Managed Care Liability Expert Witnesses: 6

David Martinez has over 35 years of experience in the field of Medical Billing. His expertise covers all facets of the revenue cycle, and he possesses a comprehensive understanding of relevant laws, regulations, and statutes, especially those applicable in California. 

Accurate Medical Billing are among the most sought-after expert witnesses. Accurate the only billing service to earn Preferred Partner status with the San Bernardino County Medical Society and the only billing service authorized in California to perform CEUs for doctors. They possess extensive knowledge and experience in insurance billing, claims, and collections. Accurate is the recommended billing service by and for CCA members and endorsed and recommended by ICAC. Co-Chair of the Insurance and Managed Care Committee – California Chiropractic Association. 

 Mr. Martinez is the administrator of the largest medical billing group on Facebook, which boasts over 6,000 members. This role entails significant responsibility and trust. He has curated a highly qualified team of experts in the field, which includes Certified Coders, Auditors, and Medical Reimbursement Specialists. His team comprises former claims examiners for insurance companies, as well as auditors, billers, coders, and compliance specialists, giving them deep insights into insurance companies' strategies.

Areas of Expertise:

Medical Billing Medical Coding Insurance Claims / Insurance Collections Revenue Cycle Management Managed Care HMO PPO HIPAA Medical Records IPA POS

Medicare Medi-Cal Medicaid UCR Athena Capitation Cost Containment Medical Group Auditing Future Medicals Expert Witness

Partial Background Experience:

• Consolidated Healthcare Services - Director of Billing and Collections for 54 current and past, state-of-the-art Open MRI, primarily in the Southeast United States. Mentored training developed a direct staff of 24 and an indirect staff of 72.
• Prime Healthcare Hospital - Business Office Manager Incorporated fully managed care training and collections. Collaborated with legal counsel in the interpretation of medical records.

 Education / Training:

• Certified Professional Coder
• Certified CE Educator (California Board of Chiropractic Examiners)
• Certified Medical Reimbursement Billing Specialist
• Certified Claims Auditor
• Certified Claims Examiner
• Certified HIPAA Professional
• Certified Medical Claims Biller
• Certified Compliance Officer (9 others) Certifications)

Paul M. Adler, DO, FACEP, MBA, Medical Director for the Ventura County, California, Department of Corrections, has worked in Correctional / Jail / Prison Medicine & COVID-19 Preparation & Response. He has overseen the care of inmates in Jails in California and New York, as well as Prison inmates who have been transferred to county facilities to serve their terms for years in county jails in California. He has also overseen Correctional health car in locked units in Hospitals . 

Dr. Adler is the President-Elect of The American Correctional Health Services Association of California / Nevada, which represents all clinicians and administrators in Jails/Prisons in California and Nevada. He previously oversaw a County Hospital, County Nursing Home and ran a County Health Department and oversaw Correctional healthcare for the Westchester, New York Jail.

Litigation Support - Dr. Adler has defended Jails and Prisons in Southern California, Idaho, Texas, North Carolina, New York, Pennsylvania, etc. He is currently the expert consultant to the California Prison System for Covid litigation and the medical consultant to the judicial consent decree overseeing care in the Philadelphia Department of Prisons. He also served as the expert consultant to the ACLU for Covid in the Illinois Department of Corrections

Dr. Adler still works as a full-time practicing physician and has helped attorneys and insurance companies in Emergency Medicine, Nursing Home Medicine, Public Health and Hospital Administration since 1985. He has been involved in Plaintiff litigation in many states including against Rikers Island, NY and Cook County Jail and is available to review and consult on clinical Correctional/Jail/Prison cases for attorneys for both Plaintiff and Defense.

Services:

• COVID-19 Preparation & Response
• Medical Oversight of Federal Consent Decrees
• Screen Cases for Merit
• Review, Analyze and interpret Medical Records
• Provide Basic or Comprehensive Written Reports
• Interpret Standards of Care, Deviation and Adherences as they Relate to Correctional Health Care
• Develop Chronological Time Lines
• Policy and Procedure Development

Yolanda Anderson, RN, BSN, CEN, CLNC is a Registered Nurse and has been working in the Emergency Department for more than 25 years. A Certified Legal Nurse Consultant with a detail-oriented approach, Ms. Anderson is knowledgeable about all aspects of Hospital Care and Standards of Care for Physicians, Nurses and Ancillary Personnel.

Ms. Anderson's background experience includes work in the Emergency Department of Los Angeles County, USC Medical Center, a level I Trauma Center and in the Emergency Department at Saint Anthony Hospital Central in Denver, Colorado, a level I Trauma Center where she helped initiate the Hyperbaric Medicine program. For 15 years, she worked as a staff RN, Charge RN and Assistant Nurse Manager in the Emergency Department at Littleton Adventist Hospital - Littleton, Colorado, a level II Trauma Center. There, she helped with the expansion and reconstruction of the current Emergency Department facility.

