Medical Expert Cleared to Testify on Treatment in Medicaid Case
Posted on July 31, 2025 by Expert Witness Profiler
The case arose from the use and reimbursement of the drug NovoSeven, which was prescribed to ten Washington Medicaid patients with severe Hemophilia A and inhibitors to Factor VIII. Some used the drug in high doses or for off-label prophylactic treatment. Washington Medicaid reimbursed these prescriptions during the relevant period.
NNI retained Dr. Michael Tarantino as an expert witness. Tarantino reviewed 65,000 pages of medical records. He found the use of NovoSeven appropriate in eight cases. For the other two, he lacked sufficient data. He also concluded the drug was used safely in the reviewed cases.
The State of Washington and plaintiff Jamie Siegel moved to exclude his testimony. They argued the case focused on Medicaid reimbursement rules—not medical appropriateness. Washington said Tarantino lacked expertise in state regulations and failed to follow the required hierarchy of evidence.
Hematology Expert Witness
Michael Tarantino is a board-certified pediatric hematologist-oncologist with over 30 years of experience in bleeding and clotting disorders. He is the Founder, CEO, and Chief Medical Officer of the Bleeding & Clotting Disorders Institute and Medical Director of the Anticoagulation Consultation Service at St. Francis Medical Center.
Since 2008, he has served as a tenured Professor of Pediatrics and Medicine at the University of Illinois College of Medicine in Peoria. He earned his M.D. from the University of Wisconsin, followed by a pediatrics residency at the University of Arizona and a fellowship in pediatric hematology-oncology at Wisconsin.
Tarantino has authored over 125 peer-reviewed publications and 140 abstracts. In 2024, he received the Lifetime Achievement Award from the National Bleeding Disorders Foundation for his contributions to patient care, research, and advocacy.
Discussion by the Court
Expert Qualifications and Scope
The Court found Dr. Michael Tarantino qualified under Federal Rule of Evidence 702. He had over three decades of clinical and academic experience in hematology. His report reviewed patient records to assess whether NovoSeven use was medically necessary, appropriate, and safe. The Court concluded that his opinions fell within his area of expertise and were relevant to the case.
Plaintiffs’ Challenge to Relevance
The State of Washington argued that Tarantino’s testimony failed to address the legal standards for Medicaid reimbursement. Specifically, it said he did not apply the “hierarchy of evidence” required under WAC 182-501-0165(6) or tie his conclusions to regulatory definitions of “medical necessity.” Washington emphasized that the question was not medical appropriateness, but whether the prescriptions met reimbursement criteria.
Court’s Response: Goes to Weight, Not Admissibility
The Court held that these arguments affected the weight of the testimony—not its admissibility. Washington had alleged the prescriptions were medically unnecessary and dangerous. Therefore, Tarantino’s analysis of the safety and appropriateness of NovoSeven was directly relevant. The Court ruled that his methodology was reliable and grounded in his clinical experience.
Context of Medicaid Reimbursement
The Court noted that Washington Medicaid reimbursed NovoSeven during the relevant time, including after a 2009 internal review by the Hemophilia Working Group. It had already allowed an adverse inference instruction due to the loss of documents related to that review. This instruction permits jurors to infer the documents supported medical necessity. The Court reasoned that expert testimony on medical necessity remained relevant under these circumstances.
Limits on Testimony Regarding Inducements
Tarantino also reviewed whether prescriptions were influenced by illegal inducements. The Court allowed him to testify about the medical reasons for using NovoSeven. However, it barred him from opining on whether the prescriptions were free from improper influence. The motion was granted to that limited extent.
Held
The Court granted in part and denied in part Plaintiff Washington’s motion to exclude the testimony of Defendant Novo Nordisk’s expert witness, Michael Tarantino.
Key Takeaway:
An expert’s failure to apply regulatory definitions or cite legal standards may affect the weight of their testimony—but not its admissibility—if their opinions are otherwise relevant, reliable, and within their expertise. Here, the Court allowed Tarantino to testify on the medical necessity, appropriateness, and safety of NovoSeven use, finding that his clinical evaluation was relevant to the claims, even if it did not directly apply Medicaid reimbursement criteria.
Please refer to the blogs previously published about this case:
Law & Legal Expert Helps Jury Understand Medicaid’s Complex Regulatory Framework
Hematology Expert’s Opinion on NovoSeven’s Medical Appropriateness Admitted
Pharmacology Expert’s Testimony About the Purpose and Effect of Illegal Marketing Tactics Excluded
Internal Medicine Expert’s Testimony Limited Despite His Physician Behavior Experience
Business Valuation Expert’s Testimony on Physicians’ Compensation Admitted
Case Details:
| Case Caption: | United States v. Novo Nordisk, Inc. |
| Docket Number: | 3:23cv5459 |
| Court Name: | United States District Court for the Western District of Washington |
| Order Date: | July 15, 2025 |
