PCG’s Health practice offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies respond to regulatory change, improve access to health care, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG’s Health team helps organizations deliver quality services with constrained resources to promote improved client outcomes.

What We Do

For State Health & Medicaid Agencies

See how we can help you increase program revenue, cut costs, and improve compliance with state and federal regulations.

For State Insurance Departments

Let us help you navigate the regulatory landscape, including the Affordable Care Act (ACA), and implement changes and new requirements with confidence.

For Provider Organizations

Boost your financial performance and compliance with our proven approach to improving claiming practices and operations management.

For Health Plans

Optimize your plan’s performance and compliance without sacrificing patient outcomes with our program integrity services.

News & Perspectives

CMS Expands Coverage Flexibility for Medicare Advantage Plans

16 days ago

On April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued instructions to Medicare Advantage plans encouraging more flexible service coverage policies in such plans for 2019. Such capitated plans cover the same services as traditional, fee-for-service Medicare, plus supplemental benefits adopted by the plan with CMS approval. Under the new CMS instructions, any Medicare Advantage plan would have additional flexibility to cover supplemental benefits to compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

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Tackling Rising Prescription Drug Costs- a report on state and federal efforts

44 days ago

On March 29th, subject matter experts from Health Policy News held a webinar and Q&A to discuss efforts at the state and federal level to address the rising cost of prescription drugs.  Many states are in the midst of their legislative cycles, with the issue of rising pharmaceutical costs on agendas across the country.

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Twenty state attorneys general file federal lawsuit claiming elimination of mandate penalty renders the Affordable Care Act (ACA) unconstitutional

51 days ago

On Monday, February 26, 2018, twenty states, led by the attorneys general of Texas and Wisconsin, sued officials of the U.S. Department of Health and Human Services (HHS) and the Internal Revenue Service (IRS), alleging that the law revoking the penalty aspect of the ACA’s individual mandate rendered the entire ACA unconstitutional.  The lawsuit was filed in the U.S. District Court for the Northern District of Texas. 

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GAO recommends improved Medicaid waiver evaluations

51 days ago

On February 20, 2018, the Government Accountability Office (GAO) released a report recommending changes in federal policies and procedures governing state-operated Medicaid demonstration waiver projects.  These projects represent the leading edge in state Medicaid innovation as well as over $109 billion in federal Medicaid spending annually. GAO found in its review of these projects that the Centers for Medicare and Medicaid Services (CMS) has not always demanded thorough, scientifically valid, and timely data evaluations as to whether the projects achieved state-specified, CMS-approved goals to improve care and to contain costs.  

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Kentucky governor files lawsuit in defense of Medicaid work requirement

51 days ago

On February 23, 2018, Kentucky Governor Matt Bevin filed a lawsuit in the U.S. District Court for the Eastern District of Kentucky requesting that the court uphold the state’s newly imposed Medicaid work requirement.  The lawsuit was filed in response to the lawsuit previously filed in the U.S. District Court for the District of Columbia challenging the new eligibility requirement. The Commonwealth of Kentucky had not been included as a party to the prior action. 

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New federal grant opportunity to support state efforts to strengthen the private health insurance market

54 days ago

On February 5, 2018, the Center for Consumer Information and Insurance Oversight (CCIIO) released a new Notice of Funding Opportunity to support states as they implement several of the market reforms and consumer protections under Title I of the Affordable Care Act (ACA). This grant program is a follow-up to the Health Insurance Enforcement and Consumer Protections Grants funded in 2016. Specifically, the new grant program – known as the State Flexibility to Stabilize the Market Grant Program (“State Flexibility Grant Program”) – is intended to provide states with the opportunity to ensure their laws, regulations, and procedures align with federal requirements.

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Meet Our Team

team-member

Amy Ferraro

Manager / Health, Human Services

Ms. Ferraro has over 22 years of public sector consulting experience and has worked on a variety of revenue management, revenue optimization, and consulting engagements in more than 35 states across a variety of different agencies. She has also worked with...

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Jim Waldinger

Manager / Health

Mr. Waldinger focuses on health care reform, Medicaid policy, analysis and implementation. His specific areas of focus are health care reform and its impact on the Medicaid program and the behavioral...

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Joe Weber

Associate Manager / Health

Mr. Weber, PMP, has been with PCG for 13 years. Mr. Weber helps lead the Health Care Financing Solutions (HCFS) Center of Excellence with over twelve years of public sector consulting focusing on publicly funded healthcare programs including Medicaid...

