Medical Billing Expert Witnesses in Texas
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, Medical Necessity, Medicare, Medicare Fraud, Pain Management, Revenue Cycle Management, Amputation, Brain Injury, Budgeting, Coding And Billing Operations, Collections Analysis, Disability Evaluation, Financial Analysis, and Health Insurance Coding.
View Full Profile
Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
View Full Profile
Lance S. Loria, CPA, LFACHE, FAAMA
National Expert in Medicare Regulatory Matters
Loria Associates, LLC
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...
View Full Profile
Joe Carnes
Medical Billing Expert Witness
Medsurity Experts
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
View Full Profile
Lance S. Loria, CPA, LFACHE, FAAMA
National Expert in Medicare Regulatory Matters
Loria Associates, LLC
Montgomery, Texas
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...
View Full Profile
Bernice Zander
Medical Billing Expert Witness
Abacus Analytics
Austin, Texas
Medical Coding, Medical Billing
-
UCR, Usual Customary Reasonable, Medical Billing Expert Witness, Medical Coding Expert Witness, Billing Expert Witness, Medical Coding Expert, Medical Billing Expert, AMA
BS, RHIT, CCS
View Full Profile
Richard F Lacy, MHA, CPC, FMC
Medical Coding and Reasonable Value Expert
Transparency Healthcare
Texas
Medical Billing, Medical Coding
-
Reasonable Value of Medical Services, Payment Disputes, Future Cost of Care, Managed Care, Reimbursement Rate Expert, Contract Rate Negotiations, Medical Claims Analysis, Cost Projections
I am the founder of Transparency Healthcare, LLC and serve as an independent medical billing and coding expert. I hold a Master of Health Care Administration (MHA) from Trinity University and a Bachelor’s degree in Psychology from Southern Methodist University. I am a Certified Professional Coder (CPC) through the American Academy of Professional Coders and a Certified Forensic Medical Coder through the Association of Forensic Medical Coders, and I maintain active involvement in multiple professional organizations related to medical billing, coding, and claims analysis.
Throughout my career, I have worked extensively with complex healthcare data, large claims datasets, and multiple healthcare information systems to support financial analysis, contract evaluation, and operational improvement. My expertise includes reimbursement methodologies, managed care contracting, utilization analysis, and medical coding compliance. As an expert consultant, I have prepared numerous reports addr...
View Full Profile
David Martinez, CPC, CMRS, CCA, CCS, CCE, CHP, CCO
Medical Billing & UCR Reimbursement Expert Witness
Accurate Billing Investigators, Inc.
McKinney, Texas
Medical Billing, Insurance
-
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...
View Full Profile
Misty Coffman, RN, MSCC, CNLCP
Nurse Life Care Plan Expert Witness - Experienced
National Life Care Planning Experts, LLC
Texas
Life Care Planning, Medical Billing
-
Life Care Plan, Life Care Planner, Nurse Expert, Nurse, LCP, TBI, Brain Injury, Amputation, Cerebral Palsy, Birth Injuries, Life Care Plans, Damage Assessments, Medical Bill Reviews, Medical Bill Review, Life Care Plan Rebuttal, Motor Vehicle Accidents, Medical Malpractice, Catastrophic Claims, Accidents, Injuries
Misty Coffman, RN, MSCC, CNLCP is a highly experienced Nurse Life Care Planning expert witness with nearly four decades of nursing practice and extensive deposition and trial experience. She brings exceptional credibility, leadership, and real-world clinical depth to complex personal injury, medical malpractice, and catastrophic injury cases.
She has been a Registered Nurse for 37 years and served as President of the American Association of Nurse Life Care Planners (AAANLCP) in 2024, following her tenure as an Executive Board Member from 2022–2024. Her national leadership role reflects peer-recognized expertise and a deep command of life care planning standards and methodology.
Her clinical and administrative background spans a broad range of healthcare settings, including orthopedic nursing, medical-surgical nursing, occupational health, long-term and skilled nursing care, medical billing, and healthcare compliance. She has held senior leadership roles such as Director of Nursing...
