Michael Arrigo

Michael Arrigo

Michael Arrigo

Four Embarcadero, Ste 1400 San Francisco, CA 94111

About the Expert

Expert in matter before Federal Trade Commission, ICD-10 and CPT medical coding, computer assisted coding, E.H.R., subrogation and claims processing. Testimony in State, Federal court regarding Affordable Care Act, HITECH Act (meaningful use), California CMIA, HIPAA Privacy Rule, HIPAA Security Rule, Evaluation, report on usual, customary and reasonable (UCR) medical, prescription charges for personal injury plaintiffs. Healthcare Practices and Records, Medical / Medicare / Medicaid Fraud,

Areas of Expertise

Affordable Care Act Maximum Out Of Pocket
Ambulance Transportation
Electronic Health Records
Emtala
Forensic Audit Of Electronic Health Records
Future Value Of Care In Life Care Plans
Health Administration
Healthcare Practices and Records
Hipaa Privacy
Hipaa Security
Independent Diagnostic Testing Facilities
Insurance - Health / HMO / Disability
Life Care Plan Rebuttals
Managed Care / HMO
Medical / Medicare / Medicaid Fraud
Medical Billing, Coding and Insurance
Medical Malpractice
Medicare Fraud Damages
Medicare Part C
Medicare Secondary Payer Act
Opioid Prescribing
Pain (Chronic) Management
Pain Management
Pass Through Billing
Patent Expert Witness Damages
Patent Expert Witness Technical
Reference Labs

Expert's Profile

Education

Harvard Law School, Cambridge MA - Studies in Bioethics
Stanford Medical School, Palo Alto CA - Studies in Biomedical Informatics (see end note )
University of Southern California, Marshall School of Business, Los Angeles – Bachelor of Science, Business Administration, 1981

Additional Coursework and Training:

• Villanova University – Lean Six Sigma and Process improvement 2007
• Wharton School, University of Pennsylvania – Leadership Strategies - 1982
• University of Calif., Irvine – Computer Science, Statistics, Economics 1976 – 1978

Clinical Documentation and Medical Coding Training:
1. ICD-9, ICD-10 and CPT for Behavioral health, November 2013
2. ICD-9, ICD-10 and CPT for Cardiology, November 2013
3. ICD-9, ICD-10 and CPT for Family practice and internal medicine, November 2013
4. ICD-9, ICD-10 and CPT for Obstetrics, November 2013
5. ICD-9, ICD-10 and CPT for Oncology, November 2013
6. ICD-9, ICD-10 and CPT for Urology, November 2013
7. ICD-9, ICD-10 and CPT for Orthopedics, November 2013
8. ICD-9, ICD-10 and CPT for General Surgery, November 2013
9. ICD-9, ICD-10 and CPT for Plastic Surgery, November 2013
10. HCC coding and clinical documentation for value based care risk adjustment, November 2013
11. DRG calculations and ICD-10, IPPS and OPPS payment systems November 2013
12. Pain management, CRPS, CRPS, future medical expenses including pain management modalities (Ketamine Infusions, Continuous Epidural Spinal Infusion, Continuous Spinal Cord Stimulator, Dorsal Root Ganglia Stimulator).
13. Trauma activation fees, ambulance fees (mileage, supplies, CMS billing rules). Medicare Secondary Payer Act in tort cases.
Instructor, HIPAA Privacy and Security, HITECH Act Electronic Health Records, value based care, affordable care act:

Best practices in HIPAA and HITECH Act Information Security 2010, 2011, 2012, 2013
Best practices Health IT, process improvement for value based care, May 2011, 2012, 2014, January 2015. industry best practices on hiring practices by the Joint Commission, the leading accreditation body for hospitals in the U.S. Eligibility to receive Medicaid and Medicare payments via accreditation.

Legal Experience
(See separate document for list of cases, testimony, basis for opinions)

Please see separate exhibit – over 40 cases before the U.S. Federal Trade Commission, other Federal, State and County Superior Court jurisdictions, written testimony in expert reports, depositions, and court appearances. Balanced plaintiff, relator, and defendant retentions and experience across pharmaceuticals, medical devices, orthotics, diagnostic imaging, orthopedics, cardiology, pediatrics, payors (including Medicare, Medicaid, social security, workers compensation, private insurance / health plans), hospital systems, patients and healthcare IT engagements. Experienced in the use of eDiscovery tools such as Relativity for expert-attorney document discovery work.