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Sean Huse

Manager / Health

Mr. Huse is an experienced health management consultant who focuses on financial management, strategic planning, policy analysis, and management reporting for Medicaid, providers, and payer organizations...

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Thomas Aldridge

Manager / Health

Mr. Aldridge is a Manager with Public Consulting Group (PCG) and has been with the firm for more than 20 years. Throughout his tenure, he has managed dozens of engagements within Health and Human Service agencies across the country...

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Peter Cheesman

Associate Manager / Health

Mr. Cheesman leads PCG Health's Member Eligibility Solutions group. In this capacity, he has overseen the implementation and operation of high-profile benefits eligibility verification systems and data broker solutions for health and human services...

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Kelly Gallagher

Associate Manager / Health

Ms. Gallagher has been with PCG for 10 years. Ms. Gallagher helps lead the Cost Allocation Center of Excellence, specializing in cost allocation, time studies, Medicaid and Title IV-E claiming programs, business process review, Targeted Case Management (TCM)...

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Marc Staubley

Associate Practice Area Director / Health

Mr. Staubley is PCG Health’s Associate Practice Area Director (APAD) and a PCG shareholder.  In this role, he provides executive leadership to over 400 staff who manage a portfolio of over 200 projects that span across more than 35 states...

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Kevin Carlson

Chief Technology Officer / Health

Mr. Carlson has more than 20 years of experience in the health care technology sector. He has overseen the development and implementation of numerous electronic health record, revenue cycle management (RCM), business intelligence, and health...

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Matthew Sorrentino

Manager / Health

Mr. Sorrentino, a Manager and Center of Excellence (COE) lead for our Healthcare Financing Solutions division, is a management consultant with 15 plus years of extensive Medicaid and healthcare experience.

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Rich Albertoni

Manager / Health

Mr. Albertoni leads PCG's policy consulting related to state health insurance exchange planning and implementation. In this role, he has worked with Arkansas, Delaware, Hawaii, Mississippi, Nevada, New Hampshire, and Tennessee.

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John Shaughnessy

Practice Area Director / Health

John Shaughnessy is Director of PCG's health division. He joined the firm in 1992 and has extensive experience in operations improvement, strategic planning, and revenue maximization consulting for...

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Dale McCourt

Associate Manager / Health

Mr. McCourt, Associate Manager, has been a member of the PCG team since 2011. Dale brings over 25 years of experience spanning many industries where he has served in a variety of roles including Chief Operating Officer, Project Manager, Manager...

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Shawn Kotoske

Director Administrative Programs / Health

Mr. Kotoske has significant experience in leadership, project management, policy analysis, application development, and data analysis. In 2014 he created the Health Project Management Office (PMO), and now directs the PCG Health Internal Administration Office...

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Lisa Lee

Associate Manager / Health

Ms. Lee has been with PCG for 1 year and helps lead the Health Innovation, Policy and Information Technology Center of Excellence, specializing in Medicaid, CHIP, and ACA policy. Project accomplishments include the creation of Mississippi’s 1115 Waiver Application...

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Kevin Hutchinson

Manager / Health

Mr. Hutchinson oversees PCG's Program Integrity and Provider Management solutions, advising and aiding Medicaid agencies and healthcare care plans in improving compliance and quality, while preventing fraud, waste, and abuse. He leads a team that provides...

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Jay Peck

Associate Manager / Health

Mr. Peck has been with PCG for over 13 years, specializing in Medicaid Program Integrity, Quality Improvement, and Beneficiary Due Process. He has successfully led the implementation of large-scale projects, such as a Provider Oversight effort in Ohio...

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Tom Entrikin

Manager / Health

Mr. Entrikin has 45 years of experience with the Medicaid and Medicare programs. From 1981 to 1992, he was a Medicaid policy specialist with the US Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS)...

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Rick Dwyer

Manager / Health

Mr. Dwyer, a Manager located in our Boston office since 1993, has over thirty years of experience in financial and operations management in corporate and healthcare provider and payer environments.  For providers, Mr. Dwyer has been actively involved...

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Aaron Holman

Associate Manager / Health

Mr. Holman has been working in health policy for the past decade, starting in the United States Senate working on Medicare, CHIP and Health IT areas for Senator Debbie Stabenow (D-Michigan) and the Finance Committee. Mr. Holman also worked as a lobbyist in Washington focusing on health IT financing and standards development...

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