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

U.S. Supreme Court agrees to hear case concerning risk corridors under the Affordable Care Act

25 days ago

On Monday, June 24, 2019, the U.S. Supreme Court agreed to hear the case involving risk corridors for insurance companies under the Affordable Care Act (ACA). A provision of the ACA established these so-called risk corridors, whereby the federal government would control gains and losses of insurance companies to help the companies cope with their risks when they participated in the ACA marketplaces from 2014 to 2016. 

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U.S. Supreme Court strikes down 2014 regulation that reduced Medicare Disproportionate Share Hospital (DSH) payments

32 days ago

On Monday, June 3, 2019, the U.S. Supreme Court upheld a Court of Appeals ruling that stated a 2014 regulation of the Centers for Medicare and Medicaid Services (CMS) – that reduced DSH payments to hospitals servicing indigent patients – should be removed for failure to follow proper notice and comment requirements. 

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New Maryland law assists individuals to qualify for Medicaid automatically based on information on state tax return

63 days ago

On Monday, May 13, 2019, Governor Larry Hogan (R) signed a bill into law, which will automatically assist individuals to become enrolled in the state’s Medicaid program. The new law will permit a taxpayer to check a box on the state tax return which will cause the state’s health care exchange to determine if the person qualifies for Medicaid, based on the information in the tax return.

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Federal district court judge strikes down federal rule authorizing association health plans

110 days ago

On Thursday, March 28, 2019, Judge John D. Bates of the Federal District Court for the District of Columbia struck down a regulation of the U.S. Department of Labor that permitted small businesses to band together to create association health plans (AHPs) that did not meet the benefits requirements of the Affordable Care Act (ACA).

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Arizona Appeals Court voids state law provisions allowing hospitals to impose liens on Medicaid injured recipients

125 days ago

On Tuesday, March 12, 2019, a three-judge panel of the Arizona Appeals Court held that Arizona statutes that allowed hospitals to impose liens on Arizona Medicaid recipients who suffered accidents in order to recover the difference between the Medicaid payments and the hospitals’ costs violated Federal law. 

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CMS offers new model for emergency medical triage and transportation

151 days ago

On February 14, 2019, the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), outlined a new model for emergency medical triage, treatment, and transportation services. CMS will offer Medicare reimbursement through the new model to transport patients to hospital emergency departments as well as other destinations appropriate to patient needs, such as primary care physicians and urgent care clinics.

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Meet Our Team

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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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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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James Dachos

Associate Manager / Health

Mr. Dachos, an Associate Manager in our Healthcare Financing Solutions division, has 12 years of Medicaid and Healthcare experience with PCG. He leads PCG’s Emergency Medical Services (EMS) division...

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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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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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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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John Blowers

Associate Manager / Health

Mr. Blowers holds an MBA from Kelley School of Business and has more than 25 years of HR experience, with approximately 2/3rds of that time holding leadership roles with General Electric, India-based Crompton Greaves...

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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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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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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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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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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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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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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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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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Marc Staubley

Practice Area Director / Health

Mr. Staubley is Practice Area Director (PAD) of PCG’s Health division 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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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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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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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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