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Medical Utilization Review Expert Witnesses

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Adam J. Carinci, MD
601 Elmwood Ave., Box 604
Rochester NY 14642
USA
phone: 585-273-5875 (Office) 845-797-2305 (Cell)
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Adam CarinciDr. Adam J Carinci, M.D. is a nationally recognized and sought after clinician, speaker and expert witness with over a decade of pain medicine experience. He is double-board certified in both Anesthesiology and in Pain Medicine and maintains an active, full time medical practice. Dr. Carinci is Chief of the Pain Management Division and Director of the Pain Treatment Center at the University of Rochester Medical Center and an Associate Professor at the University of Rochester School of Medicine. Prior to his current position, Dr. Carinci was the Director of the Pain Medicine Center at Massachusetts General Hospital and an Instructor at Harvard Medical School. Dr. Carinci trained at Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Massachusetts General Hospital and Harvard Medical School. He has been involved in over 50 cases as an expert witness for both plaintiff (35%) and defense (65%). He has qualified as an expert witness in federal court. He has authored over 30 expert reports, and has offered testimony under oath at both depositions and trials. Dr. Carinci is pleased to provide attorney references and redacted sample reports. He is an active member of the American Society of Anesthesiologists, The American Academy of Pain Medicine and the American Pain Society. He lectures nationally as an expert on opioids and pain. He is a consultant for several Federal Agencies including; CDC, HHS and USDVA.



Pain Management Credentials:

-Board Certification in Anesthesiology (ABMS)

-Board Certification in Pain Medicine (ABMS)

-Expertise: CRPS, RSD, Opioids

-Division Chief and Director at URMC

-Prior Director of the MGH Center for Pain Medicine

-Active clinical practice in pain management

-Litigation Support

-Extensive expert witness experience

-Standard of care opinions, Case merit

-Medical Necessity Standards, Medical Fraud and Abuse

-Translate complex medical issues into easily understood language -Trial Experience
5/9/2018 · Pain Management
Pain is one of the most prevalent conditions for which patients seek medical attention. Additionally, the number of patients who utilize complementary and alternative medicine as a treatment of pain either in lieu of, or concurrent with, standard conventional treatments continues to grow. While research into the mechanisms, side effect profiles, and efficacies of these alternative therapies has increased in recent years, much more remains unknown and untested. Herein, we review the literature on complementary and alternative medicine for pain, with particular emphasis on evidence-based assessments pertinent to the most common alternative therapies, including acupuncture, herbal therapy, massage therapy, hypnosis, tai chi, and biofeedback.

4/16/2018 · Addiction Issues
Addiction to opioid analgesics is an important and yet underinvestigated clinical issue, which has substantial implications in opioid therapy for chronic pain management. Problematic opioid use, including compulsive opioid seeking and addiction, arises in some fraction of opioid-treated chronic pain patients. The connection between chronic pain and opioid addiction is a complex interplay between psychological, epidemiological, and neurobiological factors. Herein, we explore this critical relationship.

4/2/2018 · Pain Management
Complex Regional Pain Syndrome (CRPS) is the great imitator1,2. The current medical literature is clear that severe CRPS, particularly CRPS that has been present for several years, is a systemic disease which can manifest in literally any organ system throughout the body. In fact, there is not a single organ system that is known to be immune from the spread of CRPS. Not uncommonly, CRPS can spread from one limb to another and from one organ system to another through interactions between the somatic and sympathetic nervous systems.

3/6/2018 · Pain Management
Torture is widely practiced throughout the world. Recent studies indicate that 50% of all countries, including 79% of the G-20 countries, continue to practice systematic torture despite a universal ban. It is well known that torture has numerous physical, psychological, and pain-related sequelae that can inflict a devastating and enduring burden on its victims. Health care professionals, particularly those who specialize in the treatment of chronic pain, have an obligation to better understand the physical and psychological effects of torture. This review highlights the epidemiology, classification, pain sequelae, and clinical treatment guidelines of torture victims. In addition, the role of pharmacologic and psychologic interventions is explored in the context of rehabilitation.