Summary of Accomplishments and Experience

Pulished author - HFMA, Healthcare IT News, GovHealth IT, nominated for Best Legal Blog 2016
I work with hospital systems, physician groups, and health IT companies, health plans, investors, and law firms. I was selected as an expert for a landmark Federal Trade Commission case regarding healthcare data, regulations and economics. I currently serve as managing partner of No World Borders. I am:
• A writer and speaker quoted in Wall Street Journal, and a regular speaker with published works as an expert in the field.
• Experienced at giving oral and written testimony, undergoing cross-examination and preparation for a Daubert hearing before FTC Commissioner Brill. Trained by leading litigation firm in in Rule 702 including applying scientific or specialized knowledge (702(a)); facts (702(b)); application of principles and methods (702(c)); application of criteria, principles, methodology, test methods (amended in Daubert, 2000 - (702(d)).
• An advisor to population health companies including health care systems, Medicare Advantage, Medicare Shared Savings ACOs, Health Plans, Accountable Care Organizations. Led investor diligence on over $4 billion in M&A activity.
• Experienced in clinician, coder, medical billing, claims, E.H.R, hospital and practice management software, and regulatory usual, customary and reasonable (UCR) medical and prescription charges experience having opined on over $1 billion in medical reimbursements for inpatient facilities (inpatient prospective payment system or IPPS and DRGs, ICD-9) and ambulatory (non-facility using CPT codes)
• Skilled at explaining complex concepts such clinical records and their financial value via medical coding, HIPAA, EDI, claims, ARRA HITECH, Affordable Care Act and other factors. I work with defense and plaintiffs on medical cost mitigation, payor-provider contracting and reimbursement, and other processes and I manage a team that has advised over 100 clients in these areas.
• Balanced experience working with counsel for plaintiffs / defendants as well as perspectives of health care payors, providers, patients, health IT. Skilled in coordination with counsel regarding the citation of statutes, case law, personal knowledge, training and experience to provide objective, documented opinions with peer-reviewed results.

Personal Achievements

Education

  • BS Business Administration, University of Southern California
  • MS Biomedical Informatics Stanford Medical School (expected 2017)

Special Training

  • Biomedical Informatics, Stanford Medical School
  • Clinical documentation, Medical coding and billing in several specialties focusing on ICD-10, ICD-9, CPT
  • HIPAA Privacy and Security
  • Healthcare IT and Meaningful Use of electronic health records
  • I provide training personally and though a team I manage in speaking engagements, webinars and on-site training:
  • Biomedical Informatics, Stanford Medical School
  • Clinical documentation, Medical coding and billing in several specialties focusing on ICD-10, ICD-9, CPT
  • HIPAA Privacy and Security Certified
  • Healthcare IT and Meaningful Use of electronic health records
  • Affordable Care Act
  • Eligibility and Health Insurance Exchanges
  • Compliance with FACTA and FCRA in health care billing disputes

Organizations

  • Health Information Management Systems Society (HIMSS), Workgroup for Electronic Data Interchange (WEDI), American Academy of Professional Coders (AAPC), American Health Information Management Assoc (AHIMA), Radiology Business Management Association (RBMA), California State Bar Association

