Forensic, General & Medical
Expert Witnesses

Medicare Experts, Healthcare Compliance & Reimbursement Expert Witness

Health Law Network, Inc.

Health Law Network, Inc.

P.O. Box 2166
Atlanta, Georgia 30077-2166

Phone(770) 645-5989
Fax (404) 759-2114

Website www.hlnetwork.com
E-mail  Send an email

Expert WitnessForensic ExpertSpeaker
Health Law Network offers expert testimony on issues related to Medicare & Medicaid compliance, clinical documentation, ICD or CPT coding, hospital or professional fee billing, health insurance or quality of care issues. HLN provides access to experienced Reimbursement Experts, Certified Public Accountants, Fraud Examiners, Credentialed Coding Experts, Medical Record & Health Information Management Professionals, Statisticians, Nurses and Board Certified Physicians. We work with Attorneys, Insurance Carriers and Healthcare Providers nationwide seeking independent investigations and advice by industry experts.

Services

Health Law Network consultants' practice expertise includes:

• Accounting
• Antitrust
• APCs
• Billing
• Clinical Documentation
• Compliance Programs
• Contractual Disputes
• Cost Reports
• Damages Quantification
• DRGs
• ERISA
• False Claims
• Forensic Accounting
• Fraud
• HIPAA
• ICD & CPT Coding
• Investigations
• Insurance
• IRO Services
• Managed Care Contracting
• Medical Records
• Medicare & Medicaid
• Physician Services
• Practice Assessments
• Professional Standards
• Rate Setting
• Quality of Care
• RAC & ZPIC Audits
• Self Disclosure
• Statistical Sampling
• UCR Charges
• Valuations

Health Law Network was founded by Lamar Blount, the co-author of the American Medical Association's second and third edition best selling "Mastering the Reimbursement Process" book. The mission of HLN is to assist attorneys and those involved in the healthcare industry in their search for experienced professionals qualified to serve as:

- Independent Investigators
- Compliance Consultants
- Expert Witnesses
- Consultants to Legal Counsel

Health Law Network brings together the range of special talent needed to address most cases involving concerns about proper
reimbursement, adequacy of clinical documentation, accuracy of coding and quality of care, as well as allegations of false claims, Medicare or Medicaid fraud, antitrust violations and more. Health Law Network professionals include:

- Certified Public Accountants (CPA)
- Certified in Financial Forensics (CFF)
- Certified in Healthcare Compliance (CHC)
- Certified Evaluation and Management Coder (CEMC)
- Certified Forensic Interviewer (CFI)
- Certified Fraud Examiner (CFE)
- Certified Health Care Auditor (CHCA)
- Certified Professional Medical Auditor (CPMA)
- Certified Valuation Analyst (CVA)
- Credentialed Coding Experts (CCS, CPC-H and CPC-P)
- Facility Coding Specialist (FCS)
- Masters in Health Administration (MHA)
- Medical Record & Health Information Management Professionals (RHIA and RHIT)
- Professional Coding Specialist (PCS)
- Radiology Certified Coder (RCC)


Litigation Support Services

Health Law Network has served in over 200 cases, and our consultants have been admitted as an expert in multiple US District Courts and State Courts in the fields of Medicare & Medicaid reimbursement, healthcare finance, and other related areas. Additional services available include medical case reviews, case law research, and background checks on expert witnesses.

Areas of Expertise

Additional Expertise:

E/M Coding, ICD/CPT Coding, IRO Services, False Claims, Reasonable Charges.

Profile

Representative Engagements:

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, 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.

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.

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

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 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.

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

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.

