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 Expert  723466

Expert in Physician CPT Coding, Billing and Chart Reviews, Overpayment, F&A and Qui Tam Rebuttal

Available for your Consulting and Expert Witness Needs

Maryland (MD)
Education Work History Career AccomplishmentsPublicationsConsulting Services Expert Witness

Summary of Expertise: Listed with other top experts in: 
He is an expert in health care billing - focusing on coding, charts audits, billing compliance and operations. His expertise will prove invaluable for Revenue Cycle Enhancement, create a Compliance Program and/or provide high ROI Litigation Support services, such as Insurance Overpayment Rebuttal, F&A Defense, Vol. Self-Disclosures, Billing Service Malfeasance Audits, Managed Care Reimbursement Challenges, Abstract records to create Service Invoice(Kaiser/Champus/etc.), Create Life Care Disability Plans and support other healthcare related reimbursement cases.

health care claims substantiation research


medical record


qui tam


false billing


Ideal Medical Practice


medical billing


Current Procedural Terminology


medical analysis


managed care


medical case review


medical record review


insurance claim audit


medicaid abuse


health care plan


medical coding




legal billing

Show Secondary and Basic Areas of Expertise
Expert may consult nationally and internationally, and is also local to the following cities: Baltimore, Maryland;  Frederick, Maryland;  Gaithersburg, Maryland;  Bowie, Maryland;  Wilmington, Delaware;  Lancaster, Pennsylvania;  and Alexandria, Virginia.

Often requested
with this expert:

Medical Coding, Subspecialty in Podiatry and DME for...
Medical Practice Consulting, Physician Contracting, Medical...
Laboratory Medicine, Pathology, CPT Coding
Healthcare, Medical Device, Diagnostics, Pharmaceuticals...

Year   Degree   Subject   Institution  
1986   BS   Health Planning & Administration   Pennsylvania State University  
1994   Certified Patient Account Representative (CPAR)   Patient Finance   Healthcare Financial Mgmt Assoc (HFMA)  
1997   Certified Professional Coder (CPC)   Physician CPT and ICD-9 Coding   Am. Academy Professional Coders (AAPC)  
  Certified Medical Practice Analyst (CMPA)   Physician Practice Analysis   Am. Academy of Medical Practice Analysts (AAMPA)  

Work History:
Years   Employer   Department   Title   Responsibilities

2001 to




Revenue and Compliance


Senior Advisor


Expert serves as HCA Senior Advisor for Revenue and Compliance Division and directs the Litigation Support Service projects they provide to Atty for cases involving billing audits, incurane overpayment demands and allegations relating to F&A or Qui Tam cases.

1998 to 2001







Expert formed EMphysys in Atlanta GA and provided compliance and litigation support services to physicians and Attys.

1992 to 1998


Healthcare Management Advisors, Inc


Physician Services


Senior Consultant


Expert started the Physician Services Div of this SE-based hospital consulting firm and grew the division to over $500K in billings in the first two years. Expert worked with large health systems on physician productivity and compliance issues.

1989 to 1992


DATAMED - Hughes Medical Billing



Asst Director of Operations


Expert serves as the Asst DO for a Billing Service in NE Ohio. Managed staff of over 15 and controlled billing for over 100 physicians.

Career Accomplishments:

Am. Academy of Professional Coders (AAPC); Health Care Compliance Association (HCCA); Medical Group Management Association (MGMA)


Certified Professional Coder (CPC); Certified Patient Accounts Representative (CPAR); Certified Medical Practice Analyst (CMPA)

Publications and Patents Summary

Expert is frequently cited in practice management, reimbursement and coding resources and lectures to trade associations.

