Health - PCG | Public Consulting Group

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 COVID-19 Health Services

Together, we can implement the innovative solutions necessary to help public health systems rise to the challenges of COVID-19.

For Health Plans

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

For Fire and EMS Provider Organizations

Helping fire and emergency medical service agencies improve operational performance, reduce costs, and deliver better outcomes to those in need.

News & Perspectives

PCG hosts “Translating Fire & EMS Operational Challenges into Financial Needs” Webinar

691 days ago

As more fire and EMS departments have been expressing the need for additional funding, countless have struggled through referendums and challenging budget meetings to justify every penny of increase. Public Consulting Group (PCG) is here to provide support to fire and EMS administrators on how to step back from challenges, consider the perspectives of the community, and determine how to communicate operational needs into simple and actionable requests that anyone can understand.

U.S. Supreme Court Ruled That HHS Wrongfully Cut Medicare Reimbursement for Certain Drugs to Hospitals Serving Low-Income Beneficiaries

874 days ago

On Wednesday, June 15, 2022, the U.S. Supreme Court unanimously held that the U.S. Department of Health and Human Services (HHS) improperly cut more than $1 billion per year since 2018 in Medicare payments for certain drugs to hospitals serving low-income communities.

U.S. Supreme Court Decides That States Can Seek Reimbursement for Future Medical Expenses from Medicaid Beneficiaries’ Injury Settlements

883 days ago

On June 6, 2022, the U.S. Supreme Court held, in a seven-to-two decision, that the Medicaid statute permits a state to seek reimbursement from settlement payments allocated for future medical care.

U.S. Supreme Court Declines to Hear Appeal by UnitedHealth Group, Inc. Requiring Return of Medicare Overpayments Based on Faulty Diagnoses

896 days ago

On Tuesday, June 21, 2022, the U.S. Supreme Court rejected an appeal by UnitedHealth Group, Inc., leaving in place a federal rule requiring Medicare Advantage plans to return overpayments based upon wrongful diagnoses.

PCG Awarded CMS Quality Improvement Organization-like Recertification

974 days ago

Public Consulting Group (PCG) is proud to announce its five-year recertification as a Quality Improvement Organization-like (QIO-like) entity by the Centers for Medicare and Medicaid Services (CMS). A QIO-like entity consists of health quality experts, clinicians, and consumers who work together to improve the quality of care delivered to Medicare and Medicaid beneficiaries.

District of Columbia Court of Appeals Panel Requires Medicare Advantage Plans to Return Medicare Overpayments

1191 days ago

On Friday, August 13, 2021, a panel of the D.C. Court of Appeals held that Medicare Advantage private insurers must return potentially billions of dollars in overpayments they receive based on incorrect diagnoses.

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...

Chy Davidson

Manager / Education

Chy Davidson has enjoyed a 23-year career in the field of education. He currently serves as Manager for Public Consulting Group, assisting educators with effective educational programs to impact student learning. He was brought onto...

Selvi Dorairaj

Director / Technology Consulting

Kalaichelvi (Selvi) Dorairaj joined PCG in 2011 and serves as a Director of the Technology Consulting team. In this role, Selvi is responsible for providing project management and technical oversight of independent verification and validation (IV&V) projects as well as business analysis services for systems development projects...

Jill Reynolds

Associate Practice Area Director / Human Services

Ms. Reynolds leads PCG’s Aging and Disability Services Center of Excellence. She provides strategic leadership and support for human services projects involving Home and Community Services, Vocational Rehabilitation, disability services, employment support programs, and other programs serving elders and people with disabilities...

Sean Huse

Manager / Health

Mr. Huse (MBA, CHFP), a Manager at Public Consulting Group, is an experienced health management consultant who focuses on financial management, strategic planning, policy analysis, information...