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Representative Engagements

Representative Engagements for Health Analytics.

  • 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.

  • Health plans and regulators have retained BRG experts on engagements that involved assessing health plans’ medical loss ratios (MLR; medical expenses divided by premium revenue).

  • BRG has been retained in several cases relating to payments made by health insurers to providers that are not in their provider networks (out-of-network reimbursement).

  • BRG experts assisted outside counsel for a global pharmaceutical company accused of fraudulent promotion of several of its products for indications that were not Food and Drug Administration approved (so-called “off-label” uses).

  • A pharmaceutical manufacturer retained BRG personnel in relation to a Department of Justice investigation with a central allegation that the manufacturer misstated its best price and underpaid Medicaid rebate.

  • BRG experts have worked on several matters involving internal or external investigations into provider billing practices to commercial and government-sponsored programs.

  • 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.”

  • Working with an academic medical center’s transformation team, BRG led a successful statewide effort to bundle readmissions into 30-day case rates that included both the initial admission and readmission.