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Stephen M. Raffle, M.D.
President
35 Wolfe Grade
Kentfield (San Francisco) CA
USA
phone: 415-461-4845
fax: 415-461-4039
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Stephen M. Raffle, M.D. is double Board-Certified in Psychiatry and Forensic Psychiatry. Dr. Raffle has over 49 years as a clinical and forensic psychiatrist offering his expert opinion in Federal and State jurisdictions nationwide. In addition to serving as an expert witness, Dr. Raffle consults to attorneys, judges, insurers, and to employers regarding Fitness for Duty and Risk of Violence (Threat) Assessment:

  • 5000+ psychiatric assessments
  • Expert testimony in 700 depositions and trials
  • Successful clinical practice

    The job of an expert witness is to educate a jury, judge, attorney, and trier of fact about the forensic psychiatrist's conclusions and how those opinions were derived in a manner well-reasoned, skillful, and easily understood by every person, not only another forensic psychiatrist. In short, an educator. Dr. Raffle’s experience as an educator extends well beyond a forensic venue, yet underpins the key to his ability to explain his opinions.

  • Prof. of Psychiatry, UCSF Medical School, 20 years
  • U.C. Hastings College of the Law postgraduate course "Trial and Appellate Advocacy" instructing seasoned attorneys about the direct and cross-examination of expert witnesses, with special focus on mental health experts and licensed medical professionals, Psychiatrists (MDs), Psychologists (LCSWs / MFTs), and physicians in other medical specialties, 11 years

    Stephen M. Raffle, M.D. & Associates' expertise is well-established in forensic assessment in the areas of:
    • Post-Traumatic Stress Disorder (PTSD)
    • Dementia and Competency
    • Testamentary Capacity
    • Undue Influence
    • Traumatic Brain Injury
    • Malingering
    • Emotional Distress: Intentional & Unintentional infliction
    • Emotional Distress: Forensic Evaluation to render medical-legal opinion
    • Diagnosis and Need for Treatment
    • Fitness For Duty
    • Risk/Threat Workplace Violence Assessment
    • Wrongful Termination
    • Discrimination (ADA, Title VII, EEOC)
    • Harassment
    • Employment Litigation
    • Medical Malpractice
    • Catastrophic Injury
    • Temporary and Permanent Disability
    • Medical Records Review
    • Assist in Preparation for Direct and Cross-examination of Expert Witnesses and Deposition of expert witnesses
    Licensed in California.
  • 12/3/2014 · Psychiatry
    In order for a medical opinion to be admissible as evidence in civil, criminal and administrative cases, the basis of the opinion must fulfill either the Daubert Criteria or the Frye test, depending on the jurisdiction. The judge of the court rules on the admissibility of the expert opinion. The effect of Daubert has been to limit expert testimony to opinions which are based on a scientific foundation. Daubert specifies that adequate scientific support and method and a known error rate must exist. The testimony of a mental health expert rendering an opinion using criteria which does not meet Daubert standards is weakened by the implication that it is not based on "sound science." In some instances, for example, a mental health expert uses an approach where there are no peer-reviewed studies or methods, such as when psychologists compose their own neuropsychological test batteries. In most cases where an attorney is considering a "Daubert challenge," a contemporaneous and up-to-date literature search is indicated. Also, extensive case law presently exists as to specific issues. Being familiar with the Daubert criteria enhances effectiveness in challenging a mental health expert's opinion, whether on voir dire or cross examination. On direct examination, the strengths of an opinion reached under Daubert criteria become a "teaching moment" for the trier of fact, because it will be founded on the science of mental health assessment.

    10/27/2014 · Psychiatry
    Undue influence occurs when the testator's freewill and freedom of choice in the disposition of the assets of his or her estate is replaced by the substituted judgment/wishes of another. This can apply to creating a will, codicil to amend a will, trust or other legal instrument.

    2/11/2014 · Psychiatry
    The medical expert cannot express an opinion about the ultimate question to the trier of fact: how much is the plaintiff's emotional distress (emotional injury) worth in dollars? Yet when the question of these monetary damages is put to a jury, their deliberations are better-served if considered in the context of a Forensic Psychiatrist's knowledgeable findings and testimony.

    5/28/2009 · Human Factors
    All psychiatric reports evaluate something, but not always the same thing. For example, eligibility for benefits, or fitness to do a job. To make sense of the report, the reader must determine what is being evaluated and how it is being done

    5/28/2009 · Psychiatry
    In civil cases where emotional distress is alleged, it often occurs that the plaintiff’s attorney designates the treater as his expert. Usually the argument is that the plaintiff’s own therapist has spent many more hours with the plaintiff than the defense expert and therefore "knows" the plaintiff better. The treater often agrees with this reasoning

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    1500 Walnut St.
    Ste. 902
    Philadelphia PA 19102
    USA
    phone: 215-731-1901
    fax: 215-731-9503
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    Richard M. Sobel, MD, DFAPA, has over 30 years of experience practicing Adult Psychiatry and Pain Management / Medicine. His specialty focus is in Pain Medicine, for which he has sub-specialty board certification, Psychotherapy, and Psychopharmacology.

