The defendant was charged on numerous counts of insurance fraud and hired an expert witness in holistic medicine to assist in his case. The plaintiff filed a motion to exclude and it was granted.
Facts: This case, (United States of America v. Roy Heilbron – United States District Court – District of New Mexico – January 11th, 2017) previously reported on here involving a Cardiology Expert Witness, deals with insurance fraud. The defendant (Heilbron) is charged with numerous counts of healthcare fraud because he submitted fraudulent claims to Medicare and private healthcare insurers. In order to prove their case, Heilbron hired two experts: John F. Kressler II, M.D. and Garry Gordon, M.D. Dr. Kressler’s testimony was withdrawn and will will not testify at the trial. Dr. Gordon is an Osteopathy Expert Witness and identifies himself as a practitioner of “holistic integrative medicine” and combines traditional medicine with alternative therapies.
Dr. Gordon see patients, but runs a cash practice as his services are not reimbursable by insurance companies. Dr. Gordon does not have any training or experience in cardiology and has never engaged in the practice of cardiology. He reviewed the charts of some of Heilbron’s patients and opined that the tests performed were medically necessary from a the standpoint of a holistic practitioner. In addition, he stated that holistic doctors should perform a variety of tests, whether or not private insurance or Medicare will be paying for it.
The United States filed a motion to exclude the expert witness testimony of Dr. Gordon.
Discussion: The United States argues that Dr. Gordon is not qualified to offer expert witness testimony in this case. They state that Dr. Gordon’s expertise in “holistic integrative medicine” does not qualify him to testify about the necessity of medical evaluations and treatments utilized by cardiologists or internal medicine physicians. The defense argues that Dr. Gordon is qualified because in his practice of holistic medicine, there are medical procedures not utilized in cardiology or internal medicine.
The court agreed with the United States. It opined that Dr. Gordon has never received training as a cardiologist and has not practiced medicine in 25 years. He did not identify any cases in which he has served as an expert witness nor has he published in any peer-reviewed scientific journal. In addition, he has no experience using codes established by the healthcare insurance companies.
The court continued their opinion by stating that this case is about cardiology, not “holistic integrative medicine” and that his experience in holistic procedures does not qualify him to testify about the medical treatments used by a physician who practices cardiology or internal medicine.
The United States also challenges the reliability of Dr. Gordon’s testimony, stating that his report is not a complete summary of the patient’s medical records. The court agreed, stating that it is possible that Heilbron provided written opinions to Dr. Gordon to use in his report. Thus, for this and other reasons, the court opined that that Dr. Gordon’s proposed testimony is not reliable.
Last, the court also opined that Dr. Gordon’s testimony is not relevant because he discusses the Heilbron’s services in the context of holistic medicine, not cardiology.
Conclusion: The motion to exclude the expert witness testimony of Dr. Gordon was granted.