Expert Witness
Medical billing and coding expert witness, HIPAA Privacy and Security Rule, Hospital Safety Processes and Electronic Health Record forensic audits, Medicare Fraud, Medicare Medicaid and SCHIP Extension Act of 2007 (MMSEA Section 111 reporting).
Expert witness in opioid prescribing case under the Controlled Substances Act. Auditing pain management practises, opining on patient impact, opioid prescribing errors, and opioid damages.
Expert witness qualifications have been confirmed by two federal judges and two state arbitrators and judges in medical coding and billing, Medicare fraud, and damage calculations.
Expert witness in rebuttal of Life Care Plan charges and future costs of care under the Affordable Care Act.
Expert Witness Qualifications and Experience – Attorney References Available Upon Request
Find an Expert witness in health care 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 $155 million settlement in favor of the U.S.
- U.S. Department of Justice – Retained by U.S. Attorney’s Office in New York regarding Evaluation And Management (E&M) coding and billing in Qui Tam False Claims Act case.
- Patent Infringement and intellectual property in healthcare IT solutions and software, processes and devices
- Affordable Care Act (including future cost of care in life care plans, disabilities, ACA qualified health plans, essential health benefits, minimum essential coverage)
- American Health Care Act – advisor re: potential impacts of the repeal and replace strategies as articulated by Trump Administration
- False Claims Act (fraud), sentencing guidelines, changes in sentencing guidelines after the ACA
- ARRA HITECH Act (meaningful use of electronic health records audit defense).
- HIPAA privacy and security breaches, best practices. Prior retention by defendants and plaintiffs
- Meaningful Use information safeguards under the ARRA HITECH Act and inter-relationship with HIPAA
- Usual Customary and Reasonable cost of care experienced in providing usual customary and reasonable charges in States where there is a collateral source rule
- 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 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 – impact of disabilities on future cost of care
- Future costs of care in life care plans with respect to personal injury and medical malpractice litigation
- Subrogation, insurance policies and contracting, medical coverage determinations, 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 involving 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 a 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 and 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 leading litigation firm, clinicians and health IT firm for landmark federal case
- Persuasive writer, speaker with experience giving oral and written testimony
- Quoted in Wall Street Journal, regular speaker, published works as expert in the field
- Advisor to value based care organizations for 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, 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
- Health care claims reimbursement
- Medicare Part C risk adjustment expert witness
- Medicare Advantage risk adjustment expert witness
- 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 including 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 health care
- 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 development disorders (PDDs)
- Americans with Disabilities Act and 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
- Fraudulent Claims Act
- Prompt Payment Act (Texas)
- Medicare, Medicaid Insurance 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.