Publications

  • Scholarly Writings & Lectures
  • Arrigo, M. F. (2015) Mobile Health, HIPAA Privacy and Security
  • Blackberry Sharpens Security with Good Technology Acquisition 
  • http://www.govhealthit.com/blog/commentaryblackberry-sharpens-security-good-technology-acquisition 
  • Arrigo, M. F. (2015) Five Interest-Piquing Trends at HIMSS15. Gov. Health IT
  • http://www.govhealthit.com/news/5-interest-piquing-trends-himss15
  • Arrigo, M. F. (2014) Cloud and Mobile Convergence: The Regulatory View. Gov. Health IT
  • http://www.govhealthit.com/blog/cloud-and-mobile-convergence-regulatory-view 
  • Arrigo, M.F. (2014) HIPAA Plain and Simple / HIPAA for Behavioral Health – Credible Behavioral Health E.H.R. Software Users Conference, Baltimore Maryland (18 March 2014)
  • Arrigo, M.F. (2014) DSM 5 and ICD-10 – Credible Behavioral Health E.H.R. Software Users Conference, Baltimore Maryland (18 March 2014)
  • Arrigo, M.F. (2014) Managed Care and Accountable Care for Behavioral Health – Credible Behavioral Health E.H.R. Software Users Conference, Baltimore Maryland (18 March 2014)
  • Arrigo, M. F. (2011) ICD-10 financial impact vs. mortgage crisis? Gov. Health IT
  • http://www.govhealthit.com/news/could-icd-10-have-big-financial-impact-mortgage-crisis
  • Arrigo, M. F. (2012) How a Flaw in the ACO Model Leaves Patients Out. Gov. Health IT
  • http://www.govhealthit.com/news/how-flaw-aco-model-leaves-patients-out
  • Arrigo, M. F. (2012) 10 ICD-10 Regulation Myths Demystified. Gov. Health IT
  •  http://www.govhealthit.com/news/10-icd-10-regulations-demystified 
  • Arrigo, M. F. (2012) Real-time location, mobile health gain traction. Gov. Health IT
  • http://www.govhealthit.com/news/real-time-location-and-mobile-health-solutions-gain-traction-show-roi
  • Arrigo, M. F. (2013) 3 Top Priorities for CommonWell. Gov. Health IT
  • http://www.govhealthit.com/news/3-top-priorities-commonwell 
  • Arrigo, M. F. (2013) Commentary: ICD-10 Arrives Early, New Claims Form. Gov. Health IT
  • http://www.govhealthit.com/news/commentary-icd-10-arrives-early-claims-CMS-coding-HIPAA-icd-9 
  • Arrigo, M. F. (2014) Increased Spending - Big Data, Cloud, mHealth Social. Gov. Health IT
  • http://www.govhealthit.com/blog/increased-spending-and-savings-tap-big-data-cloud-mhealth-and-social
  • Arrigo, M. F. (2014) Ebola: How cloud, mHealth, and ICD-10 could help. mHealth News
  • http://www.mhealthnews.com/blog/ebola-how-cloud-mhealth-and-icd-10-could-helpArrigo, M. F. (2014) How Cloud and mHealth Ease Claims Processing. Gov. Health IT
  • http://www.govhealthit.com/news/how-cloud-and-mhealth-promise-ease-claims-processing
  • Arrigo, M. F. (2014) How to Get Behavioral Health Codes Right. Gov. Health IT
  • http://www.govhealthit.com/blog/how-get-your-behavioral-health-codes-right 
  • Lectures
  • • Arrigo, M. (Speaker) (2015, November 2015) Medical Device Reimbursement, FDA, FCC and CMS regulatory disruption and opportunities. BioMed Device and Wireless Device Conference, San Jose California
  • • Arrigo, M. (Speaker) (2015, September 2015). Meaningful Use of Electronic Health Records, HIPAA Privacy and Security and potential damages for breaches under the HITECH Act as a foundation for the International Classification of Diseases from the World Health Organization (ICD-10) – Discussion of risks and opportunities in these two regulations; discrete data, quality measures, medical codes: clinical Documentation, clinical decision support, physician and patient engagement, HIPAA Privacy and Security and revenue cycle. Wolters Kluwer Corporate event presented to audience of over 1,800 participants.
  • • Arrigo, M. and Nichols J. MD - (Speakers) (2013, November). Claims Data, Clinical Data – Working together to Improve Clinical Documentation for ICD-10. Workgroup for Electronic Data Interchange (WEDI) National Conference.
  • • Arrigo, M. (Speaker) (2012, April 14). The Perfect Storm in Healthcare - How Disruptive Regulations and Technologies Create Risks and Opportunities for Medical Coding and Revenue Cycle Management. American Academy of Professional Coders (AAPC) National Conference. Lecture conducted from Las Vegas, NV. http://news.aapc.com/icd-10-monitor-wish-i-were-in-las-vegas/
  • • Arrigo, M. (Speaker) (2012, June 14). ICD-10: Impact on Payment Reform. Wisconsin Medical Society. Lecture conducted from Madison, Wisconsin. http://bit.ly/16acIDy
  • • Arrigo, M. (Speaker) (2013, April 23). The Perfect Storm in Healthcare - How Disruptive Regulations and Technologies Create Risks and Opportunities. Scripps Healthcare Summit 2013. Lecture conducted from La Jolla, San Diego California.
  • • Arrigo, M. (Speaker) (2012, May). How ICD-10 and Payment Reform Will Change the Radiology Revenue Cycle. Radiology Business Management Association (RBMA), Orlando Florida.

