Criminal Fraud – Expert Testimony
Testified as an expert in U.S. District Court rendering opinions on forensic accounting and statistical analysis related to allegations of criminal healthcare fraud. Statistically sampled and analyzed medical equipment billing and coding records along with patient medical records to identify indicia of fraud and to calculate financial damages. We analyzed over 100,000 lines of hospital billing data to determine the amount of reimbursement from Medicare/ Medicaid related to the doctors and practice groups in question.
Internal Investigation – Hostile Management Takeover
Retained as a testifying expert on behalf of an $80 million Managed Services Organization (MSO) to conduct an internal investigation following the company’s hostile management takeover. Analyzed financial records related to various Accountable Care Organizations (ACOs), healthcare IT partnerships, and joint ventures. Identified and quantified several business arrangements potentially subject to Stark and Anti-Kickback regulations.
Statistical Sampling & Extrapolation
Retained as a consulting sampling expert on behalf of a Fortune 500 hospice provider to design and select a statistically valid random sample (SVRS) of patient claims. Implemented stratification and cluster sampling and worked closely with clinical experts to extrapolate decisions of medical necessity.