Medicare, Medicaid and Billing Expert Witness

Expert Witness No. 2223

Iowa

Summary

Expert 2223 has twenty years of healthcare experience ranging from a Renal Dialysis head nurse to a Medicare Fraud & Abuse Manager. She is also a certified professional coder. During the past sixteen years, Expert 2223 has assisted physicians, hospitals and clinics with being pro active in accurately coding and billing services to Medicare and Medicaid. Expert 2223 has assisted providers during criminal and civil actions as an expert witness and investigator for the plaintiff & defense during Medicare/Medicaid audits. She has developed a strong reputation for litigation support. Expert 2223 has provided consulting services to The Department of Justice oncriminalcases.  Expert 2223 has been a frequent speaker to many organizations throughout the country regarding coding, medical record documentation, and government compliance and HIPAA regulations. The Office of Inspector General awarded Expert 2223 the Superior Achievement Award for combating fraud.  Expert 2223 is a member of the American Academy of Professional Coders.                                           

Professional Experience

1998 to Present – Private Consulting Firm, Owner

Consulting with practices of physicians, hospitals, billing organizations, home health agencies and the Department of Justice.General areas of work include:

Medicare compliance audits including interpretation of Medicare regulations. Part A & Part B

Coding & documentation audits

Expert witness for prosecution and/or defense involving criminal and civil cases.

Analyze physician operations.

1997 to 1998 - McGladry & Pullen CPA

Same responsibilities as above. Department was eliminated

1993 to 1997 - Charles Bailly & Co. CPA

 Same responsibilities as above

1988 to 1993 - Seim, Johnson, Sestak & Quist CPA

Same responsibilities as above

1980-1988 Blue Cross of Iowa & BCBS of Western Iowa & SD, Manager Medicare BMedical Review

Implementing Medicare guidelines

Drafting Medical Review policies & procedures

Oversee all pre-pay and post- pay audit

Provider education concerning Medicare B regulations

Assist with drafting claims processing internal audits & edits

Develop provider policies for new Medicare regulations

Develop and refer criminal cases to the OIG

Expert witness during trial for non compliance of Medicare rules

Part A Medical Auditor

Audit all hospitals in South Dakota & half of Iowa for Part A Medicare compliance

Audit Nursing Homes & Home Health agencies in South Dakota for Part A compliance

Provide education to hospitals, nursing homes & home health agencies

Conduct home visits to determine patient eligibility for Part A coverage

Develop and refer potential fraud cases to the OIG for prosecution

Expert witness during trials for non compliance of Medicare rules

1976 to 1980 (Marion Health Center) Head Nurse and Renal Dialysis floor nursing(surgery)

1975 to 1976 Indian Hills Nursing Home

Aide and student nurse
Patient care
Pass medications
Patient treatments
Develop plan of care for new patients

Expert Witness Case History

Available upon Request

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