Medical Billing Expert Witnesses in Connecticut

Medical Billing, HIPAA - 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...

Medical Billing, Fraud - 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...

Medical Billing, Medical Coding - 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

New Britain, Connecticut

Medical Billing, Medical Coding - Medical Records Review, Provider Documentation, Medicaid/Medicare, State Regulations/Statutes, Federal Regulations/Statutes, Regulatory Compliance, Healthcare Fraud Investigation, Data Analysis, Data Mining, Payment Integrity, False Claims Act, Fraud Waste and Abuse, Provider Billing Verification

I provide expert witness services in healthcare billing, coding, and clinical documentation, supported by over 19 years of industry experience across provider, payer, and compliance environments. My work focuses on the evaluation of medical records, coding accuracy, documentation integrity, and regulatory compliance, including alignment with federal, state and commercial payer requirements. I hold a Master of Legal Studies in Health Law, which strengthens my ability to analyze healthcare documentation within legal and regulatory frameworks and to clearly articulate findings in both written reports and testimony. I maintain multiple nationally recognized certifications, including Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Documentation Expert Outpatient (CDEO), Certified in Healthcare Compliance (CHC), Certified Fraud Examiner (CFE), and Registered Health Information Administrator (RHIA). My expertise includes auditing evaluation an...

Somers, Connecticut

Medical Coding, Medical Billing - CPT codes, Bill & Coding, Compliance, Accounts Receivable Reduction, Bill Review, Personal Injury Bill Reduction, UCR pricing, Bill Analaysis

Beth Morgan, President & CEO, is a Certified Professional Coder (CPC) and Compliance Specialist (MCS-P) since 2004. Over the past 20 years she has worked in several areas of the medical profession doing billing and coding for all sorts of providers. Her knowledge and expertise has enabled her to not only reduce provider’s accounts receivables but medical bills by 51%. She has access to a broad base of insurance company policy information, and is an information contributor, to radio and TV shows as well as magazine articles. Medical Bill Detectives reviews medical bills for errors and overcharges, reducing them down to Usual Reasonable and Customary charges, for negotiating discounts on medical bills. We are able to review bills for all 50 states.