Health Law Network - serving attorneys, insurance companies & healthcare providers nationwide

Accounting

Antitrust

APCs

Billing

Clinical Documentation

Compliance Programs

Contractual Disputes

Cost Reports

Damages Quantification

Debt Restructuring

DRGs

Electronic Health Records

ERISA

False Claims

Forensic Accounting

Fraud

HIPAA

Assisted law firm representing one of the largest national home health chains to amend over 200 Medicare cost reports and recover over $2 million in additional reimbursement.

Performed strategic operational review for a 200 bed hospital, identified and prioritized key objectives for the Board and CEO, and provided an outsourced Compliance Officer and implemented a DRG Documentation & Coding Improvement Plan.

Developed self disclosure process for 12-hospital group, audited over 1,000 Medicare claims, and statistically determined overpayment settlement.

Provided litigation support to law firm defending physician against Medicare fraud charges, including testimony in US District Court.

Assisted law firm representing one of the largest hospital chains in rebutting an insurance carrier's allegations of unbundled charges and charges not allowed by Medicare for PPO patients.

Developed proforma detailed hospital and physician bill totaling over $1 million for an attorney representing a burn victim treated by a hospital that does not charge for its services.

Assisted law firm representing one of the largest national HMO providers in defending against allegations of improper payments and recovering overpayments.

Assisted law firm representing one of the largest US health insurance carriers in pursuing a fraudulent lab services provider.

Developed strategic business recommendations for $30 million specialty MD practice to establish succession plan, implement compensation plan and reduce risks.

Assisted law firm representing a large hospital chain by providing rebuttal report on the projected financial costs for a life care plan.

Calculated economic damages and served as advisor to law firm defending a national hospital chain against allegations of lost profits resulting from a failed sale of multiple hospitals.

Quantified damages for a hospital for the failed implementation of a new billing and collection system by a major information systems vendor.

Assisted law firm representing one of the largest national oxygen provider chains to defend against allegations of Medicare false claims.

Assisted attorney defending a physician against allegations of overcoding and false claims, involving 1995 and 1997 E&M documentation standards and certain CPT codes.

Assisted law firm representing a national benefits broker against allegations of the insurance brokers negligence regarding standards that are usual and customary in the health benefits industry.

Evaluated documentation to support and reasonableness of charges for over 1,900 medical services billed to a national insurance carrier.

Assisted law firm in an appeal to defend a multi-hospital system against allegations by a national hospital chain that the purchase price determination for a hospital should be revised.

Assisted law firm in a medical malpractice cases to evaluate medical records for completeness and identify potential spoliation of evidence for records that should have been included.

Assisted a multi-facility mental health facility provider in reviewing prior Medicare cost reports to identify substantial underpayments by their intermediary.

Assisted law firm representing a national HMO in a dispute over the prompt payment requirements and the completeness of claims involving over $1 million in disputed claims.

Assisted a state Attorney General office to evaluate their State Auditor's results for possible use in criminal fraud charges against a home health provider.

Evaluated potential unbundling of IV charges and proper cost report treatment of Observation Beds by multiple hospitals for an HMO.

Assisted law firm in evaluating the results achieved by a medical billing and collections service in comparison to industry averages.

Evaluated the reasonableness of potential Medicare and Medicaid reimbursement losses resulting from a fire that destroyed certain medical records.

Assisted law firm in quantification of proper payments for inpatient outlier claims, non-ASC procedures and late claims in a dispute between a managed care organization and a hospital.

Engaged by a state Medical Board of Examiners to evaluate the reasonableness of charges for a physician's claims.

Assisted law firm in reviewing over 50,000 pages of documents to evaluate compliance with Medicare's "incident to" requirements.

Assisted law firm representing one of the largest not for profit, muti-hospital systems in obtaining muti-million dollar settlements from two health insurance carriers over their incorrect payment of managed care claims.

Directed forensic audit of labor cost and fringe benefits for a $9 million contracted service dispute between two governmental entities.

