--- title: "Medical Coding Expert’s Testimony About the Health Insurance Claims Admitted" meta: "og:description": "The medical coding expert assisted the Court in understanding healthcare claim submission and adjudication processes" "og:title": "Medical Coding Expert’s Testimony About the Health Insurance Claims Admitted" author: "Expert Witness Profiler" description: "The medical coding expert assisted the Court in understanding healthcare claim submission and adjudication processes" --- # Medical Coding Expert’s Testimony About the Health Insurance Claims Admitted Posted on September 18, 2025 by Expert Witness Profiler Plaintiff Michael Swartzendruber claimed that Defendants United Healthcare Insurance Company and United Healthcare of the Mid-Atlantic, Inc. (collectively “United”), and Defendants Sentara RMH Medical Center and RMH Medical Group, LLC (collectively “Sentara”) overcharged him for hospital services and/or by making misrepresentations about the charges for his blood tests. On each occasion, Swartzendruber’s blood was drawn at a Sentara satellite outpatient location and tested at Sentara’s main hospital location. Sentara billed, and United processed and reimbursed, charges for medical services based on rates associated with the main hospital location as opposed to rates of certain providers operating at the satellites. Plaintiff filed a motion to exclude the expert testimony of Defendants’ expert, [Kristina Kahan](https://expertwitnessprofiler.com/expert-witness/Kristina-Kahan/1552725). Kahan was retained to opine on whether or not the health insurance claims at issue in this case were properly billed. ## **Medical Coding Expert Witness** [Kristina B. Kahan](https://expertwitnessprofiler.com/expert-witness/Kristina-Kahan/1552725) is a Registered Nurse, Certified Professional Coder, and senior managing director at Ankura Consulting with decades of clinical, compliance, and coding experience in the healthcare industry. She holds multiple coding certifications: Certified Professional Coder (“CPC”), Certified Outpatient Coder (“COC”), and Certified Risk Adjustment Coder (“CRC”). [Fortify your strategy by reviewing a Challenge Study detailing grounds for excluding Kristina Kahan’s expert testimony](https://expertwitnessprofiler.com/order/add?eId=1552725&pId=3). ## **Discussion by the Court** To begin with, Plaintiff challenged the relevancy and helpfulness of Kahan’s opinions, and disputes that Kahan has offered a sufficient basis on which to offer her opinions.  #### **a) Basis for Opinions** In her report, Kahan concluded that Sentara properly submitted claims for the services at issue in this case and that United properly adjudicated the claims it received from Sentara. Specifically, Kahan concluded that Sentara appropriately billed the services rendered as originating from Sentara RMH Medical Center because the services were “performed at off-campus locations of RMH Medical Center and the blood testing was performed at RMH Medical Center’s main hospital location” and thus constituted “facility services.” Kahan concluded that Sentara properly billed and United properly adjudicated the claims. In making these conclusions, Kahan evaluated Sentara RMH Medical Center’s hospital certification and Medicare Provider Enrollment, Chain, and Ownership System information. As a result, the Court found that Kahan has developed sufficient bases on which to support her opinions. #### **b) Relevancy and Helpfulness** Defendants asserted that Kahan’s report addressed material aspects of the case—whether Sentara appropriately submitted the claims and whether United appropriately adjudicated them. However, Plaintiff argued that Kahan’s report is not helpful to the Court because Kahan offered no testimony that is helpful or necessary for the Court to interpret the contract at issue. The Court found that the Kahan Report presented relevant and helpful evidence as it served to assist the Court in understanding the healthcare claims submission and adjudication processes, including the relevant regulations governing these processes, such that the Court is better equipped to address the issues in dispute in this case.  ## **Held** The Court denied the Plaintiff’s motion to exclude Defendants’ expert Kristina B. Kahan. ## **Key Takeaway:** Basically, the parties are correct that the Court can read and interpret the contracts at issue, and the Kahan Report does not improperly delve into the world of contract interpretation. Thus, the Court may consider the Kahan Report for its value in understanding the broader environment of the instant case. ## **Case Details:** --- ## **You Might Also Like** ![Human Resources Expert Allowed to Opine on Termination](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-22T200052.311.jpg) [**Human Resources Expert Allowed to Opine on Termination**](https://expertwitnessprofiler.com/medical-coding-experts-testimony-about-the-health-insurance-claims-admitted/human-resources-expert-allowed-to-opine-on-termination)![Neuropsychology Expert Not Allowed to Opine on Cognitive Decline](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-22T144728.528.jpg) [**Neuropsychology Expert Not Allowed to Opine on Cognitive Decline **](https://expertwitnessprofiler.com/medical-coding-experts-testimony-about-the-health-insurance-claims-admitted/neuropsychology-expert-not-allowed-to-opine-on-cognitive-decline)![Human Factors Expert Not Allowed to Opine on the Tile](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-21T191749.960.jpg) [**Human Factors Expert Not Allowed to Opine on the Tile**](https://expertwitnessprofiler.com/medical-coding-experts-testimony-about-the-health-insurance-claims-admitted/human-factors-expert-not-allowed-to-opine-on-the-tile)![Insurance Expert Not Allowed to Opine on Legal Duties](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-21T155751.487.jpg) [**Insurance Expert Not Allowed to Opine on Legal Duties**](https://expertwitnessprofiler.com/medical-coding-experts-testimony-about-the-health-insurance-claims-admitted/insurance-expert-not-allowed-to-opine-on-legal-duties)![Law And Legal Expert Not Allowed to Opine on Contract Formation](https://ewp-blog.expertwitnessprofiler.org/wp-content/uploads/2026/04/blog-pic-640X480-2026-04-20T213123.718.jpg) [**Law And Legal Expert Not Allowed to Opine on Contract Formation**](https://expertwitnessprofiler.com/medical-coding-experts-testimony-about-the-health-insurance-claims-admitted/law-and-legal-expert-not-allowed-to-opine-on-contract-formation)