Expert Witness for Future Medical Costs in Life Care Plans

Expert witness who rebut life care plans often work with, attorneys in personal injury, product liability, and medical malpractice cases.  Life care plans are prepared by life care planners but may not have an accurate basis for determining current and future charges for medical care.  Clients retain our services to opine on the cost of future care under the Patient Protection and Affordable Care Act (ACA).  Life Care plans are often prepared for those with serious injuries, which specify the cost of medical care estimated over the life time of the patient for treating injuries that may have been caused or alleged to have been caused in a medical malpractice case.  Recently our firm was retained to provide opinions regarding the future cost of life care plans under the Affordable Care Act.  It is key to demonstrate that the benefits are readily available and accessible with a reasonable degree of certainty in the market where the Plaintiff resides. We have applied approaches and methods that demonstrate both future costs under the ACA and market studies, researching the ACA qualified health plans and providers available to the Plaintiff in the market where they or their caregivers will be securing insurance.  The ACA specified “Essential Health Benefits” (EHB) and Minimum Essential Care (MEC) along with our expert witness testimony with reasonable degree of certainty on the readily available coverage are combined in our opinions.

Several factors must be evaluated in rebuttals of life care plans by an expert witness, including age, life expectancy, and potential eligibility for Medicaid Expansion in those states that elected to expand.  Different levels of care, out of pocket expenses and maximum out of pocket assumptions must be considered.  Some types of care are also treated differently under the Affordable Care Act. Disability and waivers may come into play.  Expert witness testimony must include in our opinion whether benefits are available from contracted providers whether HMO, PPO, or other type of ACA Qualified Health Plan.  At

As an expert witness in life care plans in personal injury cases, depending on whether past or future costs are a factor, we may ask for medical records and other data.   Life care plans or supplemental data from a different medical expert or life care planner expert may also be considered. The same holds true of expert witness work in this context for medical malpractice cases.

This proposed rule would update the Medicaid Eligibility Quality Control (MEQC) and Payment Error Rate Measurement (PERM) programs based on the changes to Medicaid and the Children’s Health Insurance Program (CHIP) eligibility under the Patient Protection and Affordable Care Act. This proposed rule would also implement various other improvements to the PERM program. Source: Federal Register / CMS

An expert witness may be required to opine regarding diagnostic imaging, evaluation and management (E&M) primary care doctor visits, and visits to specialists for pain management, orthopedic surgery, physical therapy, home health care, cardiology or other episodic or ongoing modalities of care.

An expert witness may also be needed to opine on regional variances in the cost of care.  The cost of medical care in San Francisco will likely be far higher than the cost of care for the same medical procedure in Akron Ohio.   To provide a valid market study, national rates compared to both charges and possibly net reimbursement may also be relevant in testimony and affect the expert witness opinion regarding the Affordable Care Act and regional medical costs.

Building on the foundation of the ACA, Meaningful Use of Electronic Health Records, and PQRS quality measures we have a new 900 page regulation which will again re-factor calculations for healthcare costs: the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  Expert witness work will, I predict require re-factoring to allow for MACRA and the Affordable Care Act in the future. More on this new regulation which was posted for public comment in May 2016 in future posts.

Michael Arrigo serves as an expert witness regarding the Affordable Care Act for personal injury, medical malpractice, and product liability cases.  He has given opinions in Superior, State, and Federal Court for cases in several venues across the U.S.  Contact us about Mr. Arrigo’s expert witness CV, case list, fee schedule and retainer agreement.

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Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.