Ms. Anderson has been retained as an Expert 27 times. Her litigation support services include chart review for merit, chronologies, medical care research, Independent Medical Assessments, and more. Ms. Anderson's services are available to attorneys for both Plaintiff and Defense.

Areas of Expertise:

Emergency Department Care Inpatient Hospital Care Trauma, Cardiac, Neurological Emergency Adult, Pediatric, and Infant Care

Triage & Documentation Nursing Home Care Electronic Medical Records Worker's Compensation

View Yolanda Anderson's Consulting Profile.

Expert Witness: Retained in Washington, D.C., and over 25 states as an expert in hospital administration who could render opinion after assessing medical records, hospital policies and procedures, medical staff bylaws and regulations, JCAHO standards, depositions, etc. Served as Expert Witness for Plaintiff and Defense. 

Consultant: Has assisted hospitals and health systems with accelerating their performance improvement efforts. Speaks, writes and consults on ethical issues in health care. 

Background Highlights:

• Consultant, Executive Vice President and Chief Operating Officer of the health system.
• Executive Director of two academic medical centers: Emory University Hospital in Atlanta, Georgia, Stanford University Hospital and Clinics at Stanford.
• Past chairman of the national advisory board for the University of Chicago’s Center for Clinical Medical Ethics.
• An author of over 175 publications, he has written articles for USA Today, Health Management Quarterly, Trustee, Health Progress, the Journal of Health Administration Education, Frontiers of Health Services Management, Bioethics Forum, Modern Healthcare, the Cambridge Quarterly of Healthcare Ethics, Stanford Medicine, and Healthcare Executive among others.
• Co-editor of Management Mistakes in Healthcare: Identification, Correction, and Prevention, published by Cambridge University Press in 2005.
• Co-editor of Managing Ethically: An Executive's Guide, published by Health Administration Press in 2001, and a second edition, Managing Healthcare Ethically: An Executive's Guide was published in 2010.
• Fellow of the American College of Healthcare Executives, a past member of its Leadership Advisory Committee, and a consultant on health care management ethics since 1994.
• Served as a Distinguished Visiting Scholar at Stanford University’s Center for Biomedical Ethics.
• Recipient of American Hospital Association's Award of Honor in 2009 and an Albert Schweitzer Leadership Award in 2012.
• Faculty appointments held at Harvard, UCLA, Stanford, Emory, the University of California, and Seton Hall University.
• Bachelor of Science, Master of Public Health, and Doctor of Public Health degrees are from the University of California, Berkeley.

Megan M. Hamilton, MS, CCC-SLP earned her Master of Science degree from Marquette University and holds a lean six sigma green belt from Purdue University as well as a Certificate of Clinical Competence from the American Speech Language and Hearing Association (ASHA).  Megan serves as a forensic medical SLP throughout the United States.  Megan has held positions as direct care provider, site manager, regional vice president, and division manager of clinical education for national rehabilitation providers in long term care, sub-acute, and pediatric care.   She brings over 40 years of experience to her clients.  

Litigation Support - No healthcare provider can prevent aspiration and/or choking for all patients at all times, but all can be expected to practice within accepted standards of care.  Megan's exhaustive review of case materials can determine whether diagnosis, evaluation, recommendations and discharge determination were based upon sound clinical reasoning to mitigate adverse outcomes and facilitate improvement or if they were substandard.  Megan provides evidence-based opinions whether care contributed to negative outcomes including suspected choking event, aspiration, dehydration, health decline or death or if it did not.  

Areas of Expertise:

Speech Therapy Speech Language Pathology Swallowing Oral Dysphagia Pharyngeal Dysphagia Esophageal Dysphagia TBI Expressive Language Receptive Language Parkinsons Choking Cognition Dehydration COVIDs impact on communication, dehydration and swallowing

Dementia Diet Texture Liquid Viscosity Aphasia Apraxia Dysarthria Developmental Disabilities Stroke CVA Proximal Cause of Death Aspiration Pneumonia End of Life Nutrition Executive Skills Standards of Care

The Lios Manhe (pronounced LIZ munee) mission is to be a trusted partner to plaintiff or defense by providing thorough analysis and independent opinions supported by science and based upon evidence collected.  
   

Research & Planning Consultants, LP (RPC) has been assisting clients with expert services for over 45 years, including consulting and expert witness testimony for personal injury, healthcare litigation, commercial litigation and Certificate of Need matters. RPC also offers a wide selection of health data. They have served clients across the U.S, from Alaska to Florida and from New England to California. 