    Dr. Sobel is currently a Clinical Assistant Professor in the Department of Psychiatry at Jefferson Medical School. A Distinguished Fellow of the American Psychiatric Association, Dr. Sobel is immediate Past President and continues to serve on the board of the Greater Philadelphia Pain Society, one of six regional chapters of the American Pain Society. He is a Councilor for the Philadelphia Psychiatric Society and Representative of the Pennsylvania Psychiatry Society to the Safe and Effective Prescribing Practices and Pain Management Work Group of the Pennsylvania Department of Drug and Alcohol Programs.

    In 2014, Dr. Sobel was the recipient of the Dean's Award for Excellence in Education at Jefferson Medical College and, in 2013, was nominated Practitioner of the Year by the Philadelphia Psychiatric Society.

    Litigation Support - Dr. Sobel offers expert witness services to counsel representing both plaintiff and defendant. With voice training for public speaking, he is able to effectively communicate with judge and jury. Dr. Sobel's services include Independent Medical Exams (IMEs), medical record review, utilization review, written reports, depositions, and trial testimony as needed.

    Areas of Expertise:
    • Psychopharmacology
    • Worker's Compensation
    • Post Traumatic Stress Disorder (PTSD)
    • Sleep Disorders
    • Depression
    • Anxiety
  • Complex Regional Pain Syndrome
  • Neuropathic Pain
  • Trauma
  • Opioids
  • Addiction
  • Pain Medication
  • View Dr. Sobel's Consulting Profile.
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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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    Glenda Flemister MD, FACP, FCCP
    President/Medical Director
    21200 S. La Grange Road
    suite 273
    Frankfort Illinois 60423
    United States
    phone: 815.534.5677
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    Glenda E. Flemister, MD, FACP, FCCP, is Board Certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine. Dr. Flemister has over 30 years of experience in her field. She received her MD from Loyola University Chicago Stritch School of Medicine and is licensed to practice in Illinois, Kentucky, New Mexico, and Oklahoma.

    Dr. Flemister has over 10 years of experience in national insurance and payer companies. She has served as Medical Director for Aetna, Blue Cross Blue Shield Association, and Next Level Health Partners. She is currently the Executive Medical Director for Medical Health Solutions, a company involved in predicting trends to optimize healthcare at an affordable and sustainable rate. In this capacity, she provides education, consultation, and resources to the medical industry, medical providers, and managed care organizations.

    Litigation Support - Dr. Flemister has been providing medical legal chart review, depositions, and trial testimony to the legal community since 1994. Her cases involve Pulmonary and Critical Care medical issues. She has performed over 100 file reviews. Her services are available to counsel representing both plaintiff and defendant, private hospitals, ISMIE (Illinois State Medical Inter-Insurance Exchange), and the AMA. Dr. Flemister's cases involve:
    • Pulmonary Medicine / Disease
    • Critical Care Medicine
    • Internal Medicine
    • Pulmonary Medical Malpractice
    • Pulmonary Care Quality Assurance
  • Thoracic Surgery
  • Transplant Issues
  • Asthma
  • Obstructive Lung Disease
  • Medical Devices
  • View Dr. Flemister's Consulting Profile.
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    Dr. Mark Levin
    6 Gel Court
    Monsey NY 10952
    USA
    phone: 845-406-2183
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    Dr. Mark Levin, MD, is an Academic Physician with a wide range of experience in various practice settings, including academia, teaching hospital and private practice settings. He has a consulting practice in clinical standards and utilization review in Oncology and runs a blog devoted to Standards of Care. He is in active medical practice.

