Coding and Billing Litigation in Healthcare: Risk Areas, Disputes, and Expert Insight (VMG Health)

Frank Cohen, Senior Data Scientist | VMG Health

Frank Cohen is a nationally recognized healthcare data scientist and computational statistician whose work sits at the intersection of analytics, compliance, and litigation support. As Senior Data Scientist at VMG Health, he brings a rigorous, evidence-based approach to some of the most technically complex challenges in healthcare, from predictive risk modeling and machine learning to statistical sampling and expert analysis in high-stakes legal matters. With decades of experience spanning clinical practice, hospital administration, and consulting, Frank is a trusted resource for healthcare organizations, legal and accounting firms, and government agencies seeking data-driven insight and defensible analytical frameworks.

Education & Credentials

• Frank holds a deep foundation in computational statistics and applied healthcare analytics, with expertise in predictive modeling, machine learning, and algorithmic development. He is a published author of Don’t Do Something, Just Stand There: A Primer on Evidence-Based Thinking, and has contributed to numerous peer-reviewed articles and industry studies.

Recognition & Leadership

• Frank is widely recognized as a leading expert in healthcare statistical analysis, audit methodology, and litigation support. He has trained thousands of healthcare professionals, including physicians, administrators, and CPAs, in the practical application of analytics, and is a sought-after speaker at national conferences and CLE programs.

Professional Involvement

• Frank is a frequent speaker at national healthcare conferences and CLE programs, and regularly publishes analysis on compliance, audit risk, and regulatory developments. He has served as a contributing expert for hospitals, law firms, professional associations, and government agencies nationwide.

Experience

• Frank’s career spans clinical practice, hospital administration, and healthcare consulting, including eight years as a Physician Assistant in the United States Navy and executive roles as clinic administrator and hospital CEO. In consulting, he has worked on more than 300 litigation and compliance matters, specializing in statistical sampling, extrapolation methodology, and coding and billing analysis, and is a valued expert witness in False Claims Act investigations and overpayment proceedings.

Pam D’Apuzzo, Managing Director | VMG Health

Pam D’Apuzzo is a nationally recognized coding and compliance expert with more than 30 years of experience advising some of the country’s leading healthcare institutions. As Managing Director of Revenue Optimization Consulting at VMG Health, she specializes in coding audit and compliance services, corporate compliance program development, and revenue integrity, bringing deep technical knowledge and practical insight to complex billing and documentation challenges. Her clients range from academic medical centers and community hospitals to faculty practice plans and large private practices, and she is widely regarded as a trusted adviser to New York’s premier healthcare organizations.

Education & Credentials

• Pam holds multiple nationally recognized credentials, including Certified Professional Coder (CPC) and Certified Professional Medical Auditor (CPMA) through the AAPC, Professional Coding Specialist (PCS) through the ACMCS, and ACS-EM and ACS-MS designations through the Board of Medical Specialty Coding. She is also a certified ICD-10-CM Trainer.

Recognition & Leadership

• Pam is recognized as a leading authority in healthcare coding, compliance, and revenue integrity, with more than three decades of advisory work at the highest levels of the industry. She has built a distinguished reputation as a trusted institutional adviser and sought-after educator for major academic medical centers, health systems, and physician organizations nationwide.

Professional Involvement

• Pam is a frequent speaker at conferences hosted by the AAPC, HFMA, the New York State Society of Physician Assistants, the Suffolk County Medical Society, and the American Association of Gynecologic Laparoscopists. She is actively engaged in the healthcare compliance and coding community through education, training, and industry leadership.

Experience

• Pam’s 30-plus years of consulting experience span coding and documentation audits, revenue integrity, billing office assessments, and corporate compliance program development across a wide range of specialties and care settings. She has worked extensively with ambulatory surgery centers, physician practices, hospital-based medicine, oncology, ophthalmology, and behavioral health, and her practice includes operational review, practice start-up assistance, EMR implementation, and compliance advisory.

I. How Coding and Billing Disputes Arise: The Legal and Regulatory Landscape | 1:00pm – 1:15pm

This module sets the foundation for the program by walking attorneys through how the healthcare billing system works and where legal disputes most commonly originate. Speakers will explain the primary legal frameworks governing coding and billing, including the False Claims Act, the Anti-Kickback Statute, and the Stark Law, and how billing errors become enforcement actions. Attendees will gain a clear understanding of the key enforcement agencies involved, how government audits and whistleblower complaints trigger investigations, and what the record-high FY2024 enforcement data signals for the year ahead.

II. Navigating Gray Areas: Why Most Coding Disputes Are Not Black and White | 1:15pm – 1:30pm

Most coding disputes do not involve clear-cut fraud, they arise in ambiguous zones where clinical judgment, documentation habits, and coding standards intersect. This module explains why the same clinical encounter can legitimately support more than one code, how documentation gaps create legal vulnerability even without fraudulent intent, and which code categories generate the most disputes. Speakers will give attorneys a practical framework for evaluating whether a disputed code falls within an acceptable range, and what a defensible position looks like from both a defense and plaintiff perspective.

III. Extrapolation, Statistical Analysis, and Financial Exposure | 1:30pm – 1:45pm

This module addresses one of the most consequential and misunderstood aspects of billing litigation: how statistical sampling converts a small number of coding errors into multi-million dollar claims. Speakers will explain how government auditors and plaintiffs use extrapolation to project error rates across thousands of claims, what the legal and methodological standards are for accepting or rejecting those projections, and how defense counsel can identify and challenge flaws in the analysis. Attendees will leave with a clear understanding of how extrapolated damages work and what strategies are available to contest or limit exposure.

IV. The Strategic Use of Experts in Coding and Billing Litigation | 1:45pm – 1:55pm

Knowing when and how to engage the right expert can be the difference between a strong defense and a costly settlement. This module covers the types of experts used in coding and billing litigation, including coding auditors, statisticians, and damages experts, and how to retain, prepare, and position them effectively. Speakers will address how expert analysis shapes strategy at every stage of a case, from early case assessment through deposition and trial, and will highlight the most common vulnerabilities experts face on cross-examination and how to address them.

V. Proactive Risk Management: Advising Clients Before a Dispute Arises | 1:55pm – 2:00pm

This segment explores the economic and operational architecture supporting a token project, including token supply mechanics, distribution models, and incentive structures. It examines governance frameworks, decision-making authority, and internal approval processes, as well as operational controls designed to support compliance, risk management, and system integrity. Attention is given to aligning token economics with legal, tax, and accounting constraints to promote sustainability and regulatory readiness over the lifecycle of the token.