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Medicaid - Medicare Expert Witnesses

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Jonathan Burroughs, MD, MBA, FACHE, FAAPL
48 Forest Ledge Road
PO Box 540
Glen NH 03838
USA
phone: 603-733-8156
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Jonathon Burroughs Healthcare Expert PhotoJonathan H. Burroughs, MD, MBA, FACHE, FAAPL, is President and CEO of The Burroughs Healthcare Consulting Network, Inc., and works with some of the nation’s top healthcare consulting organizations to provide ‘best practice’ solutions and training to healthcare organizations throughout the country in the areas of governance, physician–hospital alignment strategies, credentialing, privileging, peer review and performance improvement/patient safety, medical staff development planning, strategic planning, physician performance, and behavior management as well as ways in which physicians and management can work together in new ways to solve quality, safety, operational, and financial challenges.

Litigation Support: Dr. Burroughs offers litigation support services to counsel representing both Plaintiff and Defense. He provides general expert witness services for cases involving:
  • Regulatory Compliance
  • Negligent Credentialing
  • Negligent Privileging
  • Negligent Peer Review
  • Physician Performance Management
  • Fraud and Abuse
  • Fair and Judicial Hearings
  • Patient Safety
  • Physician Contracts
  • Medical Staff Bylaws, Policies, Procedures, Rules & Regulations
  • Dr. Burroughs serves on the national faculty of the American College of Healthcare Executives and the American Association for Physician Leadership (formerly the American College of Physician Executives), where he has been consistently rated as one of their top speakers and educators. He and Dr. David Nash were recently awarded a development grant by the American College of Healthcare Executives (ACHE) to develop a twelve hour national program to address population health and the disruptive innovative business models necessary to support it. He is the author or coauthor of the following books: Redesign the Medical Staff Model-A Collaborative Approach (published by Health Administration Press, January, 2015), The Complete Guide to FPPE (2012), Medical Staff Leadership Essentials (2011), Engage and Align the Medical Staff and Hospital Management: Expert Strategies and Field Tested Tools (2010), A Practical Guide to Managing Disruptive and Impaired Physicians (2010), The Top 40 Medical Staff Policies and Procedures, Fourth Edition (2010), Emergency Department On-Call Strategies: Solutions for Physician-Hospital Alignment (2009), and Peer Review Best Practices: Case Studies and Lessons Learned (2008).

    Dr. Burroughs is a former Senior Consultant and Director of Education Services for The Greeley Company where he was rated as one of their top healthcare consultants and educators over an eight year period. He is also a past medical staff president, past president of the New Hampshire chapter of the American College of Emergency Physicians, and served as an emergency department medical director. As a member of the governing board of Memorial Hospital in New Hampshire, he chaired the ethics, succession planning, and bylaws committees and sat on the joint conference, strategic planning, and medical executive committees. He previously served as a member of the clinical faculty of Dartmouth Medical School, where his research interests included introducing EMT defibrillation and automatic defibrillation into the field.

    View Dr. Burroughs' Consulting Profile.
    11/11/2015 · Healthcare
    Population health is not possible in a discounted fee-for-service world, and the significant healthcare business challenge is how to transition from fee-for-service to risk-based capitation in a sustainable way. The following represents an outline for how this transition can be staged so that early steps exploit the benefits of fee-for-service while the latter ones exploit a more capitated model:

    10/21/2015 · Healthcare
    Not too long ago, I had the sad task of testifying at a civil litigation and a judicial hearing for two physicians who had been suspended from their respective medical staffs. In both cases, the suspensions and resultant procedural rights were avoidable because proactive communication and management did not effectively take place. Such events should be rare and most medical staffs can easily avoid them by focusing on preventive actions and addressing potential performance issues early in a supportive and assertive manner.

    Hospital CEOs may have once cast a wary eye when a retail clinic opened in their backyard, but that paradigm has shifted as health systems are increasingly opening their own retail clinics or affiliating with retail clinic operators.

    7/24/2015 · Healthcare
    Regulatory hurdles prevent more hospitals from using e-health to its full potential. Federal and state policies and regulations on care rendered via technology from a remote site spin a tangled web for providers either engaged in e-health or who want to be. A February 2014 article in Health Affairs found strong associations between state policies and hospitals' adoption of e-health, also known as tele-health or telemedicine.

