Medical Coding and Compliance Expertise Retained by Healthcare Attorneys Nationwide.

Practice Areas We Support

• Payer dispute litigation involving claim denials, downcoding, or systematic underpayment
• Arbitration and mediation proceedings with insurers to support accurate coding and educate payers on coding rules grounded in established coding principles
• False Claims Act investigations and government audit matters involving coding practices
• Malpractice cases with a coding or documentation component
• Contract disputes between physician groups and health systems
• Cases requiring independent analysis of billing practices or coding standards

What We Provide

• Independent review and analysis of medical coding in dispute
• Written expert reports with findings, methodology, and clearly stated opinions
• Consultation to inform discovery strategy and case theory
• Deposition preparation and testimony
• Courtroom expert witness testimony
• Rebuttal analysis of opposing expert reports and methodologies

Credentials, Track Record, and Confidentiality

Caral Edelberg holds active certifications in CPC, CPMA, CAC, CCS-P, and CHC, and has been awarded Honorary Lifetime Membership in the American College of Emergency Physicians (ACEP), a distinction rarely granted to a non-physician, in recognition of her decades of contributions to the specialty. She chaired the ACEP Workgroup responsible for writing and editing the Coding and Reimbursement FAQs published on the ACEP website, and is the longest-serving faculty member of ACEP's Coding and Reimbursement conferences, having received the ACEP Faculty Award for exceptional performance and the "Over the Top" Outstanding Faculty Award for teaching excellence, twice. She contributed to the development of the ACEP Facility Coding criteria, the national standard for hospital emergency department coding. This depth of involvement in the standards that govern the field is what distinguishes our expert opinions from those of general coding consultants. Because the matters we support are subject to confidentiality agreements, as is standard in litigation, we do not publish client or case names. Professional references are available upon engagement.

Attorneys We Work With

• Healthcare counsel representing physician groups, hospitals, and health systems
• General litigation attorneys with healthcare clients requiring a specialized coding expert
• Defense counsel in False Claims Act and government investigation matters
• In-house legal teams managing payer disputes or compliance investigations