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

Consulting Practice

All States

More Information

Health Law Network's Services, Expert Witness
About HLN's Professional Staff, Expert Witness
About L. Lamar Blount, CPA, FHFMA, CFF - Expert Witness
Quotes from HLN Clients, Litigation Support
Health Law Network, Inc. Resources, Legal Consultant
Contact Health Law Network, Expert Witness

Professional Experience

2003 – present - HLN – Health Law Network, Inc. - President & Founder
– Litigation support and compliance consulting practice, providing assistance in Medicare & Medicaid compliance, False Claim Act cases, hospital & physician reimbursement, clinical documentation, ICD and CPT coding, billing disputes, and quality of care issues. Clients have included hospitals, physicians, insurance companies and healthcare law firms nationwide.

2002 – present - ABA - American Benefit Advisors, Inc. - President & Founder
– Provides innovative employee benefit solutions to employers through improved benefit plans and communications, including plan design, TPA selection, web based enrollment and benefit communication systems. Clients include privately held and public organizations ranging from two to 1,000 employees throughout the Southeast.

1990 – 2002 - Healthcare Management Advisors - Chairman & Founder
- National consulting firm, which included MD, RN, RHIA, MHA, and CPA consultants who served more than 1,600 hospitals and healthcare providers in 50 states.

1981 -1990 - Hyatt, Imler, Ott & Blount - Partner & Co-Founder
- Co-founding partner of the tenth largest CPA firm in Atlanta (as of 1990).

1974 - 1981 Ernst & Young - Atlanta - Healthcare Audit Manager
- Supervised substantially all financial audits and reimbursement consulting engagements of Georgia healthcare clients.


Licenses

Certified Public Accountant - 1976 - Georgia # 3625
Property & Casualty Insurance Agent – 2001 - Georgia # 595707
Life, Accident & Sickness Insurance Agent – 2002 - Georgia # 595707


Legal Experience & Services

Advantage Health Plan v. Lake Physician Health Organization
Aetna, Inc. v. MedTest Express
Ben Bane v. Lincare, et al.
Bice, et al., v. Micon, Inc., et al.
Brooklyn Hospital v. Grinnell Corp
Bryden v. Wyoming Medical Center
Charter Northside, et al. v. Georgia DMA
City of Clinton Iowa vs. Hopkins and Michael Walker
Commonwealth of Kentucky v. Lawrence Suess, MD
DeKalb Medical Center, et al. v. Georgia DMA
Dr. Amado Viera v. FL Agency for Health Care Administration
Eastwood Enterprises, et al., v. Todd Farha, et al.
Evergreen Rehabilitation v. Senior Care Group
Fulton County Georgia v. City of Sandy Springs
Glenwood Systems, LLC vs. Augment Technology Solutions
Grady Memorial Hospital v. City of Alpharetta
Groves v. State Farm Fire & Casualty Company
Health Management Associates v. Ty Cobb Healthcare System
Healthcrest, Inc. v. American Medical International
Mariann S. Mashburn, et al., v. National Healthcare
Mashburn, et al., v. National Healthcare, Inc.
Medirest, Inc. v. Jane’s Billing & Consulting Services, Inc.
Memorial Hermann Hospital System v. Aetna Health, Inc.
Mitchell v. Conseco Life Insurance Company
Oklahoma Heart Hospital, LLC, v. OneBeacon Insurance Company
OrthoConcepts, et al. v. Shalala
Our Lady Of The Lake Regional Medical Center v. Ochsner Health Plan
Page v. Fourroux Orthotics & Prosthetics
People of Michigan v. Friends Who Care, Inc.
PPO Check v. Midwestern Regional Medical Center
Propath Associates v. First Health Group
Provident Bank Of Maryland v. RSM McGladrey
Provident Bank of Maryland v. RSM McGladrey
Rencare, LTD v. Humana Health Plan
Revco v. Georgia DMA
Schantz v. State of New Jersey
Shands Teaching Hospital and Clinics v. Beech Street
Shared Medical Resources v. Sumter County Hospital Authority
Silvana Landau v. Christopher Lucasti
State Farm Fire and Casualty Company v. Samy Bishai, M.D.
Tenet Hospitals Limited v. Trustmark Insurance Company
Texas Medical Board v. Andrew Campbell, M.D.
Timothy Schultheis v. City of Clinton, Iowa
Unterschuetz and US v. In Home Personal Care
USA ex rel. Reynolds v. Planned Parenthood Gulf Coast
USA ex rel. Sharp v. Eastern Oklahoma Orthopedic Center
Western Orthopaedic & Sports Medicine Consultants v. HealthLink
William Cronin v. PHNS, Inc.


