Medical Coding Expert Witness
& Litigation Support Services

Toward the resolution of matters in dispute, AAPC Services provides reliable medical coding and billing expertise for the litigation process — everything from investigative medical auditing and consultation to deposition and court testimony.

Medical Coding and Billing Litigation Support Services

AAPC specializes in healthcare reimbursement. We know the regulations and guidelines governing medical billing and coding. We also know the cost of error, which can exceed tens of millions of dollars. As the leading credentialing organization of healthcare information management professionals, we set the standards for expertise. Should you need that expertise in relation to litigation of alleged improper billing and coding, we can ensure you receive accurate and trustworthy litigation support.

AAPC Services offers investigative medical auditing, consultation, and expert witnesses for deposition testimony and court testimony. We work with legal teams on behalf of plaintiffs, defendants, patients, providers, payers, and government agencies. Our experts have provided litigation support in criminal and civil cases and in state and federal courts.

Our medical billing expert witnesses each bring three decades of experience to the table.

  • As medical auditors, they have consistently demonstrated accuracy assessing allegations.
  • With tenures in the classroom and bylines in industry publications, they have proven adept at breaking down coding nomenclature and simplifying the complexities of coding and billing regulations, code set guidelines, and payer guidelines.
  • As subject matter experts, they have reliably delivered compelling witness testimonies in depositions and in open court, remaining clear-headed and articulate amid adversarial cross-examination.
Medical Billing and Auditing Experts

Medical Billing Expert Witnesses: Areas of Expertise

With extended experience across multiple places of service, our medical billing experts possess master-level proficiency in ICD-10-CM and -PCS, CPT®, and HCPCS Level II — as well as the methodologies that link these code sets to APCs, MS-DRGs, MS-LTC-DRGs, HHRGs, RUGs, and CMGs. Their medical specialty experience is equally diverse, ranging from pediatrics and behavioral health to anesthesiology and level 2 trauma. Cases in which they’ve provided litigation support include:

  • Malpractice
  • Medical necessity (based on chart review)
  • Wrongful death
  • Healthcare fraud
  • Qui tam actions
  • Overbilling and concealment
  • Payer/provider disputes
  • Lack of physician oversight

Medical Coding Expert Witness Credentials

In meeting trial evidentiary standards, our expert witnesses have been qualified through knowledge, skill, practical experience, training, and education. Below is a partial list of credentials held by our three litigation support experts.

  • CPC — Certified Professional Coder
  • CPCO — Certified Professional Compliance Officer
  • CPC-I — Certified Professional Coder, Instructor
  • CHCO — Certified Healthcare Compliance Officer,
  • CIC — Certified Inpatient Coder
  • Healthcare Compliance Resources
  • CCS — Certified Coding Specialist
  • CPAR — Certified Patient Account Representative
  • CCS-P — Certified Coding Specialist, Physician
  • CRCR — Certified Revenue Cycle Representative
  • CICA — Inpatient Coding Auditor, HFMA
  • CPHM — McKesson Health Solutions
  • COC — Certified Outpatient Coder
  • CPUM — McKesson Health Solutions
  • Approved ICD-10-CM/PCS Trainer
  • CPUR — McKesson Health Solutions
  • CEMC — Certified Evaluation and Management Coder
  • ACS-OP — Decision Heath
  • CFPC — Certified Family Practice Coder
  • FCS — American College of Medical Coding Specialists
  • CDIP — Certified Documentation Improvement
  • PCS — American College of Medical Coding Specialists
  • Practitioner
  • CPMA — Certified Professional Medical Auditor
  • RCC — Radiology Coding Certification Board
  • RMC — Association of Registered Healthcare Professionals

Special Investigations & Repayment Appeals

If facing repayment request resulting from a federal contractor or payer audit, let us validate the accuracy of audit findings. We have experience responding to the Centers for Medicare and Medicaid Services reviews associated with pre- and post-payment audits, particularly with:

  • Quality Improvement Organization (QIO)
  • Recovery Audit Contractor (RAC)
  • Supplemental Medical Review Contractor (SMRC)
  • Unified Program Integrity Contractors (UPICs)
  • Investigations Medicare Drug Integrity Contractor (I-MEDIC)
  • Plan Program Integrity Medicare Drug Integrity Contractor (PPI MEDIC)

Our audit team often identifies errors in third-party determinations that reduce repayments. When money is owed, we can help you avoid repayments in the future by teaching your staff how to correct trends in documentation and coding.

Independent Review Organization

If your provider organization is required by the Office of Inspector General (OIG) to participate in a Corporate Integrity Agreement, AAPC Services can serve as your Independent Review Organization (IRO). We work with a variety of government agencies and attorneys general throughout the U.S.