Expert Details

Expert in Health Care Compliance

Expert ID: 736056 Ohio, USA

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I am a physician functioning on the business and legal sides of medicine, providing professional services and support to the health care industry. I have over 25 years of combined healthcare, business and consulting experiences in day-to-day operations as well as projects and matters involving physician practices, hospital systems, pharmacies, medical executives, office staff and administration, medical billing companies, Medicare and Medicaid, commercial insurance companies, attorneys and patients. I am frequently retained by or through health law attorneys on behalf of health care providers for compliance program, litigation support and expert witness services, including for fraud and abuse matters.

I earned my MD in 1994 and my MBA in 1999. I’ve been an American Academy of Professional Coders (AAPC) - Certified Professional Coder (CPC) since 1996, and have followed that up with certification as an instructor (CPC-I) in 2008 and Certified Professional Medical Auditor (CPMA) in 2018. My concentration is on physician / professional fee coding, compliance, auditing, billing and documentation, but I have also worked from the hospital / facility perspective. My coding expertise includes CPT, E/M, ICD10, HCPCS level II and HCCs. I’ve worked in employment roles for cancer, adult and pediatric hospitals, as well as a consultant for a big-four, mid-size, and my own consulting company.

I also completed a one-year residency in General Surgery for the academic year 2012-2013, serving as a refresher in clinical medicine, exposing me as a clinical user to electronic medical records, and providing additional insights into clinicians and the practice of medicine. My strengths include my blend of clinical and coding expertise and my attention to detail.

Expert may consult nationally and internationally, and is also local to the following cities: Columbus, OH - Cleveland, OH - Cincinnati, OH

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Education

Year Degree Subject Institution
Year: 2013 Degree: MD, PGY-1 Subject: General Surgery Preliminary Internship Institution: Michigan State University
Year: 1999 Degree: MBA Subject: Business Administration Institution: Ohio University
Year: 1994 Degree: MD Subject: General Medicine Institution: University of Cincinnati College of Medicine
Year: 1989 Degree: BS Subject: Biological Sciences Institution: Wright State University

Work History

Years Employer Title Department Responsibilities
Years: 2000 to Present Employer: Undisclosed Title: Health Care Compliance Consultant Department: Responsibilities: Provide professional billing, coding, documentation, compliance and other medical business and legal services and support to the healthcare industry.
Years: 2017 to 2019 Employer: Crowe Healthcare Risk Consulting, LLC Title: Compliance Audit Manager Department: Compliance Responsibilities: Managed healthcare client engagements primarily for audit work, in both external and internal audit capacities.
Years: 2015 to 2016 Employer: Nationwide Children's Hospital Title: Supervisor, Coding and Charge Entry Department: Pediatric Academic Association, Inc. / Professional Billing Responsibilities: Managed the Coding and Charge Entry departments (20 internal employees and external contract coders, as needed) for Pediatric Academic Association, Inc., a 500+ teaching physician and advanced practice nurse multispecialty group practice.
Years: 1998 to 2000 Employer: Ernst & Young, LLP Title: Senior Consultant Department: Healthcare Litigation Advisory Services Responsibilities: Served clients as part of the Healthcare Litigation Advisory Services and Healthcare Consulting Services teams.
Years: 1996 to 1998 Employer: DMF of Ohio, Inc. / The Ohio State University Medical Center Title: Coding and Reimbursement Manager and Specialist Department: Department of Internal Medicine Responsibilities: Managed and executed coding, compliance, contracting, credentialing and reimbursement functions for The Ohio State University Department of Internal Medicine, a then-independent 170+ teaching physician and advanced practice nurse multispecialty group practice.

Career Accomplishments

Licenses / Certifications
American Academy of Professional Coders (AAPC) member
Certified Professional Coder (CPC), 1996
Certified Professional Coder- Instructor (CPC-I), 2008
Certified Professional Medical Auditor (CPMA), 2018

Fields of Expertise

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