Hotel & Travel Page
The NAMPI 2026 Annual Conference is heading to the Pacific Northwest!
Hotel & Travel Page
NAMPI 2026 Annual Conference in-person tickets are SOLD OUT. Virtual Tickets Still Available.
NAMPI 2026 Annual Conference in-person tickets are SOLD OUT. Virtual Tickets Still Available.
NAMPI 2026 Annual Conference in-person tickets are SOLD OUT. Virtual Tickets Still Available.
NAMPI 2026 Annual Conference in-person tickets are SOLD OUT! Virtual Tickets Still Available.
NAMPI 2026 Annual Conference in-person tickets are SOLD OUT! Virtual Tickets Still Available.
NAMPI 2026 Annual Conference in-person tickets are SOLD OUT! Virtual Tickets Still Available.
Event Dates
August 23–26, 2026
Event Time
10:00 AM - 5:00 PM EST
Event Location
Hilton Portland Downtown, 921 SW 6th Ave, Portland, OR 97204
Why Attend?
Network with industry leaders and peers
Participate in interactive workshops and breakout sessions
Access the latest trends in program integrity
Explore Portland’s culture, food, and shopping
Schedule at a Glance
07:30
Crushing Fraud Together: The Medicaid Program Integrity Practitioner Forum
Crushing Fraud Together: The Medicaid Program Integrity Practitioner Forum
Join us for breakfast and an invitation-only working forum designed to strengthen Medicaid program integrity through direct collaboration between state and federal partners. This structured, working-session format brings practitioners together across facilitated roundtables to surface gaps, share operational intelligence, and generate prioritized recommendations for CMS's Center for Program Integrity. Discussions are organized around four themes: Lead Quality and Investigative Intelligence; Data Access and Analytical Tools; Interstate Provider Tracking; and Cross-Entity Coordination. The session runs from 8:00 AM to 12:00 PM and concludes with specific next steps and named ownership assignments on both the CPI and state sides. By committing to this as an annual forum, the goal is to build a continuous feedback loop that improves CPI systems, strengthens coordination, and drives lasting reform over time.
11:00
Registration Desk Open
Registration Desk Open
12:15
PI Leadership Summit Lunch
PI Leadership Summit Lunch
Vanessa Templeman
Inspector General, AHCCCS OIG
Vanessa Templeman
Inspector General, AHCCCS OIG
Ms. Vanessa Templeman is the current Inspector General for the Office of Inspector General (OIG) of AHCCCS and has been in this role since March 2022. She has been with AHCCCS since 2011. The OIG exists to prevent, detect, and recover improper payments due to Medicaid fraud, waste and abuse. Ms. Templeman has 22 years of experience in the health insurance industry spanning both private and government sectors. During her tenure with AHCCCS, Ms. Templeman has served in a variety of roles, a few of which include; Regional Representative for the Centers for Medicare and Medicaid (CMS) Technical Advisory Group regarding fraud, waste, and abuse, Instructor at the Medicaid Integrity Institute through the National Advocacy Center, Advisory Committee Member for the ASU Health Care Compliance and Regulations Program and is currently the President of the National Association of Medicaid Program Integrity (NAMPI).
14:25
State Welcome to NAMPI 2026
State Welcome to NAMPI 2026
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Frank Walsh, Jr.
Acting Medicaid Inspector General, New York State Office of the Medicaid Inspector General
Frank Walsh, Jr.
Acting Medicaid Inspector General, New York State Office of the Medicaid Inspector General
Frank has led OMIG since February 2021 and is committed to enhancing the Medicaid program integrity through education, transparency, and collaborative engagements with health care stakeholders. In this capacity, he provides executive direction and oversight of a professional staff of more than 500 dedicated public servants who are responsible for completing approximately 3,000 audits and investigations annually. Frank has been a NAMPI member since 2022, serving as a Regional Representative, and was appointed to the NAMPI Board in 2024.
Lori Stiles
Manager, Medicaid Program Integrity Unit, Idaho Department of Health & Welfare
Lori Stiles
Manager, Medicaid Program Integrity Unit, Idaho Department of Health & Welfare
Lori Stiles is the manager of Medicaid Program Integrity for the Idaho Department of Health & Welfare. She has worked in Medicaid program integrity for over 20 years.
