Medical Billing Expert Witness & Expert Witness Services in Healthcare Regulations, Medical Billing, HIPAA, Fraud and Electronic Health Records
No World Borders delivers premier medical billing expert witness services and comprehensive expert witness testimony across healthcare data, regulations, and economics. As a leading healthcare expert witness, we provide analysis and court-ready opinions on medical billing, medical coding, electronic health records, HIPAA privacy and security, Medicare/Medicaid fraud, and more. Retained by the U.S. Department of Justice and affirmed by federal and state judges, our team supports complex litigation at both state and federal levels.
As your Medical Billing Expert Witness, the HIPAA Expert Witness, Electronic Health Record Forensic Expert Witness, and expert in Hospital Safety Processes (such as the National Patient Safety Goals by the Joint Commission) and Electronic Health Record forensic audits, we also cover Medicare Fraud, the Medicare Medicaid, and SCHIP Extension Act of 2007 (MMSEA Section 111 reporting) as part of the Medicare Secondary Payer Act (MSPA).
Expert witness in the Controlled Substances Act concerning opioid prescribing. Experience auditing pain management practices, opining on the impact on patients, opioid prescribing errors, and opioid damages.
Two federal judges and two state arbitrators and judges affirmed expert witness qualifications in medical coding and billing, Medicare Fraud, and damages calculations.
Expert witness in Affordable Care Act rebuttal of Life Care Plan charges and future costs of care.
Expert Witness Qualifications and Experience – Attorney References Available Upon Request
Find a qualified expert witness in healthcare data, regulations, and economics. Our firm is engaged in cases involving complex regulation and litigation at the State and Federal level concerning:
- U.S. Department of Justice – Retained by U.S. Attorney’s Office on Federal investigation into false claims, Qui Tam False Claims Act, U.S. Attorney recently announced an over $100 million settlement in favor of the U.S.
- U.S. Department of Justice – Retained by the U.S. Attorney’s Office in New York regarding Evaluation And Management (E&M) coding and billing in the Qui Tam False Claims Act case.
- Patent Infringement and intellectual property in healthcare IT solutions and software, processes, and devices
- Electronic Health Records, HITECH Act Certified Electronic Health Record Technology (CEHRT) Certification and Information Safeguards, Privacy and Security Standards for E.H.R.s
- Affordable Care Act (including the future cost of care in life care plans, disabilities, ACA-qualified health plans, essential health benefits, and minimum essential coverage)
- Employee Retirement Income Security Act of 1974 (ERISA) regarding Standards for employer Plan Sponsors, Third Party Administrators, and Administrative Services Only contracts
- False Claims Act – electronic health records false claims act cases, medical billing false claims act cases
- Criminal Fraud – medical billing and medical coding, loss calculations, rebuttal to government pre-sentencing reports, sentencing guidelines, changes in sentencing guidelines after the ACA
- ARRA HITECH Act (meaningful use of electronic health records audit defense).
- HIPAA expert witness privacy and security breaches, utilization of generally accepted Standards, industry custom and practice. Prior retention by defendants and plaintiffs
- Medicare Local Coverage Determinations (Medicare LCDs)
- Certification of Electronic Health Records and Certified Electronic Health Record Technology (CEHRT) standards
- Meaningful Use (now called promoting interoperability) Safeguards under the ARRA HITECH Act and the inter-relationship with HIPAA and the HIPAA Omnibus Rule of 2013
- Usual Customary and Reasonable charges in the community for medical billing – experience in providing usual, customary, and reasonable charges in States where there is a collateral source rule. Typically applicable in personal injury and medical malpractice litigation.
- Medical coding, medical claims processing, and medical billing or insurance billing – application of national standards, generally accepted principles and methods, guidelines and best practices to audit records, coding and resulting reimbursement
- Fair Market Value of physician and medical director compensation based on Stark II final rules and compensation surveys.
- Physician compensation for hospital employees is based on Relative Value Units (RVUs)
- Anti-kickback statute, where safe harbors may apply under the Affordable Care Act
- Medicaid expansion and persons with disabilities under the ADA – the impact of disabilities on the future cost of care
- Future costs of care in life care plans with respect to personal injury and medical malpractice litigation.
- Subrogation, insurance policies, contracting, medical coverage determinations, and medical policies
- Medicare Secondary Payer Act (MSP)
- Drug pricing expert witness, drug supply chain
- Out-of-network charges and payments to providers
- Out-of-network reimbursements to emergency medicine specialists, EMTALA
Mr. Arrigo, managing partner for the firm, served as an expert along with a team of PhDs in economics and computer science, clinical professionals, a premier litigation firm in New York, and a large publicly traded healthcare IT firm in a matter before the U.S. Federal Trade Commission and several State Attorneys General. He is retained by the U.S. Department of Justice in a False Claims Act investigation. He has presented before the FBI, U.S. HHS Office of Inspector General (OIG) and Assistant U.S. Attorney while retained by counsel for a defendant.
Mr. Arrigo’s expertise and testimony were instrumental in helping the FTC determine that the health care matter was of national economic importance. The matter involved anti-trust issues deemed by the FTC as a matter of national economic importance. The matter also entailed large complex healthcare IT implementations, access to clinical data and documentation, electronic healthcare records, diagnosis and procedure coding, ICD-10, and computer-assisted coding (CAC) for some of the largest hospital systems in America.
