Ryan Farrell

Ryan is a partner-in-charge of the firm’s Benefit/Program Integrity (BPI) engagement team. In addition to co-leading the BPI practice area, he is responsible for the management of operations in the Austin, Texas office, as well as the management of health care engagements across numerous state and federal agencies.

In his two-decade career, he has overseen various engagements involving provider fraud, waste, and abuse detection (FWAD); managed care/health plan compliance; encounter claims analyses and auditing; Management Enterprise System (MES) assurance; payment error rate measurement (PERM) and eligibility determination evaluations; electronic health record (EHR) incentive payment analyses and audits; litigation support; and delivery system reform consulting and evaluations. His current responsibilities include providing high-level strategic input to state and federal agency clients, as well as general management and oversight of various engagements. His engagement responsibilities and experience include conducting on-site audits; evaluating provider and health plan compliance with contractual and regulatory requirements; overseeing post-payment review of service utilization claims; integrity monitoring for reimbursement systems; identification of aberrant billing and/or reimbursement practices; creation and manipulation of complex data sets; analysis of expenditure trends; development of reimbursement models; and preparation of written and oral reports and presentations.

He has been responsible for the identification of hundreds of millions of dollars in provider, health plan, and system-generated fraud, waste, and abuse throughout his career. He is experienced with the format, content, and uses for health care claims information, working extensively with Centers for Medicare & Medicaid Services (CMS) 1500, Uniform Bill (UB)-04, dental, pharmacy, reference data, shadow encounter claims, and the electronic claims formats (e.g., 837s, National Council for Prescription Drug Programs [NCPDPs], etc.) received by and from government payers and managed care organizations (MCOs).

Ryan is a Certified Fraud Examiner (CFE) and a member of the Association of Certified Fraud Examiners, the Texas Society of Certified Public Accountants, and the American Institute of Certified Public Accountants.