Affiliations

American Institute of CPAs
American Health Lawyers Association
Association of Healthcare Auditors and Educators
Georgia Society of CPAs
Healthcare Financial Management Association
National Association of Health Underwriters
Society for Financial Service Professionals


Qualifications

– Developed and manages litigation support and compliance consulting practice, providing assistance in Medicare & Medicaid compliance, False Claim Act cases, hospital & physician reimbursement, clinical documentation, ICD and CPT coding, billing disputes, and quality of care issues. Clients have included hospitals, physicians, insurance companies and healthcare law firms nationwide.

- Developed and manages insurance agency providing employee benefit solutions to employers through improved benefit plans and communications, including plan design, TPA selection, web based enrollment and benefit communication systems. Clients include privately held and public organizations ranging from two to 1,000 employees throughout the Southeast.

- Developed national healthcare consulting firm, which included 100 person staff with MD, RN, RHIA, CPC, MHA, and CPA consultants who served more than 1,600 hospitals and healthcare providers in 50 states.


Awards & Honors

Healthcare Financial Management Association Awards
- Follmer Bronze, Reeves Silver, Muncie Gold, and Founders Medal of Honor


Seminars & Training

“Blue Cross Hospital Reimbursement Issues”- Arkansas Hospital Association
“Coding & Billing Issues” - Risks & Opportunities - AICPA/HFMA
“Compliance Issues Update” - Georgia and Alabama HFMA
“Controlling Compliance Risks” - American Association of Physicians & Surgeons
“DRG Assignment and Validation” - Texas Medical Record Association
“Finance and Reimbursement Issues” - National Association of Public Hospitals
“Life Insurance and Tax Law for CPAs” - Healthcare Benefit Advisors
“OIG Workplan Update” - Georgia and Dixie Institute HFMA
“OIG & Auditing Issues” - 2010 National AHCAE Conference
“Physician Compliance Issues” – Georgia HFMA
“Self-disclosure & Corporate Integrity Agreements” - NY State Society of CPAs


Publications

Mastering the Reimbursement Process – Second & Third Editions - Co-author for AMA
Strategy Advisor – Editor and Publisher 1990 - 2003
Hospital Payment & Information Management - Editorial Advisory Board 1990 - 1995
Medical Office Manager - Editorial Board since 1992
Medical Records Briefing - Editorial Advisory Board 1992 - 2001
Physician's Payment Update - Editorial Advisory Board 1990 - 1995
Report on Medicare Compliance - Editorial Advisory Board 1997 - 2001


Professional References

Quotes from HLN's Clients:

"HLN's research and analysis identified several key points in the case that we may have overlooked without you. Your help has been invaluable."

"HLN sifted through a mass of documents, identified key facts and provided the unique insight overlooked by the other experts that was needed to provide our client with a much better settlement than we expected."

"I very much appreciated your thoroughness and timely assistance in my case. What seemed at first to be overwhelming became understandable with your guidance and perseverance. Thanks for your great work."

"The jury returned a verdict in [our] favor, which was in no small part due to your testimony. The damages awarded were less than we wanted, but [client] is quite pleased he was able to vindicate his name. And again, thanks much for all your help. It was a pleasure working with you."

"Thanks for all of your assistance in this matter. In addition to the positive result that we were able to obtain for our client with your help, we were able to get a federal court opinion touting your qualifications as an expert in the field."

"We appreciated HLN’s prompt and professional assistance, including the attorney referrals and suggested strategy for negotiating with a large commercial payer, which resulted in a very favorable settlement."


Education

BBA with Major in Accounting - 1974 - Georgia Southern University





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