A Complete Team of Damages Experts for Personal Injury Litigation

Research & Planning Consultants, LP provides the following services: 

• PERSONAL INJURY - RPC provides comprehensive damages analysis in personal injury litigation. Their expert team has life care planners, vocational evaluators, board-certified physicians, economists and neuropsychologists. 

Areas of Expertise include: Life Care Plans, Loss of Earning Capacity or Support, Present Value of Damages, Medical Bill Analysis, Chargemaster Analysis, Neuropsychological Testing & Traumatic Brain Injury, Vocational Evaluations, IMEs, Section 18.001, Prestanding ED Chargemaster Analysis

• COMMERCIAL LITIGATION- RPC has provided expert analysis on commercial litigation concerning many industries: chemicals, refining, forestry, waste management, pipelines, water resources, oil and gas EDP, fisheries, agriculture, electrical generating plants, transmission lines, telecommunications, and real estate development. Our special expertise in the healthcare industry has proven valuable to business litigators unfamiliar with this complex industry.

Areas of Expertise: Breach of Contract / Commercial Economic Damages, Construction Disputes, Litigation over Non-Competitive Agreements, Environmental Torts and Toxic Torts, Commercial Disparagement, Wrongful Termination

• HEALTHCARE LITIGATION - RPC offers economic, statistical, data and clinical analysis in a wide range of healthcare litigation. They have experience with payment disputes, qui tam litigation, physician-hospital disputes, practice valuations and construction litigation. 

Areas of Expertise: Qui Tam Healthcare Litigation, Medical Staff Disputes, Professional Liability, Payment Disputes, Health Facility Construction Disputes, Freestanding ED Chargemester Analysis

• CERTIFICATE OF NEED - RPC provides Certificate of Need (CON) planning services nationwide. We have over 35 years of experience developing regulatory strategy, preparing applications and testifying in public and administrative hearings.

Areas of Expertise: Satellite Hospitals, New Hospitals, Relocation and Transfer of Beds, Observation Beds, Geriatric Psychiatric Units, Children’s Hospitals, Comprehensive Inpatient Rehabilitation Units, Neonatal Intensive Care Units, Open Heart Surgery Services, Long Term Acute Care Units, Projects that exceed CON Capital Threshold Limits, Projects for Specifically Listed Services, Programs Requiring CON, Hospices, Senior Living Facilities

Ronald T. Luke, JD, PhD, is a principal consultant and President of RPC, LP. Ron joined RPC in 1976 and became its president and principal owner in 1979. He has consulted on projects for health care providers, managed care plans and public agencies in more than 25 states. He also serves as an expert witness in trials, administrative proceedings and legislative hearings.

Active in the Health Policy Arena, Dr. Luke has been accepted as an expert in Economics, Socioeconomic Impact Analysis, and Policy Analysis by state and federal courts, and state administrative agencies. The types of cases in which he has provided expert testimony include personal injury, contractual disputes, health care payment disputes, construction defects, utility construction permitting, and certificate of need. He has testified on health care matters including market structure, billing fraud and abuse, reasonableness of charges, medical staff credentialing, workers’ compensation fee guidelines, utilization review, physician contracts, and managed care contracts.

Kacy L. Turner, MS, CRC, CVE, CLCP, is a Certified Life Care Planner and Vocational Consultant with RPC. She has over 20 years of experience in Rehabilitation. Ms. Turner has experience writing life care plans for both plaintiff and defense clients. She has experience as a rehabilitation consultant in three states and has been qualified as a testifying expert in state and federal court.  

Ms. Turner has worked on cases in several states as well as the country of Trinidad. To determine the pre-injury and post-injury employability in personal injury cases, she provides vocational testing, transferable skills analysis, job requirements analysis, rehabilitation plans, and definition of reasonable accommodations under the American with Disabilities Act. She is a member of the International Association of Rehabilitation Professionals, the Texas Association of Rehabilitation Professionals and Providers of Services, and Vocational Evaluation and Career Assessment Professionals.

Brian Piper, PhD,  is an Economist with RPC specializing in Quantitative Analysis and Modelling. He works on a variety of cases including personal injury and certificate of need. He is experienced in data extraction, management, simulation, and analysis using STATA, SQL, ARC GIS and a variety of other programs. Dr. Piper has taught graduate classes in statistics and econometrics in both MBA and Ph.D. programs.

Dr. Piper is an experienced expert, providing testimony, reports, and affidavits on the issues of economic damages in personal injury litigation, healthcare litigation, False Claims Act litigation, and other commercial litigation. He has testified on behalf of plaintiffs and defendants. 

Dr. Piper specializes in the economics of healthcare. He has been retained by healthcare providers and insurers in payment disputes. He has analyzed the reasonableness of charges and expected payment for past and future medical services for providers, insurers, plaintiffs, and defendants. Besides work in litigation, Dr. Piper has provided analysis of Certificate of Need applications and the economic impacts of proposed legislation.