Tri MacDonald is president of Berkeley Research Group, a senior member of the BRG Health Analytics practice, and a leader in the firm’s International Healthcare and Pharmaceutical practices. For over 20 years, Mr. MacDonald has provided accounting, financial, statistical, data analytical, and operational consulting services to clients in the healthcare, life sciences, insurance, banking, and government contracting arenas.
Mr. MacDonald has extensive healthcare experience in reimbursement (both governmental and commercial), pricing, contracting, and regulatory compliance. In the pharmaceutical arena, he is well versed in contracting, pricing, rebates, federal and state reporting requirements, sales, marketing, and regulatory compliance. His clients have included insurers, managed care companies, pharmaceutical manufacturers, pharmacy benefit managers, clinical laboratories, retail and mail-order pharmacies, hospitals, specialty providers, group purchasing organizations, durable medical equipment companies, banks, government contractors, third-party administrators, trade associations, and numerous other entities.
Mr. MacDonald has been recognized numerous times as an expert in federal and state courts, as well as in other venues. His expert opinions have covered a wide range of topics including lost profits, federal false claims, breach of contract, allegations of fraud and collusion, risk sharing arrangements, sales and marketing practices, regulatory reporting requirements, healthcare billing, and claims adjudication for both in-network and out-of-network encounters, best price reporting, product liability, most favored nations clauses, and intellectual property infringement.
Much of his work has been related to large, national class-action matters brought against significant segments of the healthcare industry, as well as focused federal investigations into the business practices of single entities and broad segments of the industry. In addition to acting as an expert witness, Mr. MacDonald has played central roles in coordinating and executing complex data gathering, production, and cross-defendant data analytic projects.
Much of Mr. MacDonald’s work involves the acquisition, synthesis, and analysis of massive electronic data sets. He is intimately familiar with transactional and clinical data from across the health spectrum, including provider billing and charge master data, managed care claims adjudication, enrollment and fee schedule data, federal and state encounter data, pharmaceutical sales data for both contracted and non-contracted sales, rebate and discount data, clinical data, national survey data, accounting data, and regulatory compliance data. Mr. MacDonald’s analyses on these data sets has involved establishing historical trends, forecasting future performance, identifying instances of fraud or non-compliance, and comparing performance between various related parties. His broad experience within the heath care arena allows him to correlate disparate data sets in order to answer complex analytical questions. In addition, Mr. MacDonald is experienced in utilizing statistical and other analytical approaches to compensate for various shortcomings in available data sets.
BRG has worked with outside counsel and health plan clients on several matters involving Medicare Risk Adjustment data and payments.
BRG experts have worked on engagements for hospitals or health providers involved in disputes over reimbursement rates for both contracted and non-contracted services.
BRG experts have assisted a number of pharmaceutical manufacturers and their outside counsel with disputes related to allegedly fraudulent and inflated average wholesale prices for drugs in the so-called “AWP matters.”
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- January 30, 2012
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