Programmer Analyzes Allegedly Fraudulent Billing Software

ByVictoria Negron


Updated on May 29, 2018

This case involves suspected accounting fraud by a large pharmaceutical company. It was alleged that the company in question was acting in violation of the False Claims Act by billing for mislabeled drugs which were outside of the scope of a government contract. An expert in billing software programming platforms was sought to explain the functionality of the programming in question.

Question(s) For Expert Witness

1. Please briefly describe your experience with pharmaceutical billing software and its programming.

2. Are you able to discuss the functionality of specific coding? Please explain.

Expert Witness Response E-076003

inline imageI have 22+ years in the healthcare and pharmaceutical market. I was responsible for all pricing at a pharmacy benefit management company for 17 years. In this capacity, I had to understand claim adjudication functionality on both the pay/retailer and bill/client side of the company's process. A pure programmer can easily read code but may not be able to interpret the output of the code as it relates to the business objectives and contract requirements. I can read branching logic, as well as address the other aspects of data output to ensure business objectives and contracts requirements are being met. In all claims adjudication, the programming needs to meet NCPDP and HIPPA standards, which I am familiar with.

About the author

Victoria Negron

Victoria Negron

Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.

Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.

Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.

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