EDUCATION:

 

Duke University Medical Center, Durham, NC
Specialty Residency in Internal Medicine, 1994-1997
Assistant Chief Resident, 1997

 

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Cornell University Medical College, New York, NY
Doctor of Medicine, May 1994
Junior and Senior Member of the Alpha Omega Alpha Honor Society
Co-Valedictorian

 

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Columbia College of Columbia University, New York, NY
B.A. Biology, 1990
Magna cum Laude
Phi Beta Kappa

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Concord University School of Law, Los Angeles, CA
Juris Doctorate, 2006
Graduated with Highest Honors
Passed the California Bar Examination in 2006

 

 

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LICENSURE:

● Licensed to practice medicine in North Carolina since 1995
● ABIM Board Certified Specialist in Internal Medicine since 1997
● Licensed to practice law in California since Dec 2006
● Licensed to practice medicine in Sweden since 2020
● Licensed Internal Medicine Specialist in Sweden since 2022

 

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WORK EXPERIENCE:

Medical Necessity Expert Witness and Consultant – MedNessity AB, Stockholm, Sweden.

Owner of this consulting firm which advises on complex medical-legal issues throughout the United States, as well as provides expert witness support.
Nov 2019 – Present

● Over a decade of experience in health law compliance with a focus on medical necessity issues: Advise healthcare providers on Medicare and Medicaid medical necessity billing, coding, and documentation requirements. Educate physician advisors and admitting physicians at healthcare systems throughout the United States as to an array of medical-legal issues. Conduct documentation improvement initiatives and provider education in hospitals throughout the United States.

● Independent Review Organization Experience: Perform medical necessity audits for several US Department of Health and Human Services (HHS) Independent Review Organizations (IRO). This workconcerns federal government enforced auditing of Medicare medical necessity, billing, and documentation requirements pursuant to Corporate Integrity Agreements (CIAs).

● Expert Witness Experience: See list of matters, below. Consult or testify in Medicare fraud investigations as well as in federal and state litigation that relates to medical necessity issues. My subject matter experience includes inpatient admission, inpatient rehabilitation (IRF), home health services, hospice services, skilled nursing facility services (SNF), cardiovascular procedures, emergency care disputes, hospital length of stay necessity, out of network care disputes, and payor-provider contract disputes that concern the medical necessity of hospital care. In addition, I have written thousands of Medicare and Medicaid provider appeals related to denials of payment based on alleged documentation and medical necessity errors. I have testified in hundreds of cases before the Office of Medicare Hearings and Appeals (OMHA).

 

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Emergency Care/Internal Medicine Hospital Physician – Karolinska University Hospital, Stockholm, Sweden.
Feb 2021 – Present

 

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Hospitalist/Internal Medicine Specialist – Dosher Memorial Hospital, Southport, NC.
Apr 2018 – Present

 

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Medical Director of Regulatory Affairs – EdiPhy Advisors, LLC, Birmingham, AL.

Medical necessity expert witness and consultant. Physician advisor. See experience noted above, under MedNessity AB.
Nov 2009 – Oct 2019

 

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Hospitalist/Internal Medicine Specialist – Sampson Regional Medical Center, Clinton, NC.
Sep 2012 – 2018

 

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Hospitalist/Internal Medicine Specialist – New Hanover Regional Medical Center, Wilmington, NC.
Dec 2011 – 2016

 

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Teaching Attending Physician – SEAHEC- Internal Medicine Residency, New Hanover Regional Medical Center, Wilmington, NC.
Dec 2011 – May 2012

 

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Medical Director – Wallace Urgent Care, Wallace, NC.
2010

 

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General Counsel – New Hanover Medical Group, P.A., Wilmington, NC.

In-house attorney for New Hanover Medical Group P.A., a medical corporation with three locations, over 20 providers, and 200+ employees. Oversaw corporate compliance with federal and state laws impacting healthcare providers.
2007 – 2009

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Medical Director – New Hanover Medical Group, P.A., Wilmington, NC.
2006 – 2007

 

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Internal Medicine Specialist/Primary Care Physician – New Hanover Medical Group, P.A., and New Hanover Regional Medical Center, Wilmington, NC.
1997 – 2009

 

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Vice Chairman of the Department of Medicine – New Hanover Regional Medical Center, Wilmington, NC.
2001 – 2002

 

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Assistant/Principal Investigator – New Hanover Medical Research Associates, Wilmington, NC.
1999 – 2003

 

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HONORS & AWARDS:

● American Law Institute/American Bar Association Scholarship and Leadership Award, 2006.
● Outstanding Achievement award for best academic performance in every first year Law School subject, 2003.
● “Best Brief” and “Best Oral Advocate” (defendant category) award at Concord Law, 2006.
● ALPHA OMEGA ALPHA, Medical Honor Society at Cornell Medical School, both junior and senior years,1992-1993 & 1993-1994.
● PHI BETA KAPPA, Columbia University, National Honor Society, 1990.
● John Metcalf Polk Award - Given to the top three graduates each year at Cornell University Medical College, 1994.

