- Corewell Health (Grand Rapids, MI)
- Job Summary Performs activities related to the detection and investigation of fraud and abuse within Priority Health. Utilizes knowledge/expertise of health care ... provider and agent agreements, products offered, State and Federal laws related to fraud , waste or abuse, Medicare and Medicaid regulations, etc. + Ability… more
- CVS Health (Lansing, MI)
- …review findings. - Must be able to articulate findings to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, state regulators, etc. ... state and federal policies. - Identify potential billing errors, abuse, and fraud . - Identify opportunities for savings related to potential cases which may… more
- CVS Health (Lansing, MI)
- …Manager will oversee a team of medical coders within the Special Investigations Unit (SIU) to ensure compliance with coding practices through comprehensive record ... findings and ensure the team articulates findings effectively to investigators, Medicaid plan leadership, law enforcement, legal counsel, providers, and state… more
- CVS Health (Lansing, MI)
- …manage complex investigations into suspected and known acts of healthcare fraud , waste and abuse (FWA). **Key Responsibilities** + Conduct high level, complex ... investigations of known or suspected acts of healthcare fraud , waste and abuse. + Conduct Investigations ...federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud . +… more
- SGI Global, LLC (Grand Rapids, MI)
- …prosecution of cases under the USAO's Affirmative Civil Enforcement program. Typical investigations involve: (1) monetary fraud against a multitude of federal ... Substances Act and various environmental laws. There is a special emphasis on fraud matters involving federal health care programs including Medicare and Medicaid… more