Sunil V. Lalla
MD, FACS, CPC
Sunil V. Lalla, MD, FACS, CPC is the Founder and CEO of Integritas Healthcare Consultants, LLC, a full-service healthcare consulting firm Integritasconsultants.com providing guidance to major academic institutions, stakeholders, providers and hospitals on a myriad of issues.
He combines twenty years clinical operative experience as a board certified and twice recertified surgeon by The American Board of Surgery and as a Fellow of the American College of Surgeons. He augments this broad clinical experience with having been a Medical Director of one of the largest Medicare Administrative Contractors (MAC) in the USA (Novitas Solutions and First Coast Service Options, FCSO) handling over $110 billion dollars in claims to the Medicare Trust Fund annually each of the past five years. He has served to educate Medical Affairs, review nurses and staff on multiple Issues related to Clinical Trials, Routine Costs per NCD 310.1, Claims, Coverage and Policy Development. Dr. Lalla has authored numerous Local Coverage Determinations (LCDs) and has provided Medical Director leadership in the implementation of the Prior Authorization Program for Medicare in pilot areas. Dr. Lalla is also a Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC) and has served to instruct Medicare Medical Policy Staff on billing and coding Issues. This one-of-a kind combination makes Dr. Lalla uniquely qualified to provide perspective from an insider’s point of view.
Dr. Lalla brings invaluable experience in many areas to navigate the often complex and opaque world of claims, appeals, coverage issues related to Medicare and Commercial Payors. Dr. Lalla has been an invited Medicare Medical Director nationally to participate in the annual AMA CPT RBRVS Symposium for each of the past four years which is attended by well over 1,000 billers, coders and major institutions. Dr. Lalla has participated annually at the Clinical Trials Billing and Coding Conference, the American Urology Association (AUA), the Hematology and Oncology Carrier Advisory Committee as well as having participated in numerous Local Coverage Determination (LCD) Writer’s meetings in addition to having chaired numerous Contractor Advisory Committee (CAC) meetings.