    Alarm fatigue has moved to the forefront of hazards on the hospital floor. Nursing staff gets bombarded by hundreds or thousands of beeps, rings, whistles and pings emanating from bedside devices in a shift, and it can be difficult for them to distinguish the critical from the routine. An analysis of hospital alarms at Johns Hopkins Hospital counted a total of 59,000 alarms over a 12-day observation period, an average of 350 alarms per patient per day.1

    Jon Burroughs, MD, FACHE
    In this book, the author, an experienced physician leader and healthcare consultant, describes key changes that must be made to redesign the medical staff model. He provides specific guidance and examples to help healthcare leaders and executives work with their physician leaders to face these changes successfully. Well-regarded contributors and subject matter experts offer additional examples and insights with special content throughout the book.
    Jon Burroughs, MD, et al
    The Complete Guide to FPPE provides step-by-step guidance for developing an FPPE process and policy, selecting indicators, collecting data, conducting performance conversations with practitioners, and managing FPPE for low-volume and advance practice practitioners.
    Jon Burroughs, MD, et al
    Sharpen medical staff leadership skills with proven educational strategies and succession planning tools. Medical Staff Leadership Essentials: A Guide to Developing Leadership Skills and Recruiting the Next Generation delivers a step-by-step process for becoming an effective physician leader and training future leaders. Veteran and new physician leaders alike will gain valuable insight to help the medical staff develop, retain, and recruit a legacy of effective physician leaders.
    Jon Burroughs, MD, et al
    Real-world solutions to problem physician behavior Don t let disruptive physician behavior and impairment negatively affect your hospital s operations or put your patients, staff, and colleagues at risk. This resource will help you implement a sound program to manage impairment and prevent disruptive physician behavior.
    Jon Burroughs, MD, et al
    This resource combines the expertise of advisors from The Greeley Company and in-the-trenches hospital and medical staff leaders. You ll get real-world solutions to engage practitioners in medical staff activities and align them with hospital goals. Unlike other theory-based books, this resource provides tools and strategies that have helped your peers break the cycle of disengagement and apathy.
    Jon Burroughs, MD, et al
    Developed by trusted Greeley Company experts, the fourth edition of this concise guide will help you develop medical staff policies and procedures that comply with Joint Commission requirements and promote current industry best practices. Don t wade through lengthy manuals and Web sites full of outdated information.
    Jon Burroughs, MD, et al
    Move from reactive deals to shared costs and sustainable physician-hospital alignment. This edition provides fully updated strategies, tools, and step-by-step approaches from multiple ED call panel experts.
    Jon Burroughs, MD, et al
    Peer Review Best Practices: Case Studies and Lessons Learned will help you transform peer review theory into best practice. This book and CD-ROM set is built on contemporary peer review design and demonstrates how hospitals have used those theories to tackle real peer review challenges. Twenty case studies cover topics ranging from fixing your peer review system to tracking and trending data to reconciling peer review conflicts.
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    Erin O'Callaghan BS, MA, JD, CRC, NCC, LPC, CLCP
    145 S. Livernois #102
    Rochester Hills Michigan 48307
    USA
    phone: 248-312-9597
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    Erin O’Callaghan BS, MA, JD, CRC, NCC, LPC, CLCP, is a Life Care Planner, Vocational Rehabilitation Consultant, and Licensed Attorney with over 13 years of experience as a Rehabilitation Professional.

    Ms. O’Callaghan has consistently provided the highest standards of professional ethics while staying current with the needs of modern and complex litigation. Her experience and training gives a unique perspective as a forensic rehabilitation evaluator. She has an in depth understanding of the evidentiary requirements of an expert’s evaluation and conclusion, including the importance of following an accepted methodology in the process and preparation of an opinion.

    Ms. O’Callaghan is a member of the International Association of Rehabilitation Professionals, International Academy of Life Care Planners, Michigan Rehabilitation Association, and the Michigan Bar Association. She is also a qualified Vocational Expert by the Social Security Administration.

    Erin O’Callaghan has been providing Litigation Support to counsel for Plaintiff and Defense for 11 years. She has provided over 1,000 cost projections and has testified in both Federal and State cases. Ms. O’Callaghan has specialized knowledge of the Affordable Care Act, Social Security issues, and Medicare Set Asides. Her services include case management, earning capacity evaluations, long term care evaluations, and personal injury assessments.

