Five Expert Witnesses Allowed in Healthcare Benefits Fraud Case

This case involves healthcare benefits fraud.  The Government and the Defendants both hired expert witnesses to assist with their arguments.  Both filed motions to exclude, but the court denied both motions.

Facts:  This case (United States of America v. Bertram – United States District Court – Eastern District of Kentucky – November 9th, 2016) involves the alleged healthcare benefits fraud.  The government has accused the defendants of submitting claims to Medicaid, Medicare, and other private insurance payors for urine drug tests that were not necessary.  Both parties hired expert witnesses to help prove their respective cases.  The plaintiff hired Ms. Lee Guice (Medical Billing Expert Witness), Dr. Earl Berman (Internal Medicine Expert Witness) and Dr. Andrea Barthwell (Addiction Medicine Expert Witness) and the defendants hired Dr. Erik Sandefer (Pharmacology Expert Witness) and Dr. Scott A. R. Haas (Forensic Psychiatry Expert Witness).  Both parties have filed motions to exclude the expert witness testimonies of these experts.

Discussion:  Lee Gruice and Earl Berman were hired by the Government to opine about the rules and regulations involving Medicare and Medicaid coverage for urine drug testing.  The defendants have two chief complaints about these two experts.  First, they argue that they will just summarize administrative functions and will offer summaries of statutes and rules that will be unhelpful to the jury.  In addition, the defendants argue that these two experts are victims of the alleged fraud and cannot provide objective testimony.    The court disagreed, stating that the Medicare and Medicaid systems are complex and employees with specialized knowledge are needed to explain the systems to a jury.  In addition, the court decided that Ms. Guice and Dr. Berman were not personal victims of the fraud, but were tangential victims, and thus could provide objective testimony.

Dr. Andrew Barthwell was hired to testify on four opinions, which concern the medical necessity if SelfRefind’s drug testing practices.  The defendants argue that Dr. Barthwell’s testimony is irrelevant and thus, not admissible.  They argue that Dr. Barthwell’s Testimony relates only to the actions of SelfRefind, not PremierTox and that SelfRefind has not been formally charged in this case.  The court disagreed, stating that Dr. Barthwell’s testimony on SelfRefind is pertinent to the case, albeit indirectly and that the jury will decide whether or not this testimony leads to a conclusion about the legality or illegality of PremierTox’s drug claim submissions.

The United States has also filed motions to exclude the expert testimony of Dr. Erik Sandefer and Dr. Scott A. R. Haas.  At the Daubert hearing, the Government conceded that they didn’t have any qualms with Dr. Haas’s testimony and that they would not challenge it.  Thus, the only challenge they had was to Dr. Sandefer’s testimony.

The Government argues that Dr. Sandefer’s special knowledge about laboratory sample processing in pharmaceutical research fits this case.  The court opined that Dr. Sandefer will be allowed to testify subject to certain limitations.  Dr. Sandefer may not project his experiences on PremierTox or on any other laboratory to which he has no personal knowledge. Dr. Sandefer is free to testify, but the Government may raise concerns about his lack of experience in addiction medicine.

Conclusion:  The Defendant’s and the Government’s motion to exclude were both denied.