practice. Additional sub-specialty Certification in Sports Medicine.
Have performed over 8,000 joint replacements, hip, knee and shoulder arthroscopies and open surgeries. After developing a hand tremor, I now focus on the non-operative management of orthopedic disease and trauma.
Former Team Physician for the Oakland Athletics. United States Navy veteran.
I have been participating in expert witness work for 15+ years. I perform complex case reviews with or without an exam, as well as provide clarity to simpler incidents. I am timely and prioritize scheduling exams, depositions and court appearances. My reports provide compelling. I have given testimony in 12 trials.
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Erika Browning, BSN, RN, CCM, CLCP
Life Care Planning Expert
EB Medical Planning
Vista, California
Life Care Planning, Medical Billing
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Traumatic Brain Injury, Spinal Cord Injury, Multiple Trauma, Burn Injury, Pain Management, Chronic Illness, Chronic pain, Chronic Regional Pain Syndrome, Catastrophic Injury, Amputation Injury, Crush Injury, Life Care Plan Rebuttal, Life Care Plan
Erika Browning, BSN, RN, CCM, CLCP, is the founder and CEO of EB Medical Planning, a company that provides life care plans, life care plan rebuttals, medical record reviews, medical bill reviews, and future medical cost projections. Ms. Browning has been a Registered Nurse for 15 plus years. She graduated from Georgetown University with a Bachelor of Science in Nursing in 2011. She has extensive clinical experience in ER and ICU settings. Ms. Browning transitioned to nurse case management in 2018 where she manages, coordinates, and assesses the healthcare needs for catastrophically injured patients. She is a Certified Case Manager and a Certified Life Care Planner.
Ms. Browning has extensive experience with brain injuries, spinal cord injuries, burns, multiple trauma, orthopedic injuries, chronic pain, and amputations. She has deposition experience and has given presentations on life care planning to various organizations. She primarily works in California, but is available...
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Carol Moreali, RN, MSN
Inpatient and Post Hospital Care Management Expert
HealthTrack
Carmel, California
Nurse, Medical Management
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Inpatient and Post Hospital Care Coordination, Assessment of Inpatient Hospital Practices, Nurse Practice, Nursing Assessment, Medical Chart Documentation and Chart Review, Medical Billing, Benefit Administration, Benefit Application, and Medical Claim Review and Appeals
Ms Moreali has enjoyed 50 years of medical experience in Nursing providing patient care covering areas in critical care, case management, education and coordination of services, medical consulting, quality and regulatory management. Expertise in chart review/ analysis and documentation.
She also had over 40 years expertise in independent consulting, development of disease management programs, and with inpatient care coordination teams consisting of Hospitalists, RN, RN Case Manager, and Social Services. Working with large Integrated Healthcare Systems and singular hospital organizations.
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Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Newport Beach, California
Medical Billing, HIPAA
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Medical billing expert, Patents trade secrets, electronic medical records, Medicare fraud, medical billing fraud, qui tam false claims act, Meaningful Use Electronic Health Records, HITECH Act, Affordable Care Act, Medicare Advantage, Medicaid, insurance, EMTALA, HIPAA, rebut life care, Usual Customary Reasonable (UCR), damages
Summary of Qualifications
National healthcare expert witness with extensive federal and state court experience. Published author, speaker, and peer-reviewed authority featured in Westlaw federal court rulings.
Federal Precedent: Expert opinions considered by the U.S. Court of Appeals, resulting in a Vacated and Remanded ruling.
DOJ Retentions: Retained twice by the Department of Justice, contributing to a $155 million settlement.
Advanced Credentials: Specialized studies in HIPAA Privacy, Security, and Blockchain at MIT.
Areas of Expertise
Medical Billing, Coding & Reimbursement: Usual, Customary, and Reasonable (UCR) charges in personal injury and medical malpractice; Affordable Care Act (ACA) Life Care Plan rebuttals (future cost of care); trauma, workers' compensation, liens, balance billing, subrogation, and uninsured patient discounts (including California law/Knox-Keene Act).
Healthcare IT & Forensics: Technical Expert in healthcare IT patents and intellectual property; Elec...
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Brett Halloran, MD, SFHM
Hospitalist, Medical Billing, Medical Necessity
Napa, California
Hospitalist, Medical Billing
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Wernicke Encephalopathy, Stroke, Hospital Transfers, Heart attack, Falls, Delirium, Pulmonary embolism, Alcohol withdrawal, Hospital transfers, Pneumonia, Medication side effects, UTI, Renal failure, Medical Billing, Medical Necessity , Abdominal pain, Bed sores, C Diff, Sepsis
Nationally recognized and awarded for contributions to the field of hospital medicine. Extensive experience in medical necessity as a physician advisor.
Dr. Halloran is board certified in internal medicine and in active practice as a hospitalist in Northern California at a referral center hospital with high severity of illness. He listens to patients and specializes in complex, challenging cases. He also serves as regional medical director for utilization management.
Dr. Halloran is an expert in medical billing and medical necessity. He has served as UM medical director and physician advisor for a large regional health care entity. In that capacity, he has reviewed thousands of charts for medical necessity.
In addition to more than 15 years of clinical experience at the bedside as a hospitalist and many years as medical director, Dr. Halloran has 10+ years of experience as an expert. Dr Halloran has served as an expert in hundreds of cases, with particular expertise in commun...
You can also find Medical Billing Expert Witnesses in:
Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Indiana, Maryland, Massachusetts, Nevada, New Hampshire, New Mexico, Oregon, and Texas