Medical Billing Under Scrutiny: What Experts Look for in Complex Cases

When medical billing ends up in a courtroom, the question isn’t just what was billed — it’s why.

In this episode of On the Stand with Ashish Arun, medical coding and compliance expert Toni Elhoms breaks down how expert witnesses evaluate claims, documentation, and coding patterns to uncover the truth behind complex healthcare disputes.

From fraud investigations to payer audits to documentation gaps that reshape liability, this conversation reveals the real mechanics of healthcare litigation — and how experts turn technical billing data into clear, defensible testimony.

💡 What You’ll Learn in This Episode:

• How expert witnesses reconstruct the clinical and billing story from documentation

• The core red flags experts identify in audits, fraud cases, and disputed claims

• Why methodology — not assumptions — drives credible expert opinions

• How payer rules, coding guidelines & compliance frameworks shape testimony

• The most common coding errors that shift liability

• How experts explain complex billing issues in simple, courtroom-ready language

• What “medical necessity” and “coding integrity” truly mean in litigation

👩‍⚖️ Who This Episode Is For:

• Expert witnesses in healthcare, reimbursement, or compliance

• Attorneys handling billing disputes, payer audits & fraud allegations

• Revenue cycle, compliance, and medical billing professionals

• Medical coders and auditors exploring expert witness work

• Anyone curious about how medical billing becomes legal evidence

📌 About the Podcast

On the Stand with Ashish Arun dives into the law, practice, and business of expert witness testimony.

Each episode brings forward real-world insights from experts and litigators on credibility, evidence, methodology, and courtroom strategy.

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