health care experts

This case involves a whistle blower plaintiff who was terminated in retaliation for raising concerns about the lack of direct clinical services provided to the patients of the defending facility. The defendant offered mental health services at a residence in the community for its clients, defined as a private non-medical institution. The clients were eligible for Medicare and Medicaid and received a variety of services for which the defendant received reimbursement. The plaintiff was employed with the defendant for several years. He was described as a “top notch” performer and was praised for his role in the company. During his last few months of employment, the plaintiff became increasingly concerned that the clients were not receiving counseling or other services directly from the defendant’s clinicians. Rather, the only clinician involvement in clients’ plans was to participate in staff meetings and provide feedback to non-clinical staff regarding the clients. He repeatedly raised concerns about the lack of direct clinical services but little or nothing was done to address these issues. He witnessed the clients were not provided with updated Individual Service Plans and clients went for periods longer than ninety days without receiving an update. He was ultimately terminated. Plaintiff’s counsel seeks an expert on the issue of Medicare and Medicaid regulation, as well as the preconditions to receipt of these federal funds in the context of providing services to adults with developmental disabilities.

Question(s) For Expert Witness

1. Please discuss your background working in with Medicare and Medicaid

2. Please explain the standards, preconditions and requirements for payment by Medicare and Medicaid

3. Are you able to opine on Medicare and Medicaid standards for such services provided to the clients?

4. Have you ever served as an expert witness on a case similar to the one described above?

Expert Witness Response E-011262

This case is squarely within my expertise. When I was a provider relations specialist I would travel across the state teaching providers on billing and compliance. I also worked with counterparts to build a medicaid system that would appropriately pay medicaid claims and would comply with federal regulations.