In my previous role, I discovered a pattern of false billing by a physician who was submitting claims for services not rendered. I conducted a thorough audit, cross-referenced medical records with billing statements, and presented my findings to the compliance team. As a result, the physician was investigated and ultimately terminated, saving the organization over $500,000 in fraudulent claims.

I regularly attend industry conferences, participate in webinars, and subscribe to relevant journals and newsletters. Additionally, I maintain a network of contacts within the healthcare compliance community to exchange insights and stay informed about emerging fraud schemes and regulatory changes.

I start by analyzing data for anomalies, such as unusually high billing amounts or frequent claims for the same procedure. I then conduct interviews with staff and patients, review medical records, and collaborate with IT to extract relevant data. Finally, I document all findings meticulously to ensure a robust case that stands up to scrutiny.

I approach each case with empathy and a strong ethical compass, recognizing the impact on both patients and the healthcare system. I maintain open communication with affected parties and ensure that my investigations are conducted with integrity and respect. Balancing the emotional toll with the importance of the work helps me stay focused and committed.

I am proficient in using data analysis tools like SAS, SQL, and Excel to identify patterns and anomalies in large datasets. I also have experience with fraud detection software such as IBM Fraud Management and SAS Fraud Framework for Insurance. These tools enable me to efficiently analyze complex data and uncover fraudulent activities.