Litigation Support & Expert Testimony

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.

Post-Acquisition Investigation – Expert Report

Retained as a testifying expert on behalf a $100 million pharmacy services company to conduct an internal investigation related to the company’s acquisition. Analyzed financial records related to payer obligations for federal, state, and 3rd party payments.   Quantified in excess of $50 million of financial damages due to improper billing and accounting practices.

CMS Repayment Appeals – Expert Report

Retained on multiple occasions as a testifying sampling expert on behalf of a physician practices to assess the statistical validity and conclusions of Centers for Medicare and Medicaid Services (CMS) demands for repayment. Authored expert reports in support of the practice’s repayment appeal.

Internal Investigation – Revenue Recognition

Conducted an investigation in response to a formal SEC inquiry on behalf of a Fortune 100 energy parts manufacturer. Addressed the treatment of in-transit products and the timing of revenue recognition. The investigation resulted in a $128MM restatement of earnings.

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