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
Tamara has been with the Oregon Health Authority for 10 years, currently managing the Program Integrity Audit Unit at Oregon’s Office of Program Integrity. While at OHA, Tamara has held various positions in behavioral health licensing and certification, Medicaid provider services and quality assurance and compliance and Medicaid behavioral health policy. Tamara holds a Master of Arts degree in Communication and Leadership Studies, emphasis in strategic and organizational communication and a Bachelor of Science degree in Behavioral Science, emphasis in psychology. Outside of work, Tamara enjoys relaxing at home, cooking, reading, writing, quilting (her newest hobby), shopping and eating out.
Joan Senatore
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
Joan Senatore
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
Joan has worked at the Medicaid Agency for 20+ years and previously worked at the Massachusetts Office of the Attorney General in various roles. Joan earned a Bachelor’s and a Master’s in Business Administration at the University of Massachusetts Boston, and a Juris Doctorate from the New England School of Law. Joan is also a Certified Fraud Examiner, Certified in Healthcare Compliance, and a Licensed Attorney.
14:30
Written Right, Defended Well: Strengthening Program Integrity Audits from Protocol to Appeal
Written Right, Defended Well: Strengthening Program Integrity Audits from Protocol to Appeal
Audit outcomes are rarely decided at the end of the process — they're shaped at the very beginning. This session examines how New York develops protocols behind its audit findings and how Oregon defends audit decisions when challenged on appeal. New York’s Office of the Medicaid Inspector General will break down how its protocols take shape, from drafting through stakeholder input to multi-layered review, with practical lessons for states at any stage. The Oregon Health Authority will then discuss what happens when an audit decision is challenged and how appeals are resolved using defensible decisions grounded in fact.
Lindsay Foote
Audit Manager, OMIG
Lindsay Foote
Audit Manager, OMIG
Lindsay Foote serves as an Audit Manager at the New York State Office of the Medicaid Inspector General. She joined OMIG in 2014, bringing over a decade of prior pharmacy experience in retail and at the New York State Office of Mental Health. In her current capacity, Lindsay is the subject matter expert (SME) in pharmacy-related matters for the Division of Medicaid Audit, reviewing all pharmacy audits performed across the division’s seven regions. She also oversees OMIG’s protocol development process, guiding SMEs through revisions and reviewing content for quality and consistency across project types. When appropriate, she engages with stakeholders to inform the final product. Additionally, she supports the audit reporting process, developing and maintaining templates that help communicate audit results to providers accurately and efficiently. Lindsay welcomes the opportunity to collaborate with others working in pharmacy audit and protocol development.
Heather Laudico
Medicaid Integrity Specialist 2 (Financial Analysis), New York State Office of the Medicaid Inspector General
Heather Laudico
Medicaid Integrity Specialist 2 (Financial Analysis), New York State Office of the Medicaid Inspector General
Heather Laudico is an Audit Supervisor within the Division of Medicaid Audit at the NYS Office of the Medicaid Inspector General. In this role, she collaborates with subject matter experts across the state, actively facilitating the audit protocol development and revision process. By applying proactive problem-solving to operational nuances, she effectively assesses program vulnerabilities and strengthens the defensibility of audit findings to support and promote regulatory compliance. Dedicated to expanding her professional knowledge and fostering continuous improvement practices, she values exchanging insights with fellow professionals committed to elevating operational quality and program integrity.
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
I manage the Fraud, Waste, and Abuse Detection and Prevention Team in the Office of Program Integrity for the Oregon Health Authority. After studying Applied Mathematics as an undergraduate at Boise State University, I worked as a data analyst for a national power sports distributor. My passion for data and analytics led me to obtain my Master’s in Statistics from Oregon State University before joining Oregon’s Program Integrity as a research analyst in 2021. Now I lead a team of nine analysts, fraud examiners, and auditors to find and resolve issues of FWA. I enjoy being outside or on the lake, playing disc golf, and playing board games with friends and family in my free time.