 

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EXPERT WITNESS TESTIMONY/DEPOSITION:

 

1. Testified at deposition 2014: UNITED STATES OF AMERICA, ex. rel. and ELIN BAKLID-KUNZ, Relator, Plaintiffs, v. HALIFAX HOSPITAL MEDICAL CENTER, d/b/a Halifax Health, a/k/a Halifax Community Health System, a/k/a Halifax Medical Center and HALIFAX STAFFING, INC., Defendants. Case No. 6:09-cv-1002-Orl-31TBS. United States District Court, M.D. Florida, Orlando Division.

● My testimony involved the portion of the case that addressed allegations of FCA violations in billing Medicare for medically unnecessary inpatient admission

 

2. Testified at deposition and Jury Trial 2017: UNITED STATES OF AMERICA, ex. Rel. Angela Ruckh, Realtor, plaintiffs v. CMC II, LLC; SEA CREST HEALTH CARE MANAGEMENT, LLC, d/b/a LAVIE MANAGEMENT SERVICES OF FLORIDA; SALUS REHABILITATION, LLC, d/b/a LAVIE REHAB; 207 MARSHALL DRIVE OPERATIONS, LLC, d/b/a MARSHALL HEALTH AND REHABILITATION CENTER; 803 OAK STREET OPERATIONS, LLC, d/b/a GOVERNOR’S CREEK HEALTH AND REHABILITATION CENTER, defendants. CIVIL ACTION NO.8:11 CV 1303 SDM‐TBM United States District Court, MD Florida, Tampa Division
● My testimony involved the portion of the case that addressed alleged FCA violations regarding the medical necessity of skilled nursing facility services.

 

3. Testified at deposition 2017: United States of America, State of IL, ex rel Dolan v. Long Grove Manor Inc., et al. Civil Action No. 10-CV-0368. United States District Court, Northern District of Illinois.
● My testimony involved the portion of the case that addressed alleged FCA violations regarding the medical necessity of skilled nursing facility services.

 

4. Testified at trial/hearing 2014: Crossroads Hospice of Kansas City, LLC v. Missouri Department of Social Services, Missouri Medicaid Audit and Compliance Unit. Administrative Hearing Commission, State of Missouri.
● My testimony addressed allegations of false billing of Missouri Medicaid related to the necessity and coverage of hospice services.

 

5. Testified at Arbitration Hearing 2016: Prime Healthcare La Palma LLC v. Kaiser Foundation Health Plan Inc., et. Al. JAMS Arbitration No. 1130006307.
● My testimony addressed the medical necessity of an array of hospital services and typical documentation practices in an out-of-network hospital billing dispute.

 

6. Testified at deposition and arbitration hearing 2018: Northwest Medical Center, Inc. et. al, (HCA) v. Coventry Health Care of Florida, Inc., and Aetna Health Inc.
● My testimony addressed whether emergency room services and inpatient hospital services qualified as “emergency services and care,” as defined by Florida law. This was an out-of-network hospital billing dispute.

 

7. Testified at Arbitration Hearing 2019: MIAMI BEACH HEALTHCARE GROUP, LTD.; COLUMBIA/JFK MEDICAL CENTER LIMITED PARTNERSHIP; KENDALL HEALTHCARE GROUP, LTD.; LAWNWOOD MEDICAL CENTER, INC.; HCA HEALTH SERVICES OF FLORIDA, INC., D/B/A ST. LUCIE MEDICAL CENTER; UNIVERSITY HOSPITAL, LTD.; COLUMBIA HOSPITAL (PALM BEACHES) LIMITED PARTNERSHIP D/B/A WEST PALM HOSPITAL; OSCEOLA REGIONAL MEDICAL CENTER, et al. v. CIGNA HEALTHCARE OF FLORIDA, INC AAA CASE NO. 01-16-0005-4885
● My testimony addressed the medical necessity of inpatient hospital care, the necessity of the length of inpatient stays, the necessity of intensive care unit (ICU) care, and the necessity of Inpatient status versus outpatient status with observation. This was a contract dispute.

 

8. Testified at deposition 2021: United States of America, ex rel. Cherry Graziosi, Relator, vs. R1 RCM Inc. f/k/a Accretive Health Inc., et al., UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS EASTERN DIVISION Case Number 13 C 1194
● My testimony addressed usual practices within the hospital Medicare compliance industry with a focus on the use of external physician advisor companies to aid compliance with Inpatient Status regulations. This is a federal anti-kickback, qui tam action.

 

US Department of Health and Human Services CIA Independent Review Organization: Some examples as lead physician documentation reviewer:

1. Community Health Systems
2. Quorum Health Corporation
3. Dignity Health
4. BayCare
5. Tenet Health
6. Team Health
7. Banner Health
8. Vitas Healthcare