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

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

148 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.

ReadMore

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

157 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.

ReadMore

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

170 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.

ReadMore

PCG Awarded CMS Quality Improvement Organization-like Recertification

248 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.

ReadMore

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

465 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. 

ReadMore

Missouri Supreme Court Orders Implementation of Medicaid Expansion

473 days ago

On Thursday, July 22, 2021, the Missouri Supreme Court reversed a lower court decision and ruled unanimously that the state legislature is required to fund the new Medicaid expansion program. Doyle, et al., Barber and Chaney v. Tidball, et al. (SC 99185).

ReadMore

Meet Our Team

team-member

Heather Caldwell

Associate Manager / Health

Heather Caldwell is an associate manager in Health at PCG. In this role, she works with the cost allocation team to help government health agencies claim reimbursement from the federal government for administrative activities...

ReadMore
team-member

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.

ReadMore
team-member

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...

ReadMore
team-member

Alissa Narode

Associate Manager / Health

An Associate Manager with the firm’s Health Care Financing Solutions team, Alissa Narode has extensive experience overseeing Medicaid rate setting and rate study projects at the state, county, and provider levels.

ReadMore
team-member

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...

ReadMore
team-member

Peter Cheesman

Manager / Health

Mr. Cheesman directs PCG’s Member Eligibility Management group. In this capacity, Peter designs and deploys creative technical solutions connecting government agencies...

ReadMore
team-member

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...

ReadMore
team-member

Tony Curatola

Manager / Health

Mr. Curatola, a 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. 

ReadMore
team-member

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...

ReadMore
team-member

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...

ReadMore
team-member

Aaron Holman

Manager / Health

Aaron Holman currently runs the Medicaid Transformation practice at the Public Consulting Group. Aaron’s teams advise various Medicaid agencies, state insurance regulatory departments...

ReadMore
team-member

Garrett Abrahamson

Associate Manager / Health

Mr. Garrett Abrahamson is a healthcare consultant, delivering impactful financial deliverables with a client-centric approach. An Associate Manager with the Health Care Financing Solutions...

ReadMore
team-member

James Waldinger

Manager / Health

Mr. Waldinger, a Manager at PCG, is an experienced Medicaid policy and reimbursement professional who focuses on healthcare operations and reimbursement transformation...

ReadMore
team-member

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...

ReadMore
team-member

Andrew Heaney

Associate Manager / Health

Andrew Heaney, an Associate Manager at PCG, has extensive experience working with health information technology (HIT), health information exchanges (HIE), health insurance exchanges (HIX), electronic health records (EHR), state...

ReadMore
team-member

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...

ReadMore
team-member

Tom Kapusta

Associate Manager / Health

An Associate Manager within the firm’s Health Innovation, Policy, and Information Technology (HIPIT) team, Tom has extensive experience in health information technology (HIT), particularly in the areas of Medicaid eligibility...

ReadMore
team-member

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...

ReadMore
team-member

James Dachos

Manager / Health

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

ReadMore
team-member

Angelene Willetts-Carvi

Associate Solutions Manager / Health

Angelene Willetts-Carvi is an Associate Solutions Manager in Health Payer Services at Public Consulting Group. With over 20 years of experience in Home and Community Based Services...

ReadMore