Michael F Arrigo

Legal Experience - The U.S. Court of Appeals considered my opinion, partially VACATING and REMANDING criminal sentencing in a Medicare, Tri-Care, Medicaid, and commercial insurance criminal fraud case. Affirmed by Federal Judges as Expert, State Judges and Arbitrators. Expert has never been excluded. U.S. District Judge Lew in the Central District, 9th Circuit, Denied motion to exclude me and affirmed me as an expert in medical coding, medical billing, Medicare Fraud, and an expert in damages calculations, electronic health records.
(See separate document for list of cases, testimony, basis for opinions).

Recent work for the U.S. Department of Justice. Three-time DOJ expert, engagement on $900 million fraud investigation of EHR and $50 million fraud re evaluation and management coding and billing. Healthcare IT patent infringement cases. Testimony before the U.S. Federal Trade Commission, other Federal, State and County Superior Court jurisdictions, written testimony in expert reports, life care plan rebuttal expert witness, depositions, and court appearances. Balanced plaintiff, relator, and defendant retentions and experience across pharmaceuticals, medical devices, orthotics, diagnostic imaging, ambulance, anesthesia, orthopedics, cardiology, pediatrics, payors (including Medicare, Medicaid, social security, workers compensation, Medicare Secondary Payer Act in tort cases, private insurance / health plans), hospital systems, patients and healthcare IT engagements. Experienced in the use of eDiscovery tools such as Relativity for expert-attorney document discovery work. Plaintiff's duty to mitigate damages with respect to health care / medical costs. industry best practices on hiring practices by the Joint Commission, the leading accreditation body for hospitals in the U.S. Eligibility to receive Medicaid and Medicare payments via accreditation. Knowledgeable about Medicare Administrative contractors, Medicare Base Units, RVUs, conversion factors, geographic adjustment factors. Durable Medical Equipment (DME) / DMEPOS and HCPCS Codes, Lab test / Pathology including esoteric tests, opioid addiction, opioid prescribing and supply chain, opioid adverse reactions and patient safety, pain management contracts and toxicology tests for opioids.

Opinions regarding HIPAA Privacy and Security (as well as health care related Cybersecurity standards and preventative measures, information safeguards, such as administrative, physical, technical and policies and procedures, penetration testing 'pen testing'), Affordable Care Act, HITECH Act (essential health benefits Medicaid Expansion, qualified health plans, health plan rescission policies, federal poverty level guidelines for subsidies), Meaningful Use of Electronic Health Records, Inpatient Prospective Payment System, 3-day payment rule, CORE Operating rules, Computer Assisted Coding, Outpatient Prospective Payment System, Physician Fee Schedule, Medicare Administrative Contractors, Usual Customary and Reasonable Cost of care (medical coding and billing value), Medicaid expansion, Qualified Health plans under Nevada Labor Law, Nevada law regarding uninsured patient discounts, California Law regarding confidential medical information, Benefits Administration, Risk Adjustment and Fraud under Qui Tam Provisions of False Claims Act, Medicare Part C HCC codes. Eligibility and coverage determinations. CRPS, future medical expenses including pain management modalities (Ketamine Infusions, Continuous Epidural Spinal Infusion, Continuous Spinal Cord Stimulator, Dorsal Root Ganglia Stimulator). Trauma activation fees, ambulance fees (mileage, supplies, CMS billing rules). Prior work in EMTALA, Ambulance Diversion, Discharge and transfer documentation, history and physical and medical screening examinations (MSEs) under EMTALA. Forensic electronic health record auditor.

Summary of Accomplishments and Experience

I work with hospital systems, physician groups, and health IT companies, health plans, investors, and law firms. I was selected as an expert for a landmark Federal Trade Commission case regarding healthcare data, regulations and economics. I currently serve as managing partner of No World Borders. I am:
• A writer and speaker quoted in Wall Street Journal, and a regular speaker with published works as an expert in the field.
• Experienced at giving oral and written testimony, undergoing cross-examination and preparation for a Daubert hearing before FTC Commissioner Brill. Trained by leading litigation firm in in Rule 702 including applying scientific or specialized knowledge (702(a)); facts (702(b)); application of principles and methods (702(c)); application of criteria, principles, methodology, test methods (amended in Daubert, 2000 - (702(d)).
• An advisor to population health companies including health care systems, Medicare Advantage, Medicare Shared Savings ACOs, Health Plans, Accountable Care Organizations. Led investor diligence on over $4 billion in M&A activity.
• Experienced in clinician, coder, medical billing, claims, E.H.R, hospital and practice management software, and regulatory usual, customary and reasonable (UCR) medical and prescription charges experience having opined on over $1 billion in medical reimbursements for inpatient facilities (inpatient prospective payment system or IPPS and DRGs, ICD-9) and ambulatory (non-facility using CPT codes as well as dental CDT "D" codes.
• Skilled at explaining complex concepts such clinical records and their financial value via medical coding, HIPAA, EDI, claims, ARRA HITECH, Affordable Care Act and other factors. I work with defense and plaintiffs on medical cost mitigation, payor-provider contracting and reimbursement, and other processes and I manage a team that has advised over 100 clients in these areas.
• Balanced experience working with counsel for plaintiffs / defendants as well as perspectives of health care payors, providers, patients, health IT. Skilled in coordination with counsel regarding the citation of statutes, case law, personal knowledge, training and experience to provide objective, documented opinions with peer-reviewed results.