View Full Profile
James E Alexander, Jr., MD
Specializes in Medicare Qui Tam False Claims Cases
Healthcare Compliance Management, LLC
Fort Worth, Texas
Medical Billing, Medical Coding
-
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).
View Full Profile
Helen Spaustat, CPC, CMPA, CRC, CHC
Expert Witness Medical Billing, Coding, UCR Fees
BEST-MED CONSULTING, LLC
SAN ANTONIO, Texas
Medical Billing, Medical Coding
-
Pain Management, Orthopaedics, Anesthesia, UCR, Personal Injury, Chiropractic, Neurology, Fraud Waste Abuse, Unbundling, Fee Analysis, Physical Therapy, Radiology, Medical Record Auditing, Psychiatry, Up coding, Outpatient Hospital, Hospital Billing, Reasonable charges, Future Costs, Medical Billing Fraud
BEST-MED CONSULTING, LLC - Billing Expert Solutions of Texas. Highly Experienced Expert Witness 10 years –200 + cases. Multiple specialty expertise (Pain Management, Anesthesia, Physical Therapy, Chiropractic, Orthopedic, Radiology, Hospital) Trial and deposition experience. Certified Professional Coder and Medical Record Auditor 20+ Years. Healthcare Compliance experience for Health Plan and Large Health System. Experience in detecting Healthcare Fraud, Waste and Abuse former Special Investigation Unit Manager.
View Full Profile
Avian Tisdale, MD, MBA, Paralegal
Experienced Physician Executive and Paralegal
DHM Consulting
Richmond, Texas
Pain Management - Medicine, Fraud
-
Adoption, Arbitratilon, Mediation, Banking, Empolyment Law, Business Operations, Dispute Resolution, Document Examination, Failure Analysis, Health Informatics, HIPAA, Hospital Administration, Human Resources, Mangement, Medical Billing, Risk Management, Artificial Intelligence, Technology, School Safety, OSHA
Physician executive with over 20 years of clinical, administrative, and academic experience across hospitals, emergency departments, inpatient units, urgent care centers, and community health systems. Board-certified physician with deep expertise in medical staff management, quality improvement, and regulatory compliance. Dual-trained with a Paralegal certification and MBA in Finance, offering unique insight into how healthcare operations intersect with legal, financial, and risk domains.
Highly experienced in identifying deviations from clinical standards, assessing system-level failures, and providing objective, evidence-based opinions.
Independent, Licensed and Board Certified, Full-time Availability
AREAS OF EXPERTISE
Standards of Care
Emergency & Inpatient Pediatric Medicine
Hospital & Multi-Site System Administration
Medical Staff Credentialing & Supervision
Healthcare Compliance (HEDIS, NCQA, HRSA, FTCA)
HR Processes & Clinical Oversight
Value-Based Care & Quality Metrics
...
View Full Profile
Paul Saiz, MD, FAAOS, CIME
Spine surgery and coding expert
3 Crosses Orthopedic Spine
Texas
Spine Surgery & Spine Care, Medical Coding
-
Spine fusion, Spine tumors, Spine trauma, Laminectomy, Discectomy, Total disk replacement, Decompression, Dural tear, Pedicle screws, Independent medical examinations, IME, Causation, Medical coding, Medical billing, Medical necessity, Spinal abscess, Disability evaluation, Workers Comp, MVA
Board Certified in Orthopedic Surgery and Spine Surgery in active clinical practice. Fellowship trained in both spinal reconstructive surgery and musculoskeletal oncology and reconstruction. 20+ years clinical experience in spine surgery. Well-experienced public speaker. Special expertise in spinal care coding and medical necessity. New Mexico State Team Physician. Experienced expert witness, certified independent medical examiner, and medical necessity peer reviewer. Licensed in New Mexico, Texas and Arizona. Co-vice chair North American Spine Society Coding Committee.