    Services Include:
    • Administrative Medicine
    • Brain Tumors
    • Breast Cancer
    • Cancer - Missed Diagnosis
    • Chemotherapy
    • Experimental / Investigational Medicine
    • Hematology
    • Improper Diagnosis
    • Kidney Cancer
    • Lung Cancer
  • Medical Practice Guidelines
  • Medical Records Review
  • Medical Utilization Review
  • Mesothelioma and other Asbestos Lung Diseases
  • Oncology
  • Pain Management
  • Prognosis (Cancer)
  • Standard of Care
  • Tumor Marker Testing
  • 12/26/2012 · Robots & Robotics
    Safe and effective chronic opioid therapy for chronic cancer related pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion.

    Breast cancer patients often suffer menopausal symptoms, which include vaginal dryness. This distressing symptom is often treated with topical estrogen or progesterone creams; however, there remains a concern about systemic absorption of estrogen and its effect on breast cancer. In a group that is treated with tamoxifen, it would appear that the systemic affect would be negated by the tamoxifen's anti-estrogen blockade but the question remains hotly debated.

    4/3/2009 · Medical
    Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer

    9/23/2008 · Medical
    Acceptance and compliance with screening and genetic programs for genetic illness depends crucially on the compatibility and fit of their design with the social, cultural and religious concerns and mores of target communities. As a case in point, genetic screening programs that are currently in use within Jewish populations are considered on the background of ethical and religious concerns

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    LaTonya Washington, MD, MBA, CPE, FAAP
    2005 Elzey Avenue
    Memphis TN 38104
    USA
    phone: 901-310-8215
    fax: 1-888-859-3997
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    LaTonya Washington, MD, MBA, CPE, FAAP, is physician Board Certified in Internal Medicine and Pediatrics with clinical experience expertise in Hospital Medicine for both adult and pediatric patients. Her experience also includes pediatric urgent care and emergency care.

    Background - In addition to providing care for hospitalized pediatric and adult patients, Dr. Washington has served as a healthcare executive with experience managing an inpatient facility with a focus on clinical integration and physician alignment.

    Litigation Support - Dr. Washington serves as a medical file review consultant utilizing Interqual and Milliman guidelines. Her expertise is available to attorneys for plaintiff and defendant for medical malpractice and other cases involving Hospitals, Healthcare Systems, Insurers for Peer Review, Risk Management, and Utilization Review. Dr. Washington's services include medical chart review for medical standard of care, objective opinions, deposition, and trial testimony.

    Areas of Expertise:
    • Pediatric Medicine
    • Internal Medicine
    • Healthcare Systems
    • Hospital Medicine
    • Hospital Acquired Infections
    • Standard of Care
  • Hospitalist
  • Primary Care Hospital Management
  • Infection Control
  • Pharmacy and Therapeutics
  • Revenue Management
  • Patient Safety
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    Mark A. Smith, MD, MBA, FACS, FACHE, CPHQ
    747 Camino Norte
    Palm Springs CA 92262
    USA
    phone: 760-275-8204
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    Mark Smith Medical Management Expert PhotoMark A. Smith, MD, MBA, FACS, FACHE, CPHQ, is an independent senior Healthcare Consultant and a Practicing Vascular Surgeon as a Clinical Assistant Professor of Surgery at the University of California, Irvine.

    Dr. Smith previously served as the Chief Medical Officer with Morrisey Associates Inc/ Morcare LLC for six years. He is a member of HG Healthcare Consultants LLC. Dr. Smith brings over 30 years of clinical practice and hospital management experiences to his work with physicians and hospitals across the United States. He is Board Certified in Vascular Surgery and is a Fellow of the American College of Surgeons, the American College of Healthcare Executives. He is a member of the American College of Physician Executives, the Society for Vascular Surgery and the Southern California Vascular Surgical Society.

    Litigation Support - Dr. Smith provides expert witness services to attorneys representing plaintiff and defendant. His decades of clinical practice as a surgeon and multiple roles in senior hospital administration to his work on peer review, credentialing, ED call, and other matters involving physicians and hospitals across the United States. He has testified several times in the past 5 years.

    Areas of Expertise:
    • Physician Credentialing
    • Physician Peer Review
    • Negligent Credentialing
    • Negligent Peer Review
    • Patient Safety
    • Healthcare Quality
  • Performance Improvement
  • Fair / Judicial Hearings
  • Medical Staff Affairs
  • Medical Conflicts of Interest
  • Physician Integration / Alignment
  • Physician Conduct
  • View Dr. Smith's Consulting Profile.
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    David Clay Griffin, RPh
    4636 W Highway 67
    Cleburne TX 76033
    USA
    phone: 817-933-3136
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    David Clay Griffin, RPh, has over 30 years of experience in Retail and Community Pharmacies and still actively working as a pharmacist and pharmacy manager. Well-versed in practice standards and pharmacy operations, including controlled substance laws and policies, as well as financials, inventory, sales.

