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Jed Smith

Senior Managing Director

Photograph of Jed Smith

2000 K Street NW, 12th Floor
Washington, DC 20006

+1.202.973.2400 Main
+1.202.973.3152 Direct
+1.703.389.1603 Mobile

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Jed Smith is a Senior Managing Director at Ankura, based in Washington, DC. He has expertise in healthcare disputes and forensics. Jed focuses on performing complex data analysis for disputes and investigations for pharmacies, pharmaceutical manufacturers, providers, and payers including damages calculations and complex forensic data analytics assistance in defending government investigations and preparing self-disclosures. He has extensive experience leveraging payer and provider claims data as well as third-party data sets to analyze compliance with contracts and regulations including Medicare Advantage, Medicare Part D, and Medicaid.

Experience

Jed’s professional experience includes:

  • Project manager for multiple disputes related to allegations that a national pharmacy company was submitting false claims to federal and state funded healthcare programs.
  • Project manager for multiple disputes related to allegations that a national pharmacy was providing kickbacks to obtain additional federal and state funded business
  • Project manager for an investigation into whether a pharmacy chain was submitting false claims to the federal government related to failure to reverse returned prescriptions.
  • Project manager for an investigation into whether a national pharmacy was submitting false claims to federal and state funded programs by billing for a different drug than actually dispensed.
  • Project manager for an investigation into whether a regional pharmacy chain was submitting inaccurate usual and customary prices to a state Medicaid agency resulting in overpayments.
  • Project manager for an investigation to determine the amount overpayment, if any, received by a regional pharmacy chain that was submitting claims with incorrect information that could result in higher reimbursements.
  • Conducted a compliance review for a national pharmacy chain to evaluate the current policies and practices related to areas of significant compliance risk related to recent False Claims Act qui tams and provide recommendations to strengthen the compliance program.
  • For multiple regional and national Medicare Advantage plans, performed privileged consulting related to investigations of the accuracy of risk adjustment data submissions including the review of medical records for adequate documentation as well as proper filtering of RAPS submission to CMS.
  • Assisted providers in conducting an internal investigation to quantify the impact of potential incorrect diagnosis code submissions for risk adjustment purposes. Led teams that reviewed medical record documentation as well as analyzing claims data.
  • In a qui tam matter, led a project team that supported the expert testifier in quantifying the potential financial impact of relator’s allegation regarding fraudulent diagnosis codes submitted to a Medicare Advantage plan by capitated providers. Responsible for analyzing the client’s risk adjustment data as well as the data of relator’s expert to identify the scope of the issue and calculate the financial impact under different scenarios.
  • Privileged consulting in numerous lawsuits and investigations involving reimbursement of out-of-network providers under state regulations, contracts, and industry standards (e.g., UCR). The analyses included the review of hundreds of millions of claims records and the calculation of damages based on regulatory guidance, industry benchmarks, and plan documents.
  • Led a project calculating damages on behalf of a large physician practice related to improper billing from other providers under IPA contracts.
  • Led multiple projects, support of experts, and privileged consulting on numerous payer-provider reimbursement disputes calculating damages related reimbursement under various contract terms.
  • Analyzed damages related to appropriate reimbursement for automobile “personal injury protection”/ Med-pay payments according to various state regulations and beneficiary contracts.
  • Privileged support in numerous matters involving damages related to alleged violation of various prompt pay/ ‘clean claim’ provisions in a variety of states.
  • Supported health plans in calculating lost profits due to membership losses, allegations of breach of contract, or interference from third parties.
  • Evaluation of payer medical necessity denials and incorporating the findings of clinical reviewers to calculate damages.
  • Project manager for multiple engagements related to calculation of damages in disputes between national pharmacy benefit managers, their clients, and/or network pharmacies regarding compliance with contractual provisions related to the pricing and administration of mail order and retail drug benefits.
  • Project manager for an audit conducted on behalf of a pharmaceutical manager regarding whether a pharmacy benefit manager was complying with the terms of its Medicare Part D rebate agreements including formulary placement and utilization thresholds.
Education
  • BBA, The College of William and Mary
Certifications
  • Certified Public Accountant, Licensed in the State of California
Affiliations
  • American Society for Pharmacy Law, Member
  • National Council for Prescription Drug Programs, Member
  • American Institute for Certified Public Accountants, Member

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