Expert Qualifications

This board certified physician is currently an active consultant in medical billing compliance, device and drug marketing, and claims data analysis. He has recently been involved as consultant and expert witness in Medicare criminal and civil litigation, Qui Tam cases and administrative hearings. The expert recently served as a Medical Consultant for ICD-10 transition, coding, and policy at PricewaterhouseCoopers; he now runs his own consulting business and assists clients with all areas of Medicare coverage and billing.

Bio Snapshot

  • Location: IL
  • This expert is engaged in consulting for clients requiring expertise in medical policy, claims data analysis, claims coding and claims processing edits, Medicare audits, and clinical trials compliance. He is currently serving clients seeking coverage and payment from third party payers including medical device manufacturers and pharmaceutical companies, and companies facing Medicare audits.
  • He has served as expert witness and consultant to the US Department of Justice for Medicare fraud cases as well as for attorneys involved in Medicare related litigation. He formerly served as Contract Medical Director for the Medicare Recovery Auditor for Region A in the northeast United States. Prior to that role, he was the Medical Director for the Medicare RAC Validation Contractor. He was formerly the Lead Medical Director for National Government Services (NGS), one of the nation's largest Medicare administrative contractors (MAC). At NGS he had responsibilities for oversight of all medical policy activities for Medicare Parts A and B in all states in NGS's jurisdictions. He has been an AHIMA certified ICD-10 trainer since 2011.
  • He attended the University of Illinois, Abraham Lincoln School of Medicine in Chicago and completed residency training in psychiatry at the University of Illinois Hospitals. He practiced psychiatry for 12 years before joining Medicare in April 1994.

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This expert has over 10 years of experience in risk management and regulatory compliance in the financial services industry, with a focus on identifying compliance issues and implementing solutions to mitigate risk. In his work with ...

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