Medical Coder Donning An Expert Witnesses Garb
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Medical Coder Donning An Expert Witnesses Garb
The career path for informed medical coders is practically endless. But here’s something that might have never crossed your mind – that of an expert witness.
When providers are audited or pulled into court cases because the feds suspect them of false claims, defense attorneys quite often incorporate coders into the defense team. This is owing to the fact that federal fraud investigators and prosecutors often know very little about coding. And coding knowhow can be a key component of the provider’s defense, thus said otolaryngology coder Barbara Cobuzzi, who served as an expert witness on the defense team when the feds went after Dr. Mark Capner a few years ago. (To know about this landmark case pertaining to false claims, read American Medical News article.)
Although the Capner case is complicated, one crux of it is that federal prosecutors didn’t believe Dr Capner performed the number of sinus surgeries he submitted claims for, even though the surgeries were documented, said Cobuzzi at the Medical Billing & Collections Conference in Orlando. Although there were coding issues with his claims, he was actually undercoding his services.
Answering a question, “How does a coder get an expert witness consulting gig?” Cobuzzi says, “It’s all about networking.” Cobuzzi, who was AAPC’s ‘Networker of the year’ for 1999, spoke at AAPC local chapter events, conferences and other meetings. To paraphrase an old country song, she was blogging at a time when blogging wasn’t cool.
She relates that the Capner case was the first she worked on that went to trail and she actually took the stand. But she had other expert witness jobs where she did ENT coding research for the defense in cases that eventually settled out of court. Her first stint at an expert witness job came from an orthopedic coder who’d been approached by a defense team that needed an otolaryngology coder. The orthopedic coder recommended the lawyers call Barbara for the job as she had seen the latter comment on otolaryngology coding on list serves.
Erin Lang Masercola, PhD, CPC, has been writing about health care law, reimbursement, compliance and HIT for ten years. Most recently, she’s been collaborating with medical coders and software engineers to create an amazing new online coding reference tool called Supercoder.com. She is a certified professional medical coder through AAPC.
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