Kevin O'Brien is a leader in the firm's International Healthcare and Pharmaceutical practices. Mr. O'Brien has provided accounting, financial, economic, and operational consulting services to health service organizations involved in the healthcare, health insurance, and pharmaceuticals industries. He has extensive experience with government paid programs (e.g., Medicare, Medicaid, Federal Employees Program, and TriCare) and the intricacies of the numerous reimbursement and cost-reporting requirements associated with these programs.
Mr. O'Brien has been recognized as an expert in federal and state courts and other venues. The subject matter of his expert testimony has included regulatory guidance, fraud investigations, damage calculations, business valuations, and claims processing policies, procedures, and practices. He was the testifying expert on the Cleveland Tyson v. Amerigroup Illinois and Amerigroup Corp. qui tam case, which resulted in the largest jury award ever granted under the False Claims Act. Additionally, Mr. O’Brien has testified on numerous matters involving the usual, customary, and reasonable rates charged by hospitals to payers in conjunction with out-of-network emergency room services.
In the area of managed care, Mr. O'Brien has developed and monitored financial and operational budgets for health maintenance organizations, preferred provider organizations, and exclusive provider organizations, among others. He has performed systems reviews and implementations and has recommended changes in internal controls resulting in improved operational efficiencies and safeguards over plan and program assets. He has also performed rate setting, profit improvement, and operations studies to identify the reasons for lack of profit and determined means of improving profits or eliminating losses.
Mr. O’Brien has provided consulting and expert services to pharmaceutical manufacturers, distributors, re-packagers, wholesalers, retailers, pharmacy benefit management companies, and various regulatory bodies. He has assessed pricing strategies, rebate formulae, and inventory tracking methodologies. Specifically, Mr. O’Brien has analyzed pharmaceutical product markets, valued pharmaceutical products in conjunction with co-promotion agreements, and performed compliance and operational reviews of numerous pharmaceutical clients.
St. Joseph's College of Maine
MA, Health Service Administration, 2001
University of Southern California
MS, Systems Management, 1986
Michigan State University
BS, Accounting, 1982
2009 - 2010
Resolution Economics, LLC
2008 - 2009
2002 - 2008
Navigant Consulting, LLC
1989 - 2002
Ernst & Whinney
1987 - 1989
Allied International Holdings Corporation
1986 - 1987
United States Marine Corp
1st Lieutenant, Agent to the U.S. Treasury
1983 - 1986
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).
State departments of insurance and departments of managed healthcare have retained BRG experts to serve as interim officers and monitors for financially troubled managed health plans.
BRG experts have worked on several matters involving internal or external investigations into provider billing practices to commercial and government-sponsored programs.
News & Insights
- Acquiring an HSOManaged Care Law StategistOctober 2001
News & Commentary
- AHLAJune 30, 2015
- Press releaseJanuary 7, 2014
- Press releaseFebruary 17, 2011
- Press ReleaseJuly 13, 2010
American Bar Association – Health Law Section
American College of Healthcare Executives
American Health Lawyers Association
America’s Health Insurance Plans
American Institute of Healthcare Compliance
Association of Certified Fraud Examiners
Health Care Compliance Association
Health Care Financial Management Association
Hillsborough County Bar Association
The Institute for Internal Controls
Medical Group Management Association
National Association of Certified Valuation Analysts
Radiology Business Management Association