View Full Profile
Mark S Sanders, MD FACS
Board Certified Orthopaedic Surgeon
Sanders Clinic for Orthopaedic Surgery and Sports Medicine
Houston, Texas
Orthopedic Surgery, Spine Surgery & Spine Care
-
Medical Billing, Hospital Billing, Pain Management, Wound Care, Physical Therapy, Rehabilitation, Surgical Site Infection, Foot and Ankle Specialist, ACL, Osteotomy, Rotator Cuff, Hand/Wrist, Operating Room Procedures, Musculoskeletal Expert, Bunion correction
Certified by the American Board of Orthopaedic Surgery, Dr. Sanders also holds a Subspecialty Certificate in Orthopaedic Sports Medicine. He is a Fellow of the American Academy of Orthopaedic Surgeons and the American College of Surgeons. Dr. Sanders began his private Orthopaedic surgery practice in Houston in 1986 and maintains an office at the River Oaks Medical Tower in the heart of Houston’s Galleria area. He is a member of the American Orthopaedic Society for Sports Medicine (AOSSM), the Arthroscopy Association of North America (AANA) and the American Orthopaedic Foot & Ankle Society (AOFAS). Dr. Sanders champions advances in Orthopedic Sports Medicine and the treatment of complex fractures, malalignment, and joint degeneration. His research findings on the benefits of knee bracing in off road motorcyclists were recently published in the American Journal of Sports Medicine.
During his 45-year career in orthopedics, he has performed thousands of arthroscopic surgeries on sever...
View Full Profile
Marisa Yermakova
Expert Medical Billing - Coding & Reasonableness
Medical Equation
Austin, Texas
Medical Billing
-
Revenue Cycle Management, Chargemaster Review, Collections Analysis, Medical Coding Review, Financial Analysis, Coding and Billing Operations, Budgeting, Insurance Billing, Phantom charges, Unbundling Charges, Claims Appeals, Payment Reconciliation
With more than 10 years of experience in healthcare reimbursement and revenue cycle analysis, I offer a specialized focus on benefit verification, claims appeals, payment reconciliation and trend analysis. My background includes in-depth research of payor policy stipulations, medical coding accuracy, and resolving discrepancies through direct communication with high-level insurance representatives.
I have led special projects to secure mass payments owed to providers, launched and optimized a practice management system for a multi-provider chiropractic group, and successfully advocated for countless beneficiaries denied medically necessary procedures. I am well-versed in state-specific billing laws and guidelines nationwide and bring a detail-oriented, compliance-driven approach to every case.
Available for depositions and trial testimony and willing to travel as needed. For a full CV or testimony list, please reach out directly.
View Full Profile
Rhonda R Guitreau
Medical Billing Specialist - 40+ years experience
Medical Reimbursement Specialists
DALLAS, Texas
Medical Billing, Medical Coding
-
Medical Bill Review, Reasonableness of Medical Bills, Forensic Bill Review, Medical Cost Analysis, Expert Witness for Deposition/Trial, UCR fee analysis, Medicare/Medicaid/Work Comp, Future Medical Expenses, Geographic Specific Provider market comparisons, Affidavits/Controverting affidavits
View Full Profile
Geoff Bretches
Expert Medical Billing - Coding & Reasonableness
Medical Equation
Austin, Texas
Medical Billing
-
Revenue Cycle Management, Chargemaster Review, Collections Analysis, Medical Coding Review, Financial Analysis, Organizational Design and Review, Coding and Billing Operations, Budgeting, Insurance billing, Phantom charges, Unbundling Charges
With more than 22 years of experience in healthcare financial management, I bring a well-rounded perspective to medical billing reviews, coding accuracy, reimbursement audits and reasonable value determinations. My career spans management roles in hospital finance and revenue cycle operations and executive level leadership in private radiology and laboratory data analysis
My approach blends deep expertise with a commitment to integrity and clarity — whether reviewing complex billing files or providing Section 18.001 controverting affidavits. I specialize in analyzing the reasonableness of charges, identifying discrepancies and delivering precise objective insights that withstand legal scrutiny. I am available for depositions and trial testimony and willing to travel as needed.
For more details, a full CV or a list of prior testimony, please reach out.
