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Medical Billing Expert Witnesses

Medical billing disputes in commercial litigation typically arise when a healthcare provider, payer, or government program disagrees about whether billing practices and reimbursement claims complied with applicable billing rules, payer contracts, or regulatory requirements. These disputes surface in False Claims Act and qui tam actions alleging improper billing practices, in payer-provider disputes over usual and customary fee determinations and reimbursement calculations, and in vendor disputes over whether a billing system or outsourced billing service performed as contractually specified. Because medical billing applies detailed procedural and fee schedule rules to complex clinical services, reasonable billing professionals can reach different conclusions about whether a specific claim or set of claims was billed appropriately. The central issue is typically whether the billing practices, fee calculations, or system performance at issue met the standards the payer contract, regulation, or vendor agreement required.

A medical billing expert helps attorneys evaluate that question by reviewing billing records, fee schedules, and reimbursement calculations against the applicable payer policies, regulations, and contractual terms. In a False Claims Act matter, that analysis might involve auditing billed claims against underlying documentation and coding rules; in a usual and customary fee dispute, it can mean applying accepted fee benchmarking methodology to determine whether a reimbursement calculation was reasonable. These findings translate directly into positions on liability, damages calculated from improperly billed claims, and vendor performance, giving attorneys a defensible, methodologically grounded basis for litigation strategy.

Selecting the right medical billing expert means matching the assignment to a background in the specific billing system, payer type, or specialty at issue, since hospital billing, physician practice billing, and specialty billing systems each apply distinct rules and technology. Round Table Group's medical billing network includes health information management professionals, billing forensics specialists, and healthcare executives, several of whom have published on billing systems, fee negotiations, and billing accuracy. With more than 75,000 expert searches completed for litigators, we help attorneys match a case's specific medical billing issue to an expert whose credentials will withstand scrutiny. Let us help you find the right medical billing expert for your case by calling us at (202) 908-4500.

Kinds of Cases We Work On

Round Table Group helps our clients find a wide variety of Medical Billing expert witnesses for cases like:

01

RCM Vendor Billing Errors From a System Conversion.

A hospital system sued its outsourced revenue cycle management vendor after a system conversion caused widespread claim submission errors, resulting in a significant volume of denied and unbilled claims across several months. We identified experts with experience in revenue cycle management operations, medical claims processing, and healthcare billing systems. The expert's claims audit quantified the lost and delayed reimbursement attributable to the vendor's errors, anchoring damages for a substantial recovery.
02

Upcoding M&A Misrepresentation in a Practice Sale.

A private equity-backed platform sued the sellers of an acquired medical practice after discovering the practice's historical billing relied on a pattern of upcoded evaluation and management visits that inflated the revenue figures used to price the acquisition. We identified experts with experience in medical coding compliance, evaluation and management coding standards, and healthcare billing audit methodology. The expert's coding audit confirmed the systematic upcoding, supporting a settlement of over $28 million.
03

Payer Overpayment Recoupment Dispute Over Sampling Methodology.

A health plan sued a multi-specialty provider group to recover alleged overpayments identified in a billing audit, while the provider group disputed the payer's sampling methodology and extrapolation of the audit findings. We identified experts with experience in healthcare billing audit methodology, statistical sampling and extrapolation in payer audits, and medical coding compliance. The expert's review of the audit methodology found the extrapolation overstated the actual overpayment, supporting a substantial reduction in the recoupment claim.
04

Billing Company Timely Filing Failure on Claims Deadlines.

A physician practice sued its outsourced medical billing company after discovering the company had failed to submit a significant volume of claims within payer timely filing deadlines, resulting in unrecoverable lost reimbursement. We identified experts with experience in medical billing operations, payer timely filing requirements, and revenue cycle claims tracking. The expert's claims log audit quantified the unrecoverable lost revenue, anchoring damages for a substantial recovery.
05

Clearinghouse Processing Failure From a Software Defect.

A multi-site medical group sued its claims clearinghouse after a software defect caused a systemic pattern of claim rejections that went undetected for an extended period, resulting in significant unbilled revenue. We identified experts with experience in medical claims clearinghouse operations, electronic claims processing standards, and revenue cycle error detection. The expert's system audit traced the rejections to the clearinghouse's defect, supporting a substantial settlement.
06

DME Billing Kickback Exposure Through a Referral Network.

A durable medical equipment supplier sued a physician referral network after discovering the network had structured its referral arrangement in a way that exposed the supplier to a subsequent billing fraud investigation, alleging the network misrepresented the arrangement's compliance with billing regulations. We identified experts with experience in DME billing compliance, healthcare referral arrangement structuring, and healthcare regulatory compliance. The expert's arrangement review confirmed the compliance misrepresentation, anchoring damages for a substantial recovery.
07

Out-of-Network Reimbursement Dispute Over Emergency Claims.

A hospital system sued a health insurer over a pattern of underpaid out-of-network emergency claims, alleging the insurer's reimbursement calculation departed from the usual and customary rate methodology required under applicable billing regulations. We identified experts with experience in out-of-network billing and reimbursement methodology, usual and customary rate benchmarking, and healthcare claims payment analysis. The expert's rate benchmarking analysis confirmed the underpayment pattern, supporting a substantial settlement.
08

Chargemaster Rate Dispute Over an Outdated Schedule.

