Alex Oliphant is a member of BRG’s Health Analytics practice. He has provided analytical and strategic insight for litigation and management consulting matters for more than fifteen years.
He has wide-ranging experience managing teams tasked with designing custom algorithms to analyze medical and pharmaceutical claims for engagements involving commercial health insurers, pharmaceutical manufacturers, federal health agencies, state regulatory entities, hospital systems, and state worker-compensation agencies. His work involves assessing the accuracy of reimbursement of medical and pharmaceutical claims, conducting financial analysis on the impact of potential inaccurate claims submissions, designing statistically valid sampling methodologies for auditing claim submissions, and developing customizable front-end applications for streamlining the claim audit process.
On numerous occasions, Mr. Oliphant has worked with CMS Medicare Risk Adjustment (MRA) data (e.g., RAPS, MAO-004, MMR, MOR) in conjunction with client property data (e.g., claims, encounters, chart review, and enrollment) to assess provider and plan submission patterns and behavior in order to evaluate the financial and compliance risks associated with strategic decisions. He has also designed statistically valid sampling methodologies for conducting medical record reviews and has developed sophisticated front-end applications that record, run quality checks on, and summarize medical record review results.
Mr. Oliphant has served as the technical lead on engagements involving 340B compliance monitoring for large pharmaceutical manufacturers. He has constructed models based on pharmaceutical pricing and utilization datasets, Office of Pharmacy Affairs–related datasets, hospital cost report data, CMS claims data, and state Medicaid claims data to identify entities that may be diverting 340B product or creating duplicate discounts.
Employment History
LECG
Senior associate
2005 – 2010
Primus Telecommunications
Systems Analyst
2004 – 2005