Evaluation and report on usual, customary and reasonable (UCR) medical and prescription charges over 10 years for 20 personal injury plaintiffs involving over 150,000 pages of billing and medical record documents.

Developed statistical sampling plan to evaluate over 60,000 Medicare claims in a False Claims Act case within a tight court deadline.

Health Law Network practice expertise includes:

ICD & CPT Coding

Investigations

Insurance Claims

Managed Care Contracting

Medical Necessity

Medical Records

Medicare & Medicaid

Physician & Clinic Services

Practice Assessments

Professional Standards

Rate Setting

Reasonable Values

RAC & ZPIC Audits

Self Disclosure

Statistical Sampling

UCR Charges

Valuations

Representative Engagements

Health Law Network, Inc.

Atlanta, GA

Phone 770-645-5989

Email Info@HLNetwork.com

Health Law Network, medicare compliance, expert witness, investigations, litigation support, arbitrator, self disclosure, medicare, medicaid, compliance, compliance program, medicare fraud, healthcare fraud, insurance fraud, false claims, whistle blower, qui tam, IRO, independent review, coding, professional standards, quality of care, contractual disputes, billing, billing errors, coding errors, clinical documentation, accounting, antitrust, apc, business damages, cost reports, drg, erisa, hipaa, icd, cpt, hcpcs, insurance, managed care, medical staff, practice assessments, privacy, rate setting, rugs, valuations, hospital, physician, healthcare providers, risk management, statistical analysis, statistical projection, Certified Public Accountants, Certified Fraud Examiners, Credentialed Coding Experts, Medical Record Professionals, Nurses, Physicians, CPA, CFE, CCS, CPC, RHIA, RHIT, MT, RN, MD, Mastering Reimbursement, ADR, Alternative Dispute Resolution, Lamar Blount, HLN, HMA, Healthcare Management Advisors, key words

Health Law Network

Healthcare Billing, Reimbursement & Compliance Experts

U.S. District Court (NJ) Judge Jerome Simandle's opinion stated, "Mr. Blount is qualified to testify as an expert on Medicare reimbursement and billing issues. He possesses specialized knowledge, based on his over thirty years extensive experience as a healthcare auditor addressing Medicare reimbursement concerns and through his published works." (Landau v. Lucasti, Civil No. 06-1229)

State Court of Chatham County (GA) Judge Gregory Sapp's opinion stated, "the Court DENIES the Plaintiffs motion to exclude Mr. Blount's testimony regarding the reasonableness of her medical expenses. The Court finds this testimony might be helpful to the jury and the comparison of charges would be relevant to the jury's determination of reasonableness. (Miller vs. HFW, Civil No. STCV1702110SA)

U.S. 11th Circuit Court of Appeals opinion stated, "Blount’s and Schmor’s testimony did not violate the collateral source rule. Their testimony addressed the reasonableness and necessity of what Showan had paid for her discectomy. Whether the expenses were “reasonable and necessary” is a critical inquiry under Georgia law. ...Accordingly, the district court did not abuse its discretion in admitting the testimony of Blount and Schmor." (Showan v. Krispy Kreme, No. 17-15547)

U.S. District Court (CA) Judge Christina Snyder's opinion stated, "The Court finds that Blount is qualified to testify as an expert in this case. Blount has served as an expert in the medical billing field and has testified regarding medical billing issues in state and federal courts.... The Court also concludes that Blount’s methodology...is a sound analytical method that will assist the jury in understanding the relatively complex issue of medical billing practices." (Glenwood v. Augment, Civil No. 10-8910)

Muscogee County (GA) Superior Court Judge Maureen Gottrieds opinion stated, "“After hearing Mr. Blount's qualifications and testimony at the June 5, 2017 hearing on class certification, this Court finds that Mr. Blount is qualified to render an opinion as an expert in this case and therefore denies TMC's motion to exclude Mr. Blount's testimony.” (Enterprise Leasing and Danielle Bowden, et al v. The Medical Center, Civil Action File No. SU12CV2676)