    Throughout his Pharmacy Management career, Mr. Griffin also served as a pharmacist for the United States Department of Health and Human Services in Dallas, Texas (2002/2017). He worked with the Texas 4 Disaster Medical Assistance Team and was the Pharmacy Unit Leader with NDMS over several missions.

    Mr. Griffin consults and serves as a pharmacy expert witness for attorneys representing both plaintiff and defense. His services include medical record review, thorough reports, depositions, and trial testimony.

    Areas of Expertise:
    • Pharmacy Practice Standards
    • Retail Pharmacies
    • Community / Independent Pharmacies
    • Drug / Medication Errors
    • Pharmacy Drug Interactions
    • Medication Overdose and Under-dose
    • Medication Interaction / Drug Utilization Review
  • Pharmaceuticals Adverse Reactions
  • Pharmacy Safety and Counseling
  • Pharmacist Duty to Warn
  • Pharmacy Operation
  • Staff Supervision and Training
  • Controlled Substance Laws and Policies
  • DUI / DWI
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    IU Health Arnett Hospital
    5177 McCarty Lane
    Lafayette IN 47905
    USA
    phone: (765) 838-7480 / cell: (616) 644-6348
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    Eric M. Orenstein, MD, is a board-certified fellowship-trained Orthopedic Surgeon specializing in Hip and Knee Replacement Surgery. In practice for 32 years, he is a Clinical Assistant Professor in Orthopedic Surgery at the Indiana University School of Medicine, teaching residents and medical students.

    Dr. Orenstein has been an active member of Indiana University Hospital's Surgery Standards Committee for several years. He is ABIME certified for Independent Medical Examinations (IMEs). Dr. Orenstein has been on several state review panels for potential medical malpractice claims and has performed over 100 file reviews including disability reviews and utilization reviews. Dr. Orenstein has provided opinions, deposition testimony and trial testimony in a number of medical malpractice cases.

    Areas of Expertise:
    • Hip & Knee Replacements
    • Forensic Orthopedics
    • Workers' Compensation
    • Impairment Evaluations
  • Medical / Legal Evaluations
  • Causation
  • Utilization Review
  • Peer Review
  • View Dr. Orenstein's Consulting Profile.
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    Matthew Lee
    MD, RPh, MS
    5700 Old Richmond Ave.
    Suite A-5
    Richmond VA 23226
    USA
    phone: 804-358-1492
    fax: 804-358-1491
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    Dr. Matthew Lee is a Physician, Pharmacist, Pharmacologist and Toxicologist who also practices as an Expert Witness and Legal Strategy Consultant.

    Specific Benefits Include:
  • Increased quality and integrity of written expert reports, based on an expanded knowledge base
  • Time savings by only having to coordinate and discuss a case with one expert as opposed to two or more
  • Since there is so much overlap between fields in the medical profession it is often hard to determine where one scope ends and another begins. This ambiguity is dramatically decreased , and scope increased by combining physician, pharmacist, and pharmacologist into one
  • Communication skills of a pharmacist and experience dealing directly with the lay-public, in addition to the knowledge and background of a physician is extremely beneficial describing technical details to a jury
  • Practicing in different realms within the healthcare field has allowed Dr. Lee to integrate the multiple facets giving him a unique and distinct perspective that no other expert has
  • Case Experience Includes:
  • Criminal and Civil Cases
  • Anaphylactic Reactions
  • Overdosel
  • Wrongful Death
  • Cardiac Arrest
  • Respiratory Arrest
  • Fentanyl Overdose
  • Dilaudid Overdose
  • Pharmacist Mis-Fills
  • Pharmacist Dispensing Errors
  • Pharmacy Standard of Care
  • Medication Adverse Effects
  • Falls Related to Medications (in and out of hospital)
  • Toxicology/Toxic Reactions
  • Medical Marijuana
  • Positive Drug Screens in the Workplace
  • Workplace Safety
  • Fit for Duty Testing
  • Dilaudid is a commonly used opioid narcotic analgesic in hospitals due to its potency and effectiveness in the management of acute pain. On occasion, patients may be administered too much Dilaudid resulting in an overdose.