Mark Abernathy specializes in dispute resolution services and forensic investigations, and providing consulting services in the healthcare and life sciences industries. His more than thirty years of experience span a variety of providers, payers, and other healthcare entities, including HMOs, PPOs, pharmacy benefit managers, pharmaceutical manufacturers, hospitals, physician groups, home health agencies, ambulatory surgery centers, outpatient diagnostic centers, and state regulators. He has advised clients with commercial litigation, federal investigations, bankruptcy, turnarounds, and health plan seizures.
Mr. Abernathy’s healthcare consulting and financial management experience covers a broad range of services including:
- Expert testimony and litigation support services: lost profits, class actions, payer/provider disputes, breach of contract, buy/sell disputes, antitrust, wrongful termination, and accounting and legal malpractice defense
- Forensic accounting, statistical sampling, and valuations
- Provider and payer support during Department of Justice/Officer of the Inspector General/Attorney General investigations
- Conservator, examiner, and special monitor bankruptcy roles, and assistance with governmental agency seizures
- Development of hospital-physician networks for national HMO and PPO organizations
- HMO Certificate of Authority licensure
- Review of billing and third-party claims processing systems, internal and external financial controls and reports, and market conduct studies
- Hospital and HMO accounting and operations, treasury, budgeting, and financial planning responsibility
Middle Tennessee State University
Resolve Advisory Partners, LLC
2010 - 2010
Deloitte Financial Advisory Services, LLC
2007 - 2009
Navigant Consulting, Inc.
1998 - 2007
Jacobson, Abernathy and Associates, Inc.
Senior vice president and chief financial officer
1989 - 1998
Ernst & Young
1987 - 1989
AMI Group Health Services
1986 - 1987
Partners National Plans
Chief operating officer
1985 - 1986
CIGNA Health Plan of Florida, Inc.
Vice president and chief financial officer
1982 - 1985
INA Healthcare Group
Internal auditor and operations analyst
1980 - 1982
Hospital Affiliates International
1978 - 1980
Controller's Office of the State of Tennessee
1977 - 1978
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 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).
Bankruptcy courts have appointed BRG experts as conservator, special monitor, and trustee for managed healthcare plans undergoing liquidation or reorganization.
BRG experts have worked on several matters involving internal or external investigations into provider billing practices to commercial and government-sponsored programs.
News & Insights
- The Role of Examiner in Health Care InsolvenciesABI JournalJanuary 2004
- How to Benefit from a Managed Care Check-upFinancial ExecutiveAugust 2000
- Avoiding Common Problems in Risk-Sharing ContractsManaged Care MagazineApril 2000
Seminars & Speaking Engagements
News & Commentary
- San Jose Mercury NewsNovember 26, 2015
- AHLAJune 30, 2015
- California HealthlineOctober 24, 2012
- Ventura County StarApril 7, 2012
- Press ReleaseJuly 13, 2010
American Bar Association
American Institute of Certified Public Accountants
American Health Insurance Plans
American Health Lawyers Association
Tennessee Society of Certified Public Accountants
Florida Institute of Certified Public Accountants