Affordable Care Act Expert Witness Work Requires Attorney Education

In my work as an expert witness regarding the Patient Protection and Affordable Care Act (also known as the “ACA” or “Obamacare”), I find that more medical malpractice and personal industry cases as well as cases involving requirements for insurance coverage for self-insured employer’s employees encompass ACA in their scope.  New entities called Accountable Care Organizations (ACOs) that blend the functions of a health care provider and a payor (insurance) into a new entity may be factors.

Therefore ACA may change the economics of healthcare as they apply to a legal matter involving damages, value of care, or insurance coverage and benefits.

The Affordable Care Act contains hundreds of pages on electronic, economic, patient engagement, and fiscal revisions that impact health plans, hospital systems, physician groups and healthcare IT firms.  The Affordable Care Act must not be viewed in a vacuum; the HITECH Act, International Classification of Diseases version 10 (ICD-10) and other data, industry best practices and guidelines must be considered.  Medicaid waivers before and after the Affordable Care Act, as well as whether the matter involves Medicaid expansion which is a state by state issue.

Just as it has taken time to educate health care providers and payors, parties to litigation and their counsel will evolve to an improved understanding of the Affordable Care Act as its many complexities and nuances are included in the facts tried in court.  Expert witnesses must simplify the ACA so that the ‘trier of fact’ or jury can understand the issues that are relevant to the case.  An expert witness must do this in a neutral, unbiased way.

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Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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