We have worked for most types of healthcare entities, including hospitals, alternate care facilities, medical supply distributors, doctor groups, research firms, and pharmaceutical companies.
When serving the healthcare industry, we occasionally will team with Healthcare Management Partners (www.hcmpllc.com). HMP is a team of senior executives with a track record of delivering operational and financial performance improvement for healthcare organizations. HMP focuses on turnaround management consulting, transaction and financial advisory services, bankruptcy services, and expert testimony and dispute analysis.
- On numerous occasions, analyzed lost profits. The entities involved included:
- Surgery centers
- Medical device manufacturers
- Medical instrument manufacturers
- Drug manufacturer and distributor
- Providers of medical test kits
- An adult day healthcare (PACE) facility serving Medicare and Medicaid patients
- A regional radiology practice/center
- A manufacturer of hospital beds
- On numerous occasions, reviewed the propriety of medical billings and related receivables. The circumstances of such reviews have related to (i) a purchase transaction, (ii) compliance with applicable law and contracts, and (iii) concerns between the providers of whether payments were being allocated properly amount the providers. Consulted regarding fraud allegations and/or ways of improving the controls and reporting.
- Valued and testified regarding components a biotech company during a shareholder dispute. This company was developing an encapsulation process for pharmaceutical drugs to cure diabetes and some forms of cancer. Prepared a market assessment and a competitive analysis including alternative therapies and substitutes.
- On behalf of a class of large pharmaceutical manufacturers accused of price discrimination and price fixing of a common contraceptive, analyzed the economics of the industry, defined the relevant market, and assessed any harm to competition and to consumers using various econometric methods.
- Valued a biotechnology company that developed a new drug delivery system.
- Valued a portfolio of patents that enabled a new and highly effective method of detecting colon cancer. Valued this same portfolio as it pertained to a new application involving esophageal cancer detection.
- Valued a portfolio of patents and other intangible assets that enable a highly effective method for detecting cervical cancer.
- In a matter involving alleged billing overcharges of a major long-term care service provider, designed a random sample and estimated the total amount of billing overcharges facilities based on proper statistical sampling methods.
- In a pricing dispute between a large chain of long term care facilities and its pharmaceutical supplier, analyzed state Medicare/Medicaid drug reimbursement formularies and actual state Medicaid drug reimbursement public data to determine the appropriate price the long term care facilities should have been charged by its pharmaceutical suppliers.
- For a project analyzing data of alleged billing overcharges of a health insurance company, designed a random sample and estimated the total amount of billing overcharges based on proper statistical sampling methods.
- To identify consumer preferences between having cataract eye surgery performed at cataract eye surgery centers versus hospitals, specified and estimated binary logit, nested multinomial logit, and probit economic regression models of consumer choice.
- For a breach of contract case collected and analyzed data to determine urinary catheter demand and estimated appropriate market shares in each end user class of the innovative product. Created and maintained this database and performed statistical analyses based on economic demand models for the products to estimate and forecast but-for past and future sales.
- In an alleged wrongful marketing case, performed a “testing population means” statistical test to test whether or not the marketing claim that a manufacturer of dentist drill parts performs faster than identified comparables.
- Using substantial electronic data, quantified the amount of prescription drugs charged by a nationwide pharmacy to a major long-term care provider. We determined the amount overcharged for each prescription based on the contractual pricing arrangement between the two entities. We identified significant discrepancies between the contractual prices and the amounts actually charged. We calculated the amount due from the overcharges.
- A class of owners of a large public hospital stock alleged that “but-for” the hospital’s independent auditors failure to disclose the relatively large Medicare “outlier” payments on the hospitals public financial statements, the class would not have bought the stock resulting in a loss. To determine whether it is customary for independent auditors of U.S. hospitals to disclose hospital Medicare “outlier” revenues, analyzed CMS’s (Center for Medicare and Medicaid) HCFA (Health Care Financing Administration) database and other public hospital databases and identified top 200 hospitals and analyzed their financials.
- On multiple occasions, reviewed the accounting of capitated risk pools between involving a hospital and Independent Physician Association.
- Served as an arbitrator involving purchase price adjustments of a public company operating outpatient surgery centers.
- Served as an arbitrator involving purchase price adjustments of a major healthcare transportation company.
- Analyzed allegations of misstatements of the financial statements of a public company providing in-home patient care.
- Analyzed anti-trust allegations involving HMO’s. This required analysis of computerized records of the entities involved to estimate the market share held by each. Analyzed geographic patterns of patients to determine the impact of location of competition.
- Performed a market assessment, competitive analysis and financial forecast of an international medical diagnostics company.
- Performed a reasonable royalty analysis for an inventor and licensor of pharmaceutical products.