Consulting Services:
Selected Consulting Examples:
  • Expert has successfully represented physicians facing extrapolated overpayment demands from Medicare, Aetna, Cigna, BC/BS and Kaiser Perm. Expert's rebuttal defense has resulted in reductions of overpayment demands by over 90%, as well as quashing the demand in its entirety.
  • Expert served as the lead billing investigator in the Governments PATH audit at the Med. Univ of South Carolina (MUSC) as part of a Qui Tam suit. MUSC was ordered to repay over $6M in fines and penalties.
  • Expert has successfully represented physicians seeking financial restitution from physician billing services for poor billing performance, collections malfeasance and other breach of contract issues.
  • For PI Attys that cannot obtain a medical invoice of service charges from Insurers/Providers like Kaiser Permanente or Tricare, Expert can abstract the patients medical records and create a Medical Service Invoice detailing the CPT codes and UCR Charge Data to be included in the damages.
Recent Client Requests:
  • Expert for consulting on Telehealth solution.
  • Expert for consulting on CPT.
  • Expert for consulting on CPT - Non-invasive Central Aortic Systolic BP.
  • Certified coder expert for consulting on Require Certified Coding for a Medicare Audit.
  • CPT billing expert for consulting on Advice on how to bill for unlisted CPT reimbursements.
  • Expert in medical coding compliance auditing services for consulting on chart reviews.
  • Expert for consulting on We need an in Pathology AMA CPT Coding.
  • Expert for consulting on Medicare Reimbursement.
Click the green button above to contact Expert for a free initial screening call regarding your expert consulting needs.  Expert is available for consulting to corporate, legal and government clients.  Remember, your initial screening call to speak with Expert is free.

Expert Witness:
Expert Witness Experience Summary:
1) Lead CPC coding consultant in support of PATH and Qui Tam Litigation Support for Wyche-Burgess Law Firm representation in U.S. ex rel. Abbott-Burdick, Gridley, Koonz and Salvo v. University Medical Associates and the Medical University of South Carolina (1998-2000). Performed statistical audit, depositions, never went to trial. Government recovered over $6 million in Medicare and Medicaid funds.

2) Testified in support of two separate physician practices seeking financial restitution from their contracted billing service for malfeasance, under-performance, financial hardship and breach of contract. Awarded over $1,000,000 based on detailed financial analysis of patient accounts.

3) Quashed a $150,000 overpayment demand and threatened panel termination of a solo specialist by a major HMO in Maryland due to alleged upcoding and documentation insufficiency. Physician remains on the HMO specialist panel.

4) Reduced a $350,000 overpayment demand by Medicare against a multi-physician cardiology practice by 90%, implemented a corporate compliance program and negotiated the physicians' removal from the Physician Audit List (PAL) within 6 months.

5) Represented and reduced a $1.5 million Qui Tam/FCA demand by Medicare against a local Neurological practice by over 90%, without the need for a Corporate Integrity Agreement.

Recent Litigation Client Requests:
  • Expert for consulting on CPT Codes.
  • Expert for consulting on reasonableness of medical bills.
  • CPT codes expert for consulting on reasonableness of medical expenses.
  • Expert for consulting on Insurance Lawsuit.
  • Expert in intota for consulting on Medical Coding and billing.
  • CPT coding expert for consulting on workers compensation fee review dispute.
  • Certified coding expert for consulting on medicare medicare investigation.
  • Expert in CPT billing needed for consulting to prove client has not defrauded the government with CPT billings.
  • Medicare billing expert for consulting on rebuttal of Qui Tam action.
  • Expert certified in CPT code for consulting on review of bills for medical care provided by a non-profit hospital and determining the cost of care for several patients.
  • Expert for consulting on Billing.
  • Expert for consulting on medical billing.
  • Expert for consulting on Review of billing to medical records for determination of excess billing.
  • Expert for consulting on Looking for an who can identify timely or late paid claims.
  • Medical billing expert for consulting on medical billing fraud abuse double billing litigation case.
  • Expert in for billing codes related to pacemakers.
  • Expert in kaiser permanente billing for consulting on Kaiser Permanente treatment.
  • Cpt coding expert for consulting on CPT billing.
  • Podiatry coding expert for consulting on ZPIC Audit Chart Review.
  • CPT expert for consulting on CPT medical billing.
  • Medicaid Billing Fraud expert to review medical records.
  • Expert for consulting on permissable reuse of catheters in a hospital setting and pricing of new versus reused catheters.
  • Cpt expert for consulting on CPT Medical Procedure Codes.
  • Expert in expert witness in speech pathology.
Click the green button above to contact Expert for a free initial screening call regarding expert testimony, litigation consulting and support, forensic services, or any related expert witness services.  A few litigation needs include product liability, personal injury, economic loss, intellectual property (patent, trademark, trade secret, copyright), and insurance matters.  Remember, your initial screening call to speak with Expert is free.


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