A hospital sued a managed care payer over a reimbursement contract dispute tied to the hospital's chargemaster, alleging the payer's claims processing system was misapplying an outdated chargemaster rate schedule to current billing. We identified experts with experience in hospital chargemaster management, healthcare reimbursement contract compliance, and claims payment auditing. The expert's billing system audit confirmed the outdated rate schedule was in use, anchoring damages for a substantial recovery.
09

Telehealth Billing Compliance Failure Over Modifier Misuse.

A health system sued its telehealth platform partner after an internal audit found a pattern of billing errors in the platform's claims submission process, including improper use of telehealth-specific billing modifiers, exposing the health system to payer audit risk. We identified experts with experience in telehealth billing compliance, evaluation and management coding for virtual care, and healthcare billing modifier usage standards. The expert's claims audit confirmed the modifier misuse pattern, supporting a settlement of nearly $10 million.
10

MSO Coding Practice Dispute Over Visit Complexity.

A physician practice sued its management services organization for breach of their management agreement after discovering the MSO's centralized billing operation had implemented coding practices that systematically overstated visit complexity levels across the practice's claims. We identified experts with experience in medical coding compliance, management services organization billing operations, and physician practice revenue cycle standards. The expert's coding audit confirmed the systematic overstatement, anchoring damages for a substantial recovery.

Here are a few of our favorite Medical Billing Expert Witnesses:

Louisiana Medical Billing, Coding, Charges Expert #17141

I have 29 years of experience, and specialize in the field of health information management with specific knowledge in the areas of medical coding, medical billing and reimbursement. I have published on such topics as medical billing and reimbursement systems, ICd-9-CM coding and current procedural terminology coding of diagnoses and procedures and hospital statistics. I am a fellow of the American Health Information Management Association (AHIMA).

 

Georgia Medical Billing Expert #20699

I have 29 years of experience and specialize in the field of medical billing, with specific knowledge of CPT, ICD and E/M. I have published on such topics as reimbursement, coding and billing. I have testified on coding and medical necessity.

 

Colorado Compliance, Medical Billing Expert #28120

I have 25 years of experience, and specialize in the field of healthcare with specific knowledge in the areas of compliance, coding and operations. I have published on such topics as compliance, coding and operations. I have broad experience in all areas of healthcare including operations, billing and coding as well as experience analyzing and training external and internal personnel in various facilities across the US. My experience includes medical office and facility (hospitals, surgicenters, etc.). I have a knack for being able to analyze a process, map it, understand it and identify the areas for improvement resulting in a…

 

Florida Medical Billing Expert #30269

I have 13 years of experience, and specialize in the field of medical billing with specific knowledge in the areas of billing, accounts payable, and medical coding.

 

Michigan Medical Billing Expert #41065

I have 19 years of experience, and specialize in the field of healthcare, with specific knowledge in the areas of medical billing and coding, accounts receivables recovery, and project management. I spent one year serving as the treasurer and I have been a speaker at a university.

 

Your Case Deserves The Best Medical Billing Expert Witnesses

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The right expert witnesses and consulting experts can make your case. That’s why we have spent so many hours over the past quarter century making sure our clients have just the right expert team — whether one expert or many, early-stage advice or expert reports and testimony. Across over 50,000 expert search assignments, we have honed a unique, customized approach to identifying, analyzing and connecting with expert talent so you can focus on winning your case.

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North Dakota Medical Billing, Medical Coding Expert #44196

I have 20 years of experience, and specialize in the field of medicine with specific knowledge in the areas of medical billing, medical coding and medical payment. I have published on such topics as billing, payment and coding. I have testified 50 times on topics such as medical billing, coding, payment and medical necessity.

 

Texas Medical Billing, Billing Expert #44995

I have 20 years of experience, and specialize in the field of medical negotiation with specific knowledge in the areas of usual and customary, medical billing and coding. I have published on such topics as billing accuracy, fee negotiations and usual and customary disputes. I negotiate on behalf of individuals, insurance companies and usual and customary disputes.

 

Massachusetts Medical Billing, Coding Expert #45333

I have 35 years of experience, and specialize in the field of medical billing with specific knowledge in the areas of reimbursement, codint and compliance. I have published on such topics as medical billing.

 

Ohio Medical Billing Expert #51238

I have 35 years of experience and specialize in the field of medical billing with specific knowledge in the area of all medical specialities.

 

Pennsylvania Medical Billing Expert #51525

I have 40 years of experience and specialize in the field of health care finance, systems and medical billing with specific knowledge in the areas of physician billing, billing companies and compliance. I have published on such topics as compliance, medical billing and billing systems. I have testified 50 times on topics such as medical billing, medical fees and compliance.

 

Put Our Medical Billing Expert Network to Work for You

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Our huge network of experts – eminent university professors and practitioners who have achieved renown as thought leaders in their fields – combined with unparalleled research capabilities puts the experts you need at your disposal when and where you need them.

If you’re a litigator or general counsel, we want to put this network to work for you and your clients. Let us know how we can help by calling us at (202) 908-4500 or filling out the form on this page. We’re so confident you’ll love what we do that unless you retain an expert we present there’s no charge!

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Questions Attorneys Ask About Medical Billing Expert Witnesses:

A medical billing expert typically becomes necessary in False Claims Act and qui tam actions alleging improper billing practices, payer-provider disputes over usual and customary fee determinations, and vendor disputes over whether a billing system or outsourced billing service performed as contractually specified.
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