Jed Smith

Director

Healthcare

Washington, DC +1.202.973.3152

Areas of Expertise

Jed Smith Leads the Pharmacy Disputes & Investigations service within the Healthcare Disputes, Compliance and Investigations practice of Navigant. He serves Pharmacies, Pharmacy Benefit Managers, Managed Care Organizations, Third Party Administrators, Pharmaceutical Companies, providers and government‐paid programs that are facing intense regulation, litigation or investigations around a number of issues including False Claims Act, Anti-Kickback, diversion or commercial disputes. As part of this service line, Jed advises clients on a variety of operational, claims and reimbursement issues including: contract compliance, reimbursement, enrollment, billing, sales/marketing, claim submission, adjudication and pricing.

Jed is also a member of the firm’s Complex Data Management and Analysis practice responsible for data acquisition, discovery services and economic modeling of large volumes of transactional data in a variety of industries including financial services organizations, pension funds, health insurance companies, pharmaceutical manufacturers and hospitals. He advises clients throughout the entire life cycle of the litigation process, including data acquisition and harvesting in the discovery phase, demographic profiling for arguments against class certification and the development of a data warehouse and analytic framework to support complex analytics and modeling.

Selected engagement experiences include leading teams assisting in:

  • Defense of a qui tam matter around false claims and anti-kickback issue for a national pharmacy.
  • Defense of a qui tam matter around false claims act allegations for a national pharmacy of waiving copays, medically unnecessary prescriptions, split billing, and bypassing prior authorization requirements.
  • Conducting a compliance review of a national pharmacy chain regarding a number of claims submission issues including: Usual and Customary Pricing, Most Favored Nations Pricing, Partial Fills, Return to Stock, Gift Cards, Manufacturer Coupons and excluded provider screening.
  • Assisting a regional pharmacy under federal investigation regarding it practices of recycling unused medication and crediting government payors for prescriptions that were billed but not delivered.
  • Served as the IRO for a Pharmacy Benefits Manager (PBM) under a Corporate Integrity Agreement with the OIG.
  • Assisted numerous PBMs in defending commercial litigation stemming from plan sponsor audits around the administration of benefits and contract compliance.
Education
B.B.A. The College of William and Mary
Certifications
*Certified Public Accountant, California

*While many of Navigant’s professionals are Certified Public Accountants licensed in various states, Navigant is not a certified public accounting firm, and neither our professionals nor Navigant provide attest, or public accounting services.
Membership and Activity Information
Member of the AICPA
Member of the American Society for Pharmacy Law

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Jed Smith

Director

+1.202.973.3152

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