VERA POE
Senior Assistant Attorney General, Department of Justice, State of Oregon
VERA POE
Senior Assistant Attorney General, Department of Justice, State of Oregon
Vera Poe, an attorney licensed in Texas and Oregon, has advised and represented Oregon's Office of Program Integrity (OPI) since 2018. Ms. Poe assists OPI in creating legally sufficient notices and forms for its audit program, and represents the office when a provider appeals audit findings and associated overpayments, along with a myriad of other legal work.
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
Tamara has been with the Oregon Health Authority for 10 years, currently managing the Program Integrity Audit Unit at Oregon’s Office of Program Integrity. While at OHA, Tamara has held various positions in behavioral health licensing and certification, Medicaid provider services and quality assurance and compliance and Medicaid behavioral health policy. Tamara holds a Master of Arts degree in Communication and Leadership Studies, emphasis in strategic and organizational communication and a Bachelor of Science degree in Behavioral Science, emphasis in psychology. Outside of work, Tamara enjoys relaxing at home, cooking, reading, writing, quilting (her newest hobby), shopping and eating out.
15:40
Fraudside Chats - Round 1
Fraudside Chats - Round 1
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
I manage the Fraud, Waste, and Abuse Detection and Prevention Team in the Office of Program Integrity for the Oregon Health Authority. After studying Applied Mathematics as an undergraduate at Boise State University, I worked as a data analyst for a national power sports distributor. My passion for data and analytics led me to obtain my Master’s in Statistics from Oregon State University before joining Oregon’s Program Integrity as a research analyst in 2021. Now I lead a team of nine analysts, fraud examiners, and auditors to find and resolve issues of FWA. I enjoy being outside or on the lake, playing disc golf, and playing board games with friends and family in my free time.
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Leads the best team in Nebraska Medicaid to protect the program from fraud, waste, and abuse, and the clients from harm and exploitation. Educated at Creighton University and the University of Nebraska - Lincoln. Spends free time collecting craft supplies and making things.
15:40
Program Integrity Trivial Pursuit
Program Integrity Trivial Pursuit
15:40
Medicaid Opportunities & Low Hanging Fruit
Medicaid Opportunities & Low Hanging Fruit
<p>Opportunity to discuss state/regional trends, new enforcement methods and "low hanging fruit" (quick wins with minimal efffort).</p>
15:40
Adoption of AI: The Answer or Question?
Adoption of AI: The Answer or Question?
Report on states progress on adopting AI. Developed based upon email survey distributed by South Carolina.
15:40
Following the Money: Nursing Home Enforcement
Following the Money: Nursing Home Enforcement
Report on noteworthy enforcement actions involving nursing homes.
15:40
State Perspectives on Federal Oversight
State Perspectives on Federal Oversight
Opportunity for states to discuss their responses to recent federal requests for information concerning program integrity and react to recent enhancements in Federal oversight (i.e., Managed Care audits, Revalidation, Medicaid Emerging Vulnerabilities database).
15:40
Turning Findings into Action: A Guide to Managed Care Referrals
Turning Findings into Action: A Guide to Managed Care Referrals
Learn to evaluate, prioritize and better leverage the reviews and refrrals received from your managed care organizations.
15:40
Program Integrity War Stories: Updates from the Frontline
Program Integrity War Stories: Updates from the Frontline
Survey of current trends, state responses and early results. What are the latest trends that are making your state nervous and how are you organizing/mobilizing to adress this trend and enhance program integrity? What best practices can you identify for other states to consider?
16:35
Fraudside Chats - Round 2
Fraudside Chats - Round 2
*All Attendees Welcome*
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Leads the best team in Nebraska Medicaid to protect the program from fraud, waste, and abuse, and the clients from harm and exploitation. Educated at Creighton University and the University of Nebraska - Lincoln. Spends free time collecting craft supplies and making things.
16:35
Program Integrity Trivial Pursuit
Program Integrity Trivial Pursuit
16:35
Medicaid Opportunities & Low Hanging Fruit
Medicaid Opportunities & Low Hanging Fruit
Opportunity to discuss state/regional trends, new enforcement methods and "low hanging fruit" (quick wins with minimal efffort).
16:35
Adoption of AI: The Answer or Question?
Adoption of AI: The Answer or Question?
Report on states progress on adopting AI. Developed based upon email survey distributed by South Carolina.
