Mike is the partner in charge of the firm’s Atlanta, Georgia office and serves as an engagement team partner in charge for both our managed care, audit, and consulting practice and the benefit/program integrity team. He has extensive experience working with state Medicaid agencies, conducting examinations and performance audits testing for compliance on Medicaid managed care health plans; conducting various program integrity engagements, including payment audits; and assisting with data quality and data analysis. Mike also worked with numerous states addressing Health Information Technology for Economic and Clinical Health (HITECH) compliance issues including conducting electronic health record (EHR) post-payment reviews.
While Mike has worked on a variety of engagements throughout his two-decade career, much of his recent work has involved supporting multiple states on the implementation and oversight of the Medicaid managed care program and complying with the managed care rule. Mike has provided oversight on multiple Medical Loss Ratio (MLR) examinations and was recently a CMS invited panelist at a conference discussing MLR examinations. Another accomplishment includes helping states comply with the new managed care rule by developing a strategy to reconcile and validate managed care organization (MCO) encounter claims. With implementation of this strategy, several states have seen their MCOs raise their completion rates and clean up erroneous encounters in the process. As part of his managed care support, Mike has assisted states by conducting performance audits of the MCOs and by providing best practices and suggested contract language for states to utilize in their managed care program oversight.
Mike has worked with more than a dozen states to develop audit strategies for program oversight and payment integrity-related to the EHR incentive payment program. As part of the strategy, fee-for-service (FFS) and encounter data was utilized to develop risk assessments. This strategy was recognized by the Centers for Medicare & Medicaid Services (CMS) as a best practice, and he has been an invited speaker on this topic at the national HITECH conference. Prior to joining Myers and Stauffer in 2008, Mike managed the claims analysis unit of the Healthcare Audits Division for the Georgia Department of Audits and Accounts (GDOAA). While at GDOAA, he also supervised and audited nursing home and home health cost reports and designed a rate setting program for skilled nursing facility (SNF) reimbursement. Mike has performed on-site audits of state agencies and county school boards throughout the state of Georgia. He has also served as an expert witness for the state of Georgia and the U.S. Department of Justice (DOJ) in Medicaid fraud trials.
Mike is a Certified Public Accountant (CPA) and a Certified Fraud Examiner (CFE). He is a member of the American Institute of Certified Public Accountants, the Association of Certified Fraud Examiners, the Georgia Society of Certified Public Accountants, and the National Healthcare Anti-Fraud Association.