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 issues new guidance on using Medicaid health IT to reduce opioid risks

5 days ago

On June 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued new guidance to state Medicaid directors about how states can harness Medicaid health information technology to combat the opioid crisis. CMS encourages states to pursue strategies such as enhanced prescription drug monitoring programs, drug utilization review programs, and opioid risk assessment tools which can be integrated into electronic health record systems...

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Maine Superior Court Justice orders state administration to carry out voter-approved Medicaid Expansion

12 days ago

On Monday, June 4, 2018, Superior Court Justice Michaela Murphy ordered the Commissioner of the Maine Department of Health and Human Services to submit by June 11, 2018 a state plan to the U.S. Department of Health and Human Services (DHHS) Center for Medicare and Medicaid Services (CMS)to provide expanded Medicaid eligibility to appropriate Maine residents pursuant to the Affordable Care Act (ACA).  

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CMS launches Medicaid/CHIP performance scorecard

12 days ago

On June 4, 2018, the Centers for Medicare and Medicaid Services (CMS) unveiled a new performance scorecard offering critical metrics on state health system performance, state administrative performance, and federal administrative performance under Medicaid and the Children’s Health Insurance Program (CHIP).

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States Pursue Unique Approaches to Permit Non-Compliant Health Plans

26 days ago

While much of the attention over the debate over the Affordable Care Act (ACA) has centered at the Federal level, states continue to act as the laboratories for innovation. Last year Health Policy News featured a series of updates on activity around Section 1332 State Innovation Waivers in the states – with a focus primarily on State-based reinsurance and invisible high risk pool mechanisms.  That activity continues – though at a slower pace – with the recent waiver requests submitted by Wisconsin and Ohio.

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Movement on drug cost containment at both the State and Federal level

26 days ago

Health Policy News has devoted significant attention to State and Federal efforts to contain drug costs, including recently issuing a report and legislative tracking tool entitled “ Rising Prescription Drug Costs: A report on state and federal efforts to contain costs”. As we head into the summer we offer readers a few short updates on some of the issues we have been closely following and will continue to track...

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Looking to the Future of Workers' Compensation

26 days ago

Several members of the PCG Health team recently attended the Workers Compensation Research Institute’s Annual Issues & Research Conference in Boston. The conference convenes researchers, regulators, and other workers’ compensation professionals from around the country to discuss trends they are seeing within the industry...

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Meet Our Team

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John Shaughnessy

Practice Area Director / Health

Mr. Shaughnessy is Director of PCG Health. He joined the firm in 1992 and has extensive experience in operations improvement, strategic planning, and revenue maximization consulting for hospitals and others such as health care providers...

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James Waldinger

Associate Manager / Health

Mr. Waldinger, an Associate Manager at PCG, is an experienced Medicaid policy and reimbursement professional who focuses on healthcare operations, mental health and substance abuse policy and integration, and health care reform and its impact on Medicaid programs and providers.

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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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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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John Blowers

Associate Manager / Health

Mr. Blowers leads the newest PCG Health Center of Excellence known as Staffing Solutions Organization (SSO). While SSO just celebrated its one-year anniversary on May 1st, Mr. Blowers has over 25 years of HR experience...

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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...

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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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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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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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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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Tony Curatola

Associate Manager / Health

Mr. Curatola, an Associate Manager with PCG and certified PMP, has more than 29 years of experience in the Information Systems industry with over 22 years in project management and 18 years in Medicaid.  He has extensive project management experience in both the public and private sectors including: state government, property and casualty Insurance, healthcare insurance, and banking.

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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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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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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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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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Rich Albertoni

Manager / Health

Mr. Albertoni has 16 years of experience working in state public health programming and Medicaid. He has held leadership positions in eligibility, budget and finance, and benefits and waivers.

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Shawn Kotoske

Director of Internal Administration / 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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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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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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