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

President Signs Bipartisan Budget Act

5 days ago

On February 9, 2018, President Trump signed H.R. 1892, the Bipartisan Budget Act of 2018.  The new law reauthorizes federal funding for many health programs, modifies scheduled reductions in Medicaid disproportionate share hospital (DSH) allotments to states, tightens third party liability (TPL) billing requirements, and updates requirements affecting Medicare Advantage plans, accountable care organizations (ACOs), and providers’ adoption of telehealth.

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U.S. District Court in Missouri invalidates Final Rule of Centers for Medicare and Medicaid Services (CMS) dealing with reduction of disproportionate-share (DSH) payments

5 days ago

On February 13, 2013, U.S. District Court Judge Brian Wimes in Missouri ruled that a CMS final rule that would require Missouri Hospitals’ DSH allotments to be reduced by any Medicare or commercial insurance was invalid. This ruling is one of several decisions in an ongoing battle by states in response to a CMS policy issuance in 2010 announcing the reduction, and a final rule in effect since June 1. 

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Federal District Court in Tennessee invalidates billing threshold for enhanced Medicaid payments to physicians

14 days ago

On January 24, 2018, a Federal District Court in Tennessee held that the Centers for Medicare and Medicaid Services (CMS) improperly included a billing threshold requirement in a final rule concerning whether physicians received an enhanced Medicaid rate for primary care services under a provision of the Affordable Care Act (ACA). 

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Federal lawsuit filed challenging Kentucky’s Medicaid work requirement

19 days ago

On Wednesday, January 24th, a lawsuit was filed in the Federal District Court, District of Columbia, challenging the implementation by Kentucky of the nation’s first work requirement in a Medicaid program. The suit was filed by three organizations on behalf of 15 Kentucky citizens claiming to be at risk of losing their Medicaid coverage. They also requested to certify the suit as a class action.

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The Government Accountability Office issues recommendations on fraud prevention

26 days ago

On December 5, 2017, the Government Accountability Office (GAO) issued a a report on Centers for Medicare and Medicaid Services (CMS) fraud prevention efforts, recommending that CMS more closely align its approach with the Fraud Risk Framework put forth by the GAO in 2015. Medicaid and Medicare fraud and abuse prevention has been increasingly in the spotlight...

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Congress reauthorizes the Children’s Health Insurance Program

26 days ago

On January 22, 2018, Congress reauthorized funding for the Children’s Health Insurance Program (CHIP) through Federal fiscal year (FFY) 2023. The CHIP provisions are included as the Healthy Kids Act under H.R. 195, Division C.  Division B extends a short-term continuing resolution (CR), which was necessary to reverse a three-day federal government shut-down. Division D affects certain health care related taxes established under the Affordable Care Act (ACA). The President signed the bill into law on January 22. 

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Meet Our Team

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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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Rick Dwyer

Manager / Health

Mr. Dwyer joined PCG in 1993 and has more than 25 years of experience in financial and operations management in corporate and health care provider environments. He has been actively involved...

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Amy Ferraro

Manager / Health, Human Services

Ms. Ferraro has more than 17 years of public sector consulting experience and has worked on a variety of revenue management, revenue optimization, and consulting engagements in more...

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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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Matthew Sorrentino

Manager / Health

Mr. Sorrentino oversees statewide financial management contracts in Arizona, Georgia, Kansas, Illinois, Nebraska, North Carolina, Texas, and Wisconsin, primarily helping Medicaid and public health...

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Aaron Holman

Associate Manager / Health

Aaron Holman has been working in health policy for the past decade, starting in the United States Senate working in Medicare and Health IT areas for Senator Debbie Stabenow (D-Michigan)...

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Kevin Carlson

Chief Technology Officer / Health

Kevin Carlson has more than 20 years of experience in the health care technology sector. Mr. Carlson has overseen the development and implementations of numerous electronic health record, revenue cycle...

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Tom Entrikin

Manager / Health

Mr. Entrikin has 40 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)...

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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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Kevin Hutchinson

Manager / Health

Mr. Hutchinson oversees PCG's Program Integrity and Provider Management solutions, advising and aiding Medicaid agencies and managed care plans in compliance, fraud, waste, and abuse...

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Marc Staubley

Assistant Practice Area Director / Health

Mr. Staubley leads our revenue cycle unit within PCG's Health division. In this role, he oversees projects which include provider rate setting, cost reporting and cost settlement, third party administration, billing services...

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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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Thomas Aldridge

Manager / Health

Mr. Aldridge has been with PCG for more than 15 years. He currently leads the Payer Services Group within PCG's health division and is focused on efforts to control costs for payers through placement of tighter controls on eligibility...

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