Prior assignments

  • For a complete case list, with details of the engagements and nature of my testimony and basis for opinions, please contact me. Here is a high level summary of many assignments where I have been retained as an expert witness or expert advisor:
  • Section I – Healthcare: Complex Cases, Class Actions, Qui Tam Whistleblower cases (False Claims Act, HITECH Act, Affordable Care Act, HIPAA, etc.) 4
  •  Confidential v. Confidential in matter before Federal Trade Commission; as well as preparation for litigation filings in California, New York, Florida, Texas State Attorneys General 4
  •  U.S. Attorney General v. Confidential Hospital System in Ohio 4
  •  U.S. Attorney General and Carefirst v. Confidential 5
  •  United States of America ex. rel. Olivia Graves v. Plaza Medical Centers, Humana 5
  •  California State Compensation Insurance Fund (SCIF) v Drobot, Pacific Hospital et 6
  •  Natalie Torres v Pocatello Children and Adolescent Clinic, et al 6
  •  Graewingholt et al v St. Josephs’ Health System 6
  •  Confidential Plaintiff v. Pasadena School District 7
  •  R.D., a Pseudonym, Individually, Plaintiff, vs. Providence Family Medicine Manito Clinic d/b/a/ Providence Physician Services, Co, Providence Health Services Et al 8
  •  Confidential Plaintiff (Jane Doe) v. Brigham and Women’s Hospital. 9
  • Section II – Healthcare: Economics related to Medical Coding, Clinical Documentation and Value of Health Care Services (Usual, Customary and Reasonable Cost of Care (UCR)), economic value of healthcare claims, revenue attribution 10
  •  UCLA Medical Center v. Blue Cross Blue Shield 10
  •  Allstate v Confidential Defendants 10
  •  Rhodes v Renown 10
  •  John D. Thomson v. HMC Group, Torrance Medical Center 11
  •  Joann Hilton v. USA Logistics Carriers, LLC and Jose Juan Soto-Estrada 11
  •  Jorge Uribe v. City of Maywood and Andrew Serrata 12
  •  Jim Casciani v. Gerald Anger, Jr., et al 12
  •  Raul Martinez v. Lee Ill Young 12
  •  Smith vs. Musinski MD et al 13
  •  California Accounts Service v. William Henry Tarkington 13
  • Section III – Healthcare: Expert Advisor / Consultant 14
  •  Preferred Care – Florida 14
  •  United Healthcare, Florida 14
  •  Optum, Minneapolis 14
  •  Boies Schiller & Flexner, LLP 14
  •  Regence BlueCross BlueShield, Seattle, Salt Lake, Portland 14
  •  TennCare II – Tennessee State Medicaid and TN Insurance Exchange eligibility 15
  •  Essence Health Plan 15
  •  Conemaugh Health System (owned by Duke Lifepoint Health System) 15
  •  Citra Health Solutions, Jacksonville FL 16
  •  Advisor: E.H.R., Accountable Care Organizations, practice management IT companies 16
  •  Ability Networks and Medicare Administrative Contractors (MACs) for Confidential Private Equity Firm 16
  •  Wal-Mart – Expert advisor to largest self-insured employer globally re: CORE Operating Rules, Patient Protection and value of care under the Affordable Care Act, ICD-10 medical coding; HIPAA 5010 EDI 17
  • Section IV - Financial Services Regulations 18
  •  First American - (“FACTA”) Fair Credit Reporting Act (FCRA). FACTA §312(a), (FACTA§312(c), FCRA §623(e)(1)), FCRA §623(a)(8)) – Lead executive on CredCo process and systems teams to ensure compliance with FCRA and FACTA with respect to loan origination and refinancing 18
  •  First American - 15 U.S. Code § 1639e - Appraisal independence requirements Office of the Comptroller of the Currency (OCC) 18

Percentage of time spent as expert

  • 25%%

Number of expert assignments / year

  • 12

More Information

Listed in the Following States

Michael Arrigo is listed with ExpertPages in the following jurisdictions: All US Regions and States, Canada (all Provinces).