Julie Nielsen is a member of the Health Analytics practice at BRG, where she specializes in providing dispute resolution, litigation support, forensic investigation, and data analysis services to healthcare entities and their legal counsel. Her more than 20 years of consulting experience span a variety of payers, providers, and manufacturers, including hospitals, physicians, clinical laboratories, pharmacies, managed care organizations, health plans, third-party administrators, pharmacy benefit managers, and pharmaceutical and medical device manufacturers. She primarily advises clients and their counsel with addressing liability, economic damages, and class-certification issues related to investigations, litigation, and disputes, including:
- Conducting and assisting with internal investigations as a privileged consultant
- Analyzing and assisting with responding to fraud or other allegations made during government investigations
- Assessing the economic impact of alleged noncompliance with contractual obligations and federal, state, and local regulations
- Providing damages and industry-specific litigation and dispute resolution support, including complex data analytics and financial modeling
- Performing compliance and fraud risk assessments and developing risk management programs
- Assessing current and historic billing, claims processing, and claims reporting operations
Much of Ms. Nielsen’s work is focused on assessing internal controls and regulatory compliance risks under Medicare, Medicaid, and commercial contracts and assisting clients that are facing allegations of violations of the False Claims Act, Anti-kickback Statute, or other legal, regulatory, or contractual requirements. She has detailed knowledge of the billing, payment, financial, and other transactional data systems maintained by various parties in the healthcare system. She specializes in marrying key transactional data, such as healthcare claims and member eligibility data, with her expertise in billing, coding, claims processing, and reimbursement. This enables her to provide her clients with a more global view of the issues or allegations and enhances the ability to develop timely, independent, and supportable conclusions and opinions.
University of Wisconsin, Madison
Deloitte Financial Advisory Services, LLP
Principal, Healthcare Forensics and Dispute Services
2007 - 2009
Navigant Consulting, Inc.
Director, Healthcare Disputes and Investigations
1994 - 2007
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 experts have worked with outside counsel and healthcare clients in large class action matters to address class certification, liability, and damages issues.
BRG has been retained by outside counsel to advise health providers and health plans with addressing breach of contract allegations regarding risk-sharing arrangements, employment agreements, purchase agreements, reinsurance arrangements, and IT vendor services.
News & Insights
Seminars & Speaking Engagements
- May 2-3, 2017
- October 6, 2016
- June 26-29, 2016
- May 13, 2015
- NACDL White Collar Criminal Defense CollegeMarch 13, 2015
- January 15, 2015
- October 6-7, 2014
- September 16, 2014
- May 21, 2014
- February 7, 2014
- January 8-12, 2014
News & Commentary
- AHLAJune 30, 2015
- Modern HealthcareJuly 24, 2014
American Institute of Certified Public Accountants
Wisconsin Institute of Certified Public Accountants
American Health Lawyers Association
American Bar Association
Healthcare Businesswomen's Association
Certified Public Accountant (CPA), licensed in the State of Wisconsin
Certified in Financial Forensics (CFA)
Chartered Global Management Accountant (CGMA)