Mr. Arrigo supports attorneys in civil and criminal matters of reimbursement; forensic audits; provider & payor disputes; white collar crime, medical record & billing documentation; ICD & CPT coding for a variety of medical specialties including orthopedics, obstetrics and cardiology; compliance programs; business damages; personal injury; Medicare, Medicaid and Insurance fraud; OIG self disclosure; and antitrust. Mr. Arrigo manages a team of MD, RN, RHIA, CPC, CFE, ChFC, MHA, CCS, CCS-P, CPC, CHTS PW and CPA experts and integrates their views into a single expert report or testimony when needed, including over 30 years of experience in coding, fraud, waste, and abuse. Experienced in population health methods, including Risk Adjustment Factors (RAF) scores and Medicare Shared Savings Plan (ACOs). These principles and experience are rounded out by physicians with 40 years of experience who know disease management stratification, analytics, and bioinformatics. Mr. Arrigo brings in-depth experience supported by local, state and national data on reasonable and customary fees, practices and technologies.
- Worked with a leading litigation firm, clinicians, and a health IT firm for a landmark federal case
- Persuasive writer and speaker with experience giving oral and written testimony
- Quoted in the Wall Street Journal, a regular speaker, and published works as an expert in the field
- Advisor to value-based care organizations for the Medicare Shared Savings Program (MSSP) Accountable Care Organizations (ACOs) on value-based care
- Advisor to Medicare Advantage firms
- Opinion on over $1 billion in healthcare costs to date
- Diligence on over $4 billion in healthcare Merger & Acquisition transactions
- Advisor to investors and outsourcing firms serving Medicare Advantage health plans.
Additionally, Mr. Arrigo has led healthcare investor diligence for Merger and Acquisition transactions totaling over $4 billion.
Team Overview
The team has overseen complex electronic medical record implementations and is knowledgeable about clinical workflow and clinical notifications to primary care physicians and patients. Notification of critical findings (adverse findings) is a key area in legal work in medicine today. Failure to notify of critical findings is the leading reason for medical malpractice litigation in the U.S. today.
Mr. Arrigo and his team are experienced in all aspects of the Patient Protection and Affordable Care Act (PPACA), HITECH Act, ICD-10, and HIPAA Privacy and Security.
The team has experience in expert witness work related to:
- Anti-Trust and Competition Law in Healthcare
- Eligibility and coverage determinations for healthcare exchanges
- Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) section 111 reporting
- Workers compensation fraud expert witness
- Healthcare claims reimbursement
- Medicare Part C risk adjustment expert witness
- Medicare Advantage Risk adjustment expert witness
- The 3-day rule for inpatient (DRG) episodic care and claims
- Forensic audits
- Usual, customary, and reasonable (UCR) medical and prescription charges (42 CFR § 42 – Prospective Payment Systems for Inpatient Hospital Services)
- Expert witness MRI charges and costs
- Expert witness PET Scan charges and costs
- Meaningful Use Stage 1, Meaningful Use Stage 2
- HITECH Act Meaningful Use Audits expert witness
- HITECH Act Safeguards include Administrative Safeguards, Physical Safeguards, Technical Safeguards and Organizational Policies and Procedures
- ICD-10, ICD-9, CPT medical coding
- Electronic Health Records / Electronic Medical Records
- HIPAA Privacy and Security
- California Confidentiality of Medical Information Act (CMIA) expert witness
- URAC accreditation standards for Utilization Management and other processes in healthcare
- Third Party Liability (TPL)
- Genetic test billing expert witness
- Genetic privacy expert witness
- Genetic accuracy reporting, CLIA, HIPAA, and patient identification errors expert
- Computer-Assisted Coding expert witness
- Clinical documentation
- Clinical workflows, including failure to notify of stat / critical findings, and supporting CTRM systems
- Reasonable and customary fees for procedures (includes several medical specialties)
- Cost of Pain Management Under the Affordable Care Act in personal injury and medical malpractice damages
- Americans with Disabilities Act and Affordable Care Act for specific diagnoses, including Autism and other pervasive developmental disorders (PDDs)
- Americans with Disabilities Act and the Affordable Care Act with respect to respite care and Habilitative Care under the ACA
- Americans with Disabilities Act and workplace accommodations for workers with PDDs, such as Autism or other disabilities, such as Multiple Sclerosis
- Failure to notify regarding positive test results, biopsies, radiology studies, litigation/discovery
- Patient chart audits
- False Claims Act
- Prompt Payment Act (Texas)
- Medicare, Medicaid Insurance, and electronic claims
- RAC Audit Defense
- Pathology coding and billing expert witness
- Esoteric test coding and billing expert witness. Our team has expertise in these and other key regulations with respect to expert reports and expert testimony.
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Michael Arrigo expert witness. Contact Now to request CV, references, fee schedule and retainer agreement.
Expert in Federal State and Civil Courts regarding medical coding and medical billing, the Affordable Care Act, HIPAA, Healthcare costs in malpractice and personal injury, False Claims Act cases involving Medicare Advantage and Electronic Health Records and fraud. He has been widely quoted in the television, radio, print, and digital news media.
Michael Arrigo expert witness in Federal State and Civil Courts as a Technical Patent Expert in healthcare, Damages expert in patent litigation, Damages expert in health care fraud, Life Care Plan future costs under the Affordable Care Act, Medicaid Expansion and Medicaid Waivers, in malpractice and personal injury, False Claims Act, HITECH Act and Meaningful Use, HIPAA, Usual Customary and Reasonable charges for medical care, Risk Adjustment and values based care including MIPS and MACRA, and drug pricing and drug classification codes as they are used in pharmaceutical claims.
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