Project Description

Medical Billing Expert

for False Claims Act Suit

The need

Attorneys representing the whistleblower in a False Claims Act suit against a large medical service provider needed an expert on medical billing for separately billable drugs to prove their case. The suit alleged that the defendant improperly billed Medicare for many millions of dollars in excess drugs. It was alleged that the defendant made excessive claims about their ability to capture and utilize 100% of the overfill of drugs used for a common medical procedure. Allegedly, the defendant then billed Medicare for utilized overfill. As such, the ideal expert would need to have deep knowledge of separately billable drugs as well as be able to opine on how overfill could or could not be billed under Medicare’s drug reimbursement methodology.

Our approach

From speaking to the client, it was clear the expert would not need prior deposition or trial experience as the attorney felt he could prepare them for either. The proper credentials were the priority. We went to work to quickly find the best expert for the case.

The expert

We found an expert who was a forensic accountant with over 30 years of experience working in healthcare both as an entrepreneur and for prominent accounting firms. He was the President of his own accounting firm and had significant experience with billing practices as he owned a medical billing and management firm for 10 years providing medical billing service to medical providers. As a result, he had a deep understanding of the practices and procedures required for proper coding and billing for medical services. Furthermore, he was an expert in Medicare billing, coding and cost reporting and had in-depth insight into healthcare fraud schemes. Finally, he had served as an expert witness many times having written expert reports, been deposed, and testified.