Health Consulting Services

Health Consulting Services to state and federal regulators by seasoned regulatory professionals skilled in managing audits, examinations, and investigations across the full spectrum of complex health insurance regulations and reforms.

Major Areas of Specialization

  • Compliance with the requirements of the Affordable Care Act (ACA)
  • Mental Health Parity and Addiction Equity Act (MHPAEA) specialist reviews
  • Review of Life and Health form filings for federal and state health regulations
  • Qualified Health Plan Certification Application Materials and Review Tools
  • Comprehensive and targeted market conduct examinations, including MHPAEA Compliance, Reproductive Health Benefits, Essential Health Benefits, Preventative Services Benefits
  • No Surprises Act (NSA) enforcement with a focus on qualifying payment amount (QPA) audits and overlapping specified state law
  • Transparency in Coverage data and the Claims Payment Policies
  • Network Adequacy reviews
  • Pharmacy Benefit Management (PBM) audits
  • Drug formulary and pharmacy claim reviews
  • Clinical Pharmacy-focused EHB, Clinical Appropriateness, and MHPAEA reviews
  • Training, audit design and development, and process improvement
  • Health regulation research projects for state and federal partners

DIVISION LEADERSHIP

Christine Thomas, MCM

Managing Director

Katie Dzurec, JD, LLM, MCM

Director

Mitchell Ristine, JD, CIE, FAHM, MCM

Director and In-House Counsel

Caroline Bergh, CIE, FAHM, MCM

Senior Manager

Chris Cagle, JD, CIE, MCM

Senior Manager

Melinda Domzalski-Hansen, MCM, AIE, PAHM

Senior Manager

Whitney Ederer, JD, MPH, CIE, FAHM, MCM

Manager

Rebecca Palasek, CIE, FAHM, FHIAS, HCP, MCM, MHP

Manager

Tiffany Caverhill, CIE, HCP, MCM

Supervisor

Jennifer Fuller, MCM, CIE

Supervisor

Monica Rutkowski

Supervisor

Stephanie Alfonso, CIE, FAHM, MCM

Assistant Supervisor

Amanda Rockefeller, CIE, FAHM, MCM

Assistant Supervisor

Doug Stephens

Assistant Supervisor

Lisa Uku, MSM, CIE, MCM, FAHM

Assistant Supervisor