- 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
- Molina Healthcare (Detroit, MI)
- …for compliance by overseeing, follow-up and resolution of investigations . **Knowledge/Skills/Abilities** * Assists with implementation and day-to-day operations ... of the Compliance Program, Compliance Plan, Code of Conduct, and Fraud , Waste and Abuse Plan across the enterprise while ensuring compliance with governmental… 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 ... emphasis on fraud matters involving federal health care programs including Medicare and Medicaid. The contractor will report to the Civil Division Chief of… more
- Highmark Health (Lansing, MI)
- …including auditing/monitoring operational processes, conducting or overseeing compliance investigations , and ensuring that adequate training takes place under ... and external audit progress, recurring risk and compliance reporting, mandated training, investigations , and the impacts of new and changing laws, regulations, and… more
- Corewell Health (Grand Rapids, MI)
- …with in-house and external legal counsel in conducting, authorizing and/or overseeing investigations of matters that merit investigation under the Compliance ... system clinical compliance team to ensure effective compliance with Medicare Conditions of Participation as evaluated by deeming agencies...Program. From time to time, performs investigations at the direction of legal counsel and works… more