Vident Partners provides vetted medical billing and coding expert witnesses for cases involving upcoding, unbundling, False Claims Act allegations, Medicare and Medicaid billing fraud, and improper reimbursement practices nationwide. Request a referral today.
Find a Medical Billing & Coding Expert →Overview
Medical billing and coding experts evaluate the accuracy of diagnosis and procedure codes, the documentation supporting claims, and compliance with payer and federal billing rules. The AAPC awards the Certified Professional Coder (CPC) credential to professionals who demonstrate proficiency in CPT, ICD-10-CM, and HCPCS coding rules for physician and outpatient services, while AHIMA awards the Certified Coding Specialist (CCS) credential to master clinical coders for inpatient and outpatient hospital settings 12. The False Claims Act (31 U.S.C. section 3729) imposes civil liability on anyone who presents a false or fraudulent claim to a federal program, with penalties including treble damages and up to $11,000 per false claim, and no specific intent to defraud is required 3. Their analysis is central to fraud, overpayment, and reimbursement disputes. The OIG enforces compliance through audits and civil and criminal prosecution of upcoding, unbundling, and documentation fraud 4.
The False Claims Act imposes civil liability for fraudulent Medicare or Medicaid billing, with penalties up to three times program losses plus $11,000 per claim and no requirement of specific intent to defraud.
Case Types
False Claims Act and qui tam billing allegations
Upcoding, unbundling, and miscoding disputes
Medicare and Medicaid reimbursement fraud
Payer audit and overpayment recovery matters
Documentation and medical necessity compliance
Qualifications
Related Specialties
FAQ
A qualified medical billing and coding expert witness should hold a CPC certification from AAPC or a CCS certification from AHIMA, with extensive coding, billing, and compliance auditing experience. Familiarity with CPT, ICD-10, and CMS regulations and prior deposition or trial testimony experience are strongly preferred.
Medical billing and coding experts are retained for False Claims Act and qui tam matters, upcoding and unbundling disputes, Medicare and Medicaid fraud, payer audits, and overpayment recovery actions. They also evaluate documentation and medical necessity to determine whether claims accurately reflect services rendered.
In general, medical expert fees are determined by the expert themselves, based on a variety of criteria. Among those criteria are clinical experience, forensic experience, academic qualifications such as Fellowships, clinical settings, and publications. Vident does have some influence over expert fees by comparing experts within a specialty, but ultimately it is a personal decision by the expert.
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Vident Partners connects attorneys with qualified medical billing & coding expert witnesses. Complimentary consultation, 24-hour turnaround, no obligation.
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