Find a Pain management expert witness understanding capabilities

Finding a pain management expert witness requires special criteria.  For example, there are a few key elements one should evaluate. Execution of provider, prescribing data, and payor audits for Controlled Substances Act compliance and pain management.  Specifically, experience in chart reviews may be relevant.  Furthermore, coding and billing disputes and DEA Diversion Control investigations of controlled substances providers. 

Controlled Substances Act Compliance Audits

Pain ManagementTo find a Pain Management expert witness assess their familiarity with audit protocols based on the Controlled Substances Act:

    1. Audit Protocol Development Methodology
    2. Goals in Reviewing a Pain Management Practice
    3. Physician Prescribing Analytics
    4. Examine Prescribing Volume and Days of Supply per Patient
    5. Diagnoses of population and medical necessity of opioids
    6. Initial Patient Intake and Examination
    7. Formulation of Treatment Plan
    8. Pain Management Agreement
    9. Re-Assessment
    10. Objective Measures and Corrective Action
    11. State PDMP Database Checks
    12. Toxicology / Drug Screening
    13. Titration / Weaning

      Pain management expert witness
      Pain management expert witness. Ability to audit practices for DEA Diversion Control, Controlled Substances Act, State Opioid Prescribing Laws
    14. Termination and referral, termination for drug-seeking behavior
    15. PEG Screening Tool
    16. Objective tools to describe pain levels in patients based on CDC and other standards
    17. DOJ Diversion Control Division CSA Guidelines
    18. Medical Necessity and the CSA
    19. The Practitioner’s Manual:
      • Record Keeping – Section IV
      • Valid Prescription Requirements – Section V
      • Opioid Addiction Treatment Programs – Section VI

State Standards

In most states, treatment with opioids requires Patient Agreements and compliance. A pain management expert witness should be familiar with these Standards.

Above all, at a State level a review of pain management contracts, toxicology testing protocols, state prescription drug monitoring programs or PDMP data may be relevant.

Data Analytics competencies:

Similarly,  analysis of pharmaceutical data related to high-risk populations, patient access, adverse events, or biomedical research may be relevant.

    1. Human Data Science analytics regarding the use of Naloxone, Narcan, Evizio (high-risk / low-risk populations)
    2. Patient access data, utilization reviews, abuse patterns
    3. Medicare, Medicaid, and private payor coverage determinations and claims analytics
    4. FAERSAdverse Event reports (see Attachment 15) and National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) Addiction Severity Index (ASM-MV), Comprehensive Health Assessment for Teens (CHAT), RADARSOpioid Treatment and Survey of Key Informants Programs (OTP and SKIP, respectively),Treatment Episode Data Set (TEDS) admission-based census that includes data from facilities that receive public funds
    5. BARDA– Biomedical Advanced Research and Development Authority HHS ASPR, the Technical Resources, Assistance Center, and Information Exchange (TRACIE)

Clinical Trials Research Data Forensics (CDISC)

      1. Organize (SEND)
      2. Plan (PRM)
      3. Collect (CDASH)
      4. Organize (SDTM)
      5. Analyze (ADaM)

Expertise in analysis of prescribing data, data standards, distribution and Coverage Determinations by payors, Guidance from the Substance Abuse and Mental Health Services Administration SAMHSA:

Prior Speaking Engagements re Behavioral Health and Substance Abuse

Drug Utilization Data and Coverage Determinations

  • Fee for Service Medicaid plan
  • Medicaid managed care organizations (MCOs)
  • Medicare (Local Coverage Determinations or LDCs retired and active during the applicable date(s) of service
  • Commercial Medical Policies (over 15 across 60 payors) such as ultra-rapid detoxification (UROD)
  • Presence or absence of a diagnosis, diagnosis codes and other indications for medically necessary care determinations

Drug Classification Systems

  • HCPCS codes for drugs,
  • drug classification systems (published author with prior experience in compounding pharmacies – see C.V. attachment 8),
  • DOJ investigations of data standards for ePrescribing and E.H.R.

Opioid Use Disorders and Medications

  1. Buprenorphine (sublingual)
  2. Buprenorphine (subdermal/implant) (Probuphine)
  3. Buprenorphine (extended-release injectable) (Sublocade)
  4. Buprenorphine/ naloxone (oral, Bunavail [buccal], Suboxone [sublingual], Zubsolv [sublingual])
  5. Methadone (oral) (Dolophine)
  6. Naltrexone (oral)
  7. (extended-release injectable) (Vivitrol)

Recent Engagements

  1. Audit of pain management physician practice as a component of expert consulting work for Defendant in DEA investigation
  2. Rebuttal of a life care plan which included a significant component of pain management including ketamine, injection blocks and other treatment
  3. Rebuttal to assertions regarding facility fees that were charged for a physician in an office, not in a CMS certified ambulatory surgery center

Related topics

 Medical Billing Expert Witness

Pain Management and Opioid Prescribing Audit Protocol to prevent drug diversion and identify drug seeking behavior