16:35
Following the Money: Nursing Home Enforcement
Following the Money: Nursing Home Enforcement
Report on noteworthy enforcement actions involving nursing homes.
16:35
State Perspectives on Federal Oversight
State Perspectives on Federal Oversight
Opportunity for states to discuss their responses to recent federal requests for information concerning program integrity and react to recent enhancements in Federal oversight (i.e., Managed Care audits, Revalidation, Medicaid Emerging Vulnerabilities database)
16:35
Turning Findings into Action: A Guide to Managed Care Referrals
Turning Findings into Action: A Guide to Managed Care Referrals
Learn to evaluate, prioritize and better leverage the reviews and refrrals received from your managed care organizations.
16:35
Program Integrity War Stories: Updates from the Frontline
Program Integrity War Stories: Updates from the Frontline
17:30
Exhibit Hall Opening Reception
Exhibit Hall Opening Reception
*All Attendees Welcome*
07:30
Networking Breakfast (Sponsored by PwC)
Networking Breakfast (Sponsored by PwC)
07:30
Exhibit Hall Open
Exhibit Hall Open
07:30
Registration Desk Open
Registration Desk Open
08:25
Welcome to NAMPI 2026
Welcome to NAMPI 2026
Frank Walsh, Jr.
Acting Medicaid Inspector General, New York State Office of the Medicaid Inspector General
Frank Walsh, Jr.
Acting Medicaid Inspector General, New York State Office of the Medicaid Inspector General
Frank has led OMIG since February 2021 and is committed to enhancing the Medicaid program integrity through education, transparency, and collaborative engagements with health care stakeholders. In this capacity, he provides executive direction and oversight of a professional staff of more than 500 dedicated public servants who are responsible for completing approximately 3,000 audits and investigations annually. Frank has been a NAMPI member since 2022, serving as a Regional Representative, and was appointed to the NAMPI Board in 2024.
Vanessa Templeman
Inspector General, AHCCCS OIG
Vanessa Templeman
Inspector General, AHCCCS OIG
Ms. Vanessa Templeman is the current Inspector General for the Office of Inspector General (OIG) of AHCCCS and has been in this role since March 2022. She has been with AHCCCS since 2011. The OIG exists to prevent, detect, and recover improper payments due to Medicaid fraud, waste and abuse. Ms. Templeman has 22 years of experience in the health insurance industry spanning both private and government sectors. During her tenure with AHCCCS, Ms. Templeman has served in a variety of roles, a few of which include; Regional Representative for the Centers for Medicare and Medicaid (CMS) Technical Advisory Group regarding fraud, waste, and abuse, Instructor at the Medicaid Integrity Institute through the National Advocacy Center, Advisory Committee Member for the ASU Health Care Compliance and Regulations Program and is currently the President of the National Association of Medicaid Program Integrity (NAMPI).
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
Tamara has been with the Oregon Health Authority for 10 years, currently managing the Program Integrity Audit Unit at Oregon’s Office of Program Integrity. While at OHA, Tamara has held various positions in behavioral health licensing and certification, Medicaid provider services and quality assurance and compliance and Medicaid behavioral health policy. Tamara holds a Master of Arts degree in Communication and Leadership Studies, emphasis in strategic and organizational communication and a Bachelor of Science degree in Behavioral Science, emphasis in psychology. Outside of work, Tamara enjoys relaxing at home, cooking, reading, writing, quilting (her newest hobby), shopping and eating out.
Joan Senatore
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
Joan Senatore
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
Joan has worked at the Medicaid Agency for 20+ years and previously worked at the Massachusetts Office of the Attorney General in various roles. Joan earned a Bachelor’s and a Master’s in Business Administration at the University of Massachusetts Boston, and a Juris Doctorate from the New England School of Law. Joan is also a Certified Fraud Examiner, Certified in Healthcare Compliance, and a Licensed Attorney.
08:35
Welcome from the Oregon Health Authority
Welcome from the Oregon Health Authority
Traditionally centered on fraud detection and error prevention, program integrity is evolving into a more holistic framework that is focused on being a proactive and person-centered practice rather than a purely investigative one. These brief welcoming remarks will highlight the traditional view of program integrity and how it’s evolving into a modern and balanced approach that supports integrity, equity and compliance.
