Federal Healthcare Fraud Defense: Clinical Expert and Legal Scholar
Retained consulting for plaintiff and defense counsel in federal healthcare enforcement matters.
Federal healthcare fraud cases turn on clinical judgment, billing intent, and the gap between what administrators knew and what prosecutors allege. Most expert witnesses can speak to one of those. Dr Sonny Saggar MD speaks to all three, from the inside.
Oxford and Barts trained. 25 years of emergency medicine including hospital administration, ATLS instruction, and urgent care operations. Author of six published papers specifically on federal healthcare fraud enforcement, the post-Loper Bright regulatory landscape, intent standards under 18 USC 1347, and private credentialing fairness. SEAK registered expert witness. Active in both plaintiff and defense matters.
What makes this different: Dr Saggar has navigated the federal enforcement system as a defendant, as a physician, and as a scholar. He understands the clinical context that creates administrative ambiguity, the billing mechanics that produce false-positive fraud findings, and the statutory framework that governs what prosecutors must prove. That combination does not exist anywhere else on the SEAK directory.
Initiate Conflict CheckEngagement Areas
Standard of Care Evaluation
Clinical evaluation of emergency medicine standard of care, charting logic, medical necessity documentation, and treatment decisions under federal audit review.
EMR Forensic Audit Review
Technical review of Electronic Medical Record (EMR) audit trails and metadata (Epic, Cerner, Meditech, T-System) to reconstruct real-time clinical timelines and counter false fraud assertions.
Sentencing Mitigation & ESI
Expert consulting on post-conviction custody scoring, pre-sentencing mitigation reports, and clinical evaluation modeling using the Emotional Stability Index (ESI).
Fee Structure
- Document Review & Consultation From $350 / hr
- Expert Declarations (Rule 26) From $3,500
- Retained Monthly Advisory From $5,000 / mo
- CLE Presentations & Seminars From $2,500
2-hour conflict clearance SLA. Encrypted intake portal. All engagements executed through HiveAdvisory, a DBA of Universal Document Inc.
Case Studies
Medicare Billing Compliance Audit
Scenario: Regional healthcare system facing Medicare billing audit involving 47 physician group practice.
Engagement: Clinical document review and EMR audit trail metadata forensic analysis to isolate charting timeline anomalies.
UPIC Investigation Defence
Scenario: Multi-specialty outpatient surgery center under active UPIC billing audit investigation.
Engagement: Rule 26 expert declaration preparation evaluating medical necessity parameters for complex diagnoses.
Supervised Release Sentence Modification
Scenario: Former healthcare executive petitioning for early termination of federal supervised release.
Engagement: Clinical evaluation report drafting applying the Emotional Stability Index (ESI) framework metrics.