Joseph Hoang is a Managing Director at Ankura Consulting Group and is based in Washington, DC. Mr. Hoang specializes in assisting clients and leading teams in healthcare regulatory, compliance, dispute, and operations matters with an emphasis on performance and process improvement, complex data management and analysis, claim reviews, and claim-related audits. His 17 years of experience spans a variety of healthcare clients including; health insurers, managed care organizations (MCOs), physician enterprises, health systems, pharmacy benefit managers (PBMs), as well as pharmaceutical manufacturers and wholesalers. Mr. Hoang has assisted these organizations with issues related to analytics, data validation audits, information systems capability assessments, large volume claims billing and payment disputes (often involving automated claims auditing), prompt-payment, fraud, breach of contract, and contractor performance. Mr. Hoang has extensive experience developing and managing business and technical requirements involving data warehousing, healthcare claims analysis, and data mining as they relate to healthcare payers’ claim systems and auditing programs.
Medicaid and Medicare Compliance Matters – Mr. Hoang has conducted numerous compliance audits focused on contractor performance for hospitals and health plans as well as CMS Program Audits, Data Validation Audits and Information Systems Capabilities Assessments for Medicare and Medicaid plan sponsors. Some audits included the review for accuracy of procedural (including: CPT, ICD-9, and revenue) code changes by contractors, the appropriateness of those code changes, and the use of automated bridge routines. Other matters evaluated the contractual responsibilities and procedural accurateness of a contractor’s efforts in identifying supplemental diagnosis codes (i.e., ICD-9) from medical record documentation and the subsequent submissions to the Centers for Medicare and Medicaid Services (CMS) for risk adjustment and reimbursement. For a Fortune 50 payer client, Mr. Hoang has provided process improvement services as it relates to extensive updates to the client’s existing Alternate Submission Method SAS/SQL logic and technical system enhancements to enact new levels of error handling (e.g., eligibility handling), end-to-end record level tracking, and real-time client reporting for encounters and diagnoses submitted to CMS for Medicare Risk Adjustment purposes.
Fraud, Investigation and Dispute Matters – For numerous clients, Mr. Hoang has conducted investigations or provided privileged consulting on matters that involved allegations of fraud and/or misconduct. This included cases that involved contractor misconduct, inventory shrinkage anomalies, billing and payment inconsistencies as well as falsification of pharmaceutical prescription fill turnaround times. Oftentimes these cases required large-scale transactional data analysis used to detect the abhorrent patterns and trends that are atypical of normal business operations. In one whistleblower case, Mr. Hoang analyzed over 6 terabytes of claims data to uncover and isolate the transactions with fraudulent patterns to substantiate any related misconduct within those facilities.
Hospital and Health System Performance Improvement and Analytics Matters – Mr. Hoang has led the development of robust performance analytics and teams responsible for the data requirements gathering, project management, collection, validation, analytics and visualizations to support the revenue generating and cost saving opportunities associated with performance improvement (including areas such as clinical, labor productivity, supply chain, revenue cycle, and physician enterprise). Mr. Hoang is a thought leader in analytics development, process standardization and data flow automation that allow for efficient review, analysis, and reporting of EHR/EMR system information (i.e., EPIC, Meditech, Cerner, etc.) to all stakeholders, including client personnel, executives and internal Service Line consultants. In this capacity, he has worked with a diverse set of children’s hospitals, large integrated health systems and many regional hospitals throughout the country.
IT Due Diligence and Management Analytics Matters – For private equity clients and their portfolio companies, Mr. Hoang has conducted in-depth technical reviews and due diligence of healthcare companies’ IT organization, architecture, infrastructure, and customer relationship management (CRM) platforms. For these clients, the goal is to evaluate the viability of the target companies’ service and/or product offering(s) from an information technology, analytics and data perspective and to assist the client in determining whether the capabilities warrant the potential financial investment by their investors. In addition, Mr. Hoang has conducted key performance indicator mappings from a revenue, cost, and other operational metrics leveraging the company’s existing workflow tools and databases.
Operational Analytics Matters – Mr. Hoang has extensive experience with utilizing, mapping, and managing data from enterprise data warehouses, billing, claims, and decision support systems. In addition, he is well versed in developing and managing databases in Microsoft SQL Server and other relational database programs. His skills include being able to process large volumes of data in an efficient manner, identify and work through data integrity issues and standardize data across disparate data sources to allow for meaningful and effective analyses and reporting to the organization. Mr. Hoang has led engagements that analyzed hundreds of millions and dozens of Terabytes of healthcare operational and transactional data to perform large scale and complex data analyses. Oftentimes the analytics become executive level dashboards and reporting to assist the organizations’ stakeholders identify areas of opportunity and address major operating concerns.
Mr. Hoang holds a BS in Business Administration with a concentration in Finance, from Villanova University. He is a member of the Association of Certified Fraud Examiners (ACFE).