Fariborz Pakseresht
Interim Director, Oregon Health Authority
Fariborz Pakseresht
Interim Director, Oregon Health Authority
Fariborz Pakseresht currently serves as Interim Director of the Oregon Health Authority (OHA), having returned to public service at the request of Governor Tina Kotek to lead the agency during a period of transition.
Previously, he served as Director of the Oregon Department of Human Services (ODHS), Oregon's largest state agency, following five years as Director of the Oregon Youth Authority (OYA). He retired from state service in 2025 as the longest-serving Director in ODHS's 35-year history.
Over a 35-year career in public service, Fariborz has led large-scale organizational and systems transformation with a focus on stewardship, leadership development, operational excellence, and improving outcomes for children, families, and communities. He is recognized for advancing evidence-informed decision-making, data analytics, technology modernization, and cross-sector collaboration while fostering organizational cultures grounded in trust, learning, and continuous improvement.
Fariborz also serves as Senior Advisor to the Center for Civic Futures. He is a Fellow of the American Leadership Forum, former Chair of the Leadership Council for the American Public Human Services Association (APHSA), and recipient of APHSA's 2025 Jerry W. Friedman Human Services Impact Award.
His interests include public stewardship, leadership, systems thinking, organizational transformation, human potential, and the conditions that enable people and communities to flourish.
08:45
Fraud Is a System: The Patterns Behind the Schemes
Fraud Is a System: The Patterns Behind the Schemes
Tom Mueller
investigative journalist, (self-employed)
Tom Mueller
investigative journalist, (self-employed)
I am a free-lance writer of non-fiction and fiction, currently a Senior Researcher at The New School and a Senior Research Fellow at the Institute for Futures Studies (Stockholm) and the Vienna Centre for Societal Security. I studied at Oxford (DPhil, Rhodes Scholar), Harvard (BA, summa cum laude), and Alief Hastings High School in rural east Texas, home of the Fighting Bears. After that, I worked as an associate in M&A at Goldman Sachs in their London and Frankfurt offices, and I studied classical guitar in Seville, Spain with América Martínez, a disciple of Andrés Segovia. I've lived or worked in 48 countries.
My most recent book, How to Make a Killing, is a look at the world of the US healthcare through the lens of the dialysis industry, where a miracle cure has become a nightmare for many patients. My previous books are: Crisis of Conscience (Penguin Random House, 2019), a cultural history of whistleblowing and fraud; and Extra Virginity (W W Norton, 2013), a New York Times best-selling account of olive oil culture, history, and crime. My articles have appeared in the New Yorker, National Geographic Magazine, New York Times Magazine, Atlantic Monthly, and elsewhere, and have been included in anthologies like Best American Science Writing and Best American Travel Writing.
I am currently performing research supported by the Robert Wood Johnson Foundation to improve dialysis and chronic kidney disease treatment in Los Angeles, Chicago and New York City.
09:40
Networking Break
Networking Break
10:10
Upstream Controls, Downstream Payoff: The Power of Prepayment Review (Health Management Systems, Inc. [HMS]))
Upstream Controls, Downstream Payoff: The Power of Prepayment Review (Health Management Systems, Inc. [HMS]))
Health Management Systems, Inc. (HMS) Session
For more than a decade, CMS has encouraged Medicaid programs to move fraud, waste, abuse, and error detection upstream—shifting from “pay and chase” activities to prevention‑focused controls before claims are paid. As scrutiny around improper payments intensifies, states are increasingly reassessing how prepayment review can strengthen program integrity while easing downstream operational burden. This session examines the role of prepayment review within Medicaid claims payment and processing and its ripple effects across program integrity functions. Presenters will explore how well‑designed prepayment controls influence post‑payment audits, investigations, provider appeals, overpayment recovery, and referrals, helping agencies reduce rework and improve payment accuracy. The discussion will focus on practical lessons from implementing prepayment review within existing payment and compliance structures, including how states identify services or providers for review, align prepayment findings with downstream processes, and maintain documentation that supports oversight and referral decisions. The session will also address common challenges, such as balancing timely access to care with payment safeguards and ensuring consistent