View Full Profile
Michael F Arrigo
Medical billing, fraud, HIPAA privacy, damages
No World Borders
Texas
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
Writer, speaker, published peer-reviewed works as an expert in the field recent Federal court rulings as a qualified expert published in Westlaw
• US COURT OF APPEALS considered expert opinions, VACATED AND REMANDED
• Two DOJ retentions, $155 million settlement
• Healthcare IT patents intellectual property Technical Expert, Medicare Damages Expert
• Medical coding medical billing, claims, usual customary and reasonable charges in personal injury and medical malpractice cases, Lifecare plan rebuttal under ACA on the future cost of care, trauma
• Electronic medical record forensics / electronic health record forensics, E.H.R, practice management IT, medical, prescription charges, workman's compensation, insurance fraud
• genetic testing, novel genetic sequencing, esoteric testing, laboratory testing
• HIPAA Privacy, Security, Blockchain special studies MIT
• Affordable Care Act, HITECH Act, electronic medical records, meaningful use, patents, and intellectual property in heal Healt...
View Full Profile
Dawn Espinoza, RN, MSN, CCM, CDMS, CNLCP, LNCC
Life Care Planner, Medical Billing
Dawn Espinoza Consulting, PLLC
Arlington, Texas
Life Care Planning, Medical Billing
-
Case Management, Medical Cost Projection, Vocational Expert, Employability Expert, Nursing, Personal Injury, Property Liability, Workers Compensation, Brain Injury, Back Injury, Burns, Assault Injury, Trip Fall Injuries, Motor Vehicle Accident Injury, Chronic Pain, Spinal Cord Injury, Amputation, Whiplash, Concussion
A licensed Registered Nurse with over 30 years of experience. I have provided care for and developed treatment plans for a multitude of patients, including those patients experiencing orthopedic conditions that require inpatient and outpatient rehabilitation, patients with burn injuries, patients with spinal cord injuries, patients who have experienced with amputations, patients with visual impairments, and patients with acquired brain injuries.
I trained as and began working as a medical and vocational case manager in 2006, becoming certified in 2007. As a case manager, I perform assessment, planning, implementation, coordination of care, monitoring, evaluation, and outcomes management in a variety of practice settings. My work as a case manager included medical billing audit, utilization review, as well as appeals and denials of hospital services which included medical and procedural coding, medical necessity, and cost review.
In 2011, I became a certified disability management ...
View Full Profile
Douglas L Constant, MD
Pain Management- Medicine and IME
360 Orthopedics
Texas
Pain Management - Medicine, Independent Medical Examinations
-
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.
View Full Profile
Megan Smith, DO, MBA
Medical Qui Tam False Claims Expert Witness
MAS Medical Consulting, LLC
Aledo, Texas
Medical Billing, Medical Coding
-
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.
View Full Profile
Nestor Bonilla
Healthcare Finance & UCR Billing Expert Witness
Eagle Pass, Texas
Medical Billing, Hospital Administration
-
Healthcare Finance, Medical Billing, Usual Customary and Reasonable Charges, Revenue Cycle Management, Medical Cost Evaluation, Expert Witness Reports, Billing Reasonableness, Fee Schedule Compairson, Expert Rebuttal Reports, Medical Economics, Medical Charge Validation, Provider Charge Analysis, Medical Cost Benchmarking
I am a healthcare finance professional with over 18 years of experience in hospital finance, revenue cycle operations, and medical billing analysis. I currently serve as the Chief Executive Officer of Maverick County Hospital District (MCHD) in Eagle Pass, Texas, where I previously held the position of Chief Financial Officer for 11 years.
In addition to my executive leadership roles, I have been retained as an expert witness in legal cases involving the reasonableness of medical billing charges. My work includes providing opinions on past medical expenses, authoring rebuttal reports to challenge unsupported methodologies, and offering deposition testimony. I base my evaluations on actual billed charges, widely accepted industry standards, and a comprehensive understanding of how providers establish pricing.
I hold an MBA in Healthcare Management from the University of Texas at Tyler and a BBA in General Business from Sul Ross State University. I also earned an AAS in Computer Inf...
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