Plaintiff hired cardiology expert to opine on medical tests and procedures in his field. Defendant filed a motion to exclude this testimony. The court allowed the testimony to proceed.
Facts: This case (United States of America v. Roy Heilbron – United States District Court – District of New Mexico – December 1st, 2016) involves 21 counts of healthcare fraud and three counts of wire fraud. The United States alleges that the Defendant (Heilbron) submitted claims to Medicare and numerous private health insurers. These claims were fraudulent, the United States claims, because Heilbron knew that they included false diagnoses, sought payment for services that were medically unnecessary, and sought payment for medical services that were not performed. In addition, the United States claims that Heilbron submitted claims for tests with false diagnoses codes. In order to assist in their case, the United States hired Neal Shadoff, M.D. (Cardiology Expert Witness).
Dr. Shadoff will be testifying that the medical tests and procedures performed by Heilbron we not medically necessary. In addition, he will be testifying on the evaluation and management of cardiology patients as well as the appropriateness of diagnoses that were provided by Heilbron as well as the medical necessity of treatment provided by Heilbron.
Heilbron filed a motion to exclude the testimony of Dr. Shadoff on qualification, reliability, and relevance grounds.
Discussion: The court considered Shadoff’s qualifications and finds that he is qualified to render an expert opinion on the medical tests ordered, the appropriateness of diagnoses and treatment by Heilbron, and the evaluation and management of patients, internal medicine and cardiovascular disease, and the diagnoses thereof. Heilbron argues that Shadoff does not qualify to testify because he does not have any knowledge, training or practice in the area of holistic medicine. The United States replied that the insurers did not evaluate the diagnoses based on holistic medicine as they do not pay claims for these types of services. The court agreed and opined that Dr. Shadoff is qualified to provide expert testimony in this case.
Regarding reliability, the defendant argues that Dr. Shadoff’s testimony should not be allowed because he is board certified in internal medicine and cardiovascular disease and Dr. Heilbron is board certified in holistic medicine., which is a different specialty. The court disagreed, stating that Dr. Shadoff’s methodology in reaching his conclusions is sound and, therefore, reliable. The court stated this because he is a cardiologist with experience and the defendant diagnosed patients with cardiovascular issues. Dr. Shadoff does not need to be board certified in holistic medicine to render opinions in this particular case.
Last, in relation to relevance, the defense argues that Dr. Shadoff’s testimony is not relevant because he is rendering an opinion on the defendants testing procedures, but he is not an expert in holistic medicine. The United States responded that the defendant was credentialed by the insurance companies as a cardiologist and an internist and a cardiologist, not a practitioner in holistic medicine. The court disagreed with the defendant and opined that Dr. Shadoff’s testimony is relevant in this case.
Conclusion: The defendant’s motion to exclude the expert witness testimony of Dr. Shadoff is denied.