    Litigation Support Services for:
    • Tortious Injury / Negligence
    • Medical Malpractice
    • Worker's Compensation
    • Auto No Fault
    • Wrongful Death
    • Long Term Disability
    • Divorce
    View Erin O’Callaghan's Consulting Profile.
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    L. Lamar Blount
    CPA/CFF, FHFMA
    P.O. Box 2166
    Atlanta GA 30077-2166
    USA
    phone: 770-645-5989
    fax: 770-282-8410
    During 30+ years of serving the Healthcare Industry, Mr. Blount has served more than 300 clients in 30 states in the areas of Reasonable Charges (UCR), Medical Billing; False Claims, Regulatory Compliance, Reimbursement, Damage Quantification, and Financial Management.

    Mr. Blount is a Fellow and Certified Financial Professional in HFMA, member of the American Institute & Georgia Society of CPAs, and National Association of Health Underwriters, and has been an Arbitrator for American Health Lawyers Association. He has been admitted as an expert in multiple US District and State Courts and Administrative Hearings, and has testified for plaintiffs and defendants, providers, payors and government clients.

    A nationally recognized author, Mr. Blount has co-authored AMA’s best selling "Mastering the Reimbursement Process" book.

    Expertise Includes:
  • Accounting
  • APCs
  • Business Damages
  • Contractual Disputes
  • Cost Reports
  • DRGs
  • ERISA
  • False Claims - Fraud
  • HIPAA
  • ICD & CPT Coding
  • Insurance
  • Rate Setting
  • Self Disclosure
  • Valuations
  • CV and Legal references provided upon request.
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    Elliott M. Stein, MD
    Chief of Psychiatry
    302 Silver Ave.
    San Francisco CA 94112
    USA
    phone: 415-672-9352
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    Elliott M. Stein, MD is a Geriatric Psychiatrist with over 40 years of experience caring for the elderly. Dr. Stein is Board Certified by the American Board of Psychiatry and Neurology in General Psychiatry (October, 1979), and in Geriatric Psychiatry (April, 1991; Re-Certified, December, 2001, and in April, 2011). He is licensed to practice in California and Florida.

    Dr. Stein is currently the Director of Psychiatry at the Jewish Home of San Francisco, and the Medical Director of their Geriatric Psychiatry Hospital. He treats older individuals from all over the San Francisco Bay area, typically people who have complex combination of psychiatric and medical problems.

    Dr. Stein is a Member of the Task Force on Testamentary Capacity and Undue Influence, for the International PsychoGeriatric Association. He is available to serve as an Expert Witness, do legal and forensic consultation, record review, and assessments concerning Psychiatric issues in older individuals. Dr. Stein offers his services to attorneys for both Plaintiff or Defense.

    Areas of Expertise:
    • Contested Wills and Trusts
    • Testamentary Capacity, Undue Influence, Insane Delusions
    • Geriatric Competence
    • Dementia and Delirium, Alzheimer’s Disease
    • Geriatric Psychiatry Evaluation and Treatment, Psychiatric Medication, Psychotherapeutic Issues
    • Depression and Anxiety Disorders
    • Relationship Problems between the Elderly and their Adult Children
    • Aging and Mental Disorders
    • Geriatric Psychiatry issues concerning Hospitals, Nursing Homes, Independent and Assisted Living Facilities
    • Medicare Psychiatric Services Coding and Documentation
    View Dr. Stein's Consulting Profile.
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    Mary Wickens, JD, CFE
    2237 Raby Road
    East Lansing MI 48823
    USA
    phone: 248-770-4906
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    Mary Wickens, JD, CFE has over 35 years experience in the Healthcare Insurance, Managed Care, and Compliance Industry. Her experience includes advising and counseling health care providers, insurers, government contractors, and others in compliance, ethics, fraud and abuse, Medicare, Medicaid and Federal Employees Plan, managed care, and other matters.

    Background Experience - Ms. Wickens is a former compliance officer for a major health insurer and former legal and compliance specialist for a CMS Medicare Program Safeguard Contractor. Also a former operations director for government programs (Medicare Part C, Medi-gap, and FEHBP) for a major HMO, she is experienced with government audits and investigations, commercial audits, as well as self-reporting and internal investigations.

    Ms. Wickens has decades of experience as in house counsel to HMOs and health insurers. She has drafted, developed, negotiated, and implemented numerous healthcare provider-payor contracts, and developed and implemented codes of conduct, ethics programs, compliance programs and numerous corrective action plans.

    Litigation Support - Mary Wickens provides litigation support, including skilled expert services, reports and testimony in federal False Claims Act cases, arbitrations, and provider-payer disputes. She is an experienced testifying expert, responsive to the needs of counsel, with excellent report writing skills. Ms. Wickens' services are available to counsel representing both plaintiff and defendant.

    Areas of Expertise:
    • Medicare
    • False Claims Act (FCA)
    • Health Insurance
    • HMO
    • Medicare Advantage
    • Provider / Payor Disputes
    • Claims Audits and Appeals
    • Federal Employees Health Benefits Plans (FEHBP)
  • Medicare Part D
  • Government Audits
  • DME
  • Home Health Care
  • Hospice
  • Managed Care Contracting
  • Anti-Kickback Compliance
  • Self-disclosures
  • View Mary Wickens' Consulting Profile.
    6/6/2018 · Healthcare
    The US Department of Justice (DOJ) recently joined a federal qui tam lawsuit1 brought against a private equity firm that specializes in health care pharmacies. Notably, the case also charges individual partners of the private equity firm, Riordan, Lewis & Haden, Inc. (RLH) based in Los Angeles2. They are charged with violations of the federal Anti-Kickback Statute (AKS) and the federal False Claims Act (FCA) in connection with their management of Diabetic Care Rx/Patient Care America (PCA), a compounding pharmacy. The case involves reimbursements from TRICARE, the health care program for the military and their families.

    4/12/2017 · Healthcare
    Health care fraud and abuse cases are often won or lost on the effective use of expert witnesses. As health care fraud cases have become more complex and technical, the scope and use of expert testimony has proliferated, and the successful use of experts is one of the lawyer's most important jobs. False Claims Act, Anti-Kickback Statute, and Stark Law cases all demand various types of experts to assist the trier of fact in understanding the nature of the case, the morass of rules at play, the evidence, and a variety of billing, valuation, contractual, technical, and compliance concepts. Increasingly, expert reports and testimony play a pivotal role in motions for summary judgment, as well as at trial. Experts also are used in "conference room litigation," such as mediations or negotiations between defense counsel and enforcement agencies. This article is the result of interviews with health care fraud litigators and expert witnesses in the field who identified their best practices to produce optimum outcomes for their clients.

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    Patrice Morin-Resch (formerly Morin-Spatz)
    CPC, CMCS, CHCI, CPMA
    1300 Shamrock Lane
    Plano TX 75093
    USA
    phone: 972-955-4855
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    Patrice Morin-Resch (formerly Morin-Spatz), CPC, CMSCS, CHCI, is a professional Medical Coding and Reimbursement subject matter expert supporting clientele throughout the United States with more than 30 years of experience in her field.

    Ms. Morin-Resch is a former editor of the American Medical Association’s (AMA) Current Procedural Terminology (CPT®) book, and a published author of more than 15 books on coding. Her legal and coding expertise has been utilized by the Department of Justice, Department of Defense, attorneys, insurance companies, clinics, medical associations, and organizations.

    Whether testifying for medical fraud and abuse cases, assisting in the recouping of monies for physicians, providing medical coding seminars, audits, in-house consultations, superbill reviews or fee slip analysis for clients, her emphasis and expertise remains solely on medical coding and reimbursement. Ms. Morin-Resch services are available to attorneys representing both Plaintiff and Defense. She has testified in district, state, and federal court.

    Areas of Expertise:
    • Usual, Customary & Reasonable(UCR) Fees
    • Medicare Standard Fees
    • Fraud & Abuse
    • Bundling / Unbundling
  • Medicare & 3rd Party Payments
  • Medicare Audits
  • Double Billing
  • RICO & Qui Tam Cases
  • View Patrice Morin-Resch's Consulting Profile.
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    Beth Morgan, CPC, MCS-P
    376 Belden Hill Rd.
    Wilton CT USA
    phone: 203-807-4007
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    Beth Morgan, CPC, MCS-P, President & CEO, has served as a Certified Professional Coder (CPC) and Compliance Specialist (MCS-P) since 2004. She has over 25 years of experience in the Medical Billing and Coding field working with various types of providers during this time.

    Ms. Morgan's knowledge and expertise have enabled her to reduce providers' accounts receivables and medical bills by over 50%. She has access to a broad base of insurance company policy information, and is an information contributor to radio and TV shows as well as magazine articles.

    Litigation Support - Ms. Morgan provides expert witness services to insurance companies and attorneys for cases involving Abusive Medical Billing Practices. She offers expertise reviewing medical bills for errors and overcharges and reducing them down to Usual, Reasonable, and Customary Charges. The majority of these reviews are settled using her findings before they go to trial. She also negotiates discounts for the uninsured and underinsured.

    Areas of Expertise:
    • CPT Codes
    • Bill & Coding Review
    • Billing Compliance
    • Accounts Receivable Reduction
    • Personal Injury Bill Reduction
    • Workman Compensation Bill Review
    • Auto Accident Bill Review
  • Fall Accident Bill Review
  • UCR Pricing
  • Concealed Items/ Concealed Services
  • Services / Item Overcharges
  • Undocumented or Cancelled Items
  • Unbundled Code
  • Geographic Area Usual and Customary Charges
  • View Medical Bill Detectives' Consulting Profile.
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    William C. Mohlenbrock, MD, FACS

    816 C Avenue
    Coronado CA 92118
    Email: bmohlenbrock@gmail.com
    phone: 858-354-0415
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    William (Bill) C. Mohlenbrock, MD, FACS, has practiced General Orthopedics and Trauma Care, including total joint and arthroscopy surgeries and sports medicine and related injuries for many years at Scripps Memorial Hospital in La Jolla, California. He is senior physician in a group of 8 orthopedic surgeons and 2 Physician Assistants.

    In addition to orthopedic experience, Dr. Mohlenbrock is a nationally recognized expert in the objective assessment of hospital medical outcomes, Clinical Quality and Cost Efficiencies for inpatient care. He has consulted for hospitals who have found themselves in potential legal situations where the quality of their clinical care has been called into question.

    Dr. Mohlenbrock received his BS degree from the University of Illinois and his MD from the St. Louis University School of Medicine. He holds fellowships in the American Academy of Orthopaedic Surgeons, American College of Surgeons and the American Association of Physician Leadership. He is a noted lecturer and has published numerous articles on measuring and improving the quality and cost efficiency of medical care.

    Comprehensive Quality Data used to Defend Hospitals for Med Mal


    Litigation Support - Attorneys wishing to take advantage of Dr. Mohlenbrock's orthopedic and quality assessment experience as well as his communication skills, will receive unbiased, evidence-base opinions. He assists the legal profession whose clients are either plaintiffs or defendants.

    Areas of Expertise:
    • Orthopedic Surgery
    • Adult Reconstructive Surgery
    • Total Joint Surgery
    • Scoliosis Surgery
    • Arthroscopy Surgeries
  • Sports Medicine
  • Sport-related Injuries
  • Hospital Medical Outcome Assessments
  • Medical Care Efficiency
  • Medical Care Quality
  • View Dr. Mohlenbrock's Consulting Profile.
    The legal strategies for defending hospitals against medical legal liabilities are certainly many and varied. An additional consideration to augment every defense strategy might be contained in each hospital’s own store of big data. Heretofore these data have been underutilized for medical legal purposes...

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    Michael F. Arrigo
    620 Newport Center Drive
    Suite 1100
    Newport Beach CA 92662
    USA
    phone: 949-335-5580 x101
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    Managing Partner, Healthcare Practice works with health systems, health IT companies, and health plans. Recent retentions by the U.S. Department of Justice (DOJ). Drug pricing, patent infringement, medical coding and billing and Qui Tam False Claims Act and fraud case specialties.

    He has in-depth experience in HIPAA mandates, the HITECH Act and Patient Protection and Affordable Care Act (PPACA) and is a published author and regular speaker. He consults to clients including Health IT investors, Health IT companies, and health plans and hospital systems in matters regarding:HIPAA Privacy Rule, HIPAA Security Rule, HIPAA Breaches, Revenue Cycle Management
  • Meaningful Use of Electronic Health Care Records
  • Quality Measures for Medicare Advantage Hospital Value Based Purchasing
  • Medicare Advantage HEDIS 5-Star Ratings for Health Plans Mr. Arrigo was recently quoted in the Wall Street Journal Venture Capital Dispatch regarding medical coding standards and Wall Street Journal Health Blog regarding venture-backed information-technology companies that serve hospitals and health insurers.
  • 4/3/2018 · Healthcare
    Clinical documentation improvement (CDI) initiatives are underway in healthcare organizations across the country, with the aims of improving care and reducing costs. Are they working? At least one such initiative, at Baptist Health South Florida, is providing solid return on investment.

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    Richard K. Baer, MD
    2727 N Lakewood Ave
    Chicago IL 60614
    USA
    phone: 773-477-0201
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    Richard K. Baer, MD, is a Healthcare Coverage consultant with over 20 years of experience in medical director roles for the Medicare Administrative Contractor (MAC), the Recovery Auditor (RAC), and regional home health and hospice contractors. He most recently served as the Medical Director for the RAC, Region A, in the northeast US.

    Dr. Baer is a Distinguished Life Fellow of the American Psychiatric Association, and a member of numerous state and national medical societies. He served as President of the Illinois Psychiatric Society, Editor of its newsletter, and Chairman of its Ethics Committee.

    During his tenure with the Medicare program, Dr. Baer authored several hundred Local Coverage Determinations (LCDs) and other medical review policy articles and documents for new technologies, pharmaceuticals, and highly utilized services covering millions of Medicare beneficiaries. He has provided medical policy assistance to CMS on national coverage issues, and has been involved in federal investigations and audits of Medicare improper payments and fraud matters for a variety of health care providers.

    Litigation Support - Dr. Baer has extensive experience consulting and testifying for the United States Department of Justice in Medicare criminal and civil fraud trials and other civil proceedings. He provides expert medical consultation on Payer Coverage Requirements for the Medical Device Industry.

    Areas of Expertise:
    • Medical Devices
    • Medical Device Design
    • Medicare Rules
    • Medicare Regulation Compliance
  • RAC Audits
  • Medical Billing
  • Medical Coding
  • Pharmaceutical Compliance
  • View Dr. Baer's Consulting Profile.
    Richard Baer, MD
    A Doctor’s Harrowing Story of Treating a Woman with 17 personalities.
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    Herschel R. Lessin, MD
    Founder, Vice President
    28 Kingwood Drive
    Poughkeepsie NY 12601
    USA
    phone: 845-452-1700 ext. 1184
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    Herschel R. Lessin, MD, CMCE, has been a full-time practicing Pediatrician since 1982. Trained at Stanford and Yale, he the senior partner of one of the larger single specialty Pediatric practices in the United States, The Children's Medical Group, PLLC, with 9 offices and 24 clinicians in NY's Hudson Valley. His practice includes children from birth through the end of college.

    Dr. Lessin see office based patients and rounds on newborns in the nursery. He takes call at nights and weekends as well. With 36 years of clinical practice, he is experiences in all aspects of general Pediatric care.

    Dr. Lessin is active on a national policy level, having been co-lead author on several American Academy of Pediatrics policy statements and technical reports, as well as being a member of the authoring committee on several others. He has reviewed a majority of AAP policy statements during his 6 years on the nation Committee on Practice and Ambulatory Medicine, making comments for possible revision as needed. He is currently serving on the committee revising the national guidelines for the care of ADHD.

    Dr. Lessin has had broad media experience, hosting medical spots on radio, TV, and online. He has authored a biweekly column for a regional newspaper on general pediatrics. He has appeared on regional radio providing advice, both prerecorded and live call in.

    Litigation Support - Dr. Lessin has served as an expert witness in Pediatric Malpractice litigation for over 30 years, working for both plaintiff and defense. He has reviewed and provided opinions in hundreds of case and testified at deposition dozens of times. He has been qualified as an expert at trial on 16 cases to date (March 2018) He is willing to travel if required. Dr. Lessin provides honest opinions based solely on the facts of the case materials reviewed, without regard to the position of retaining counsel. He has lectured to physicians on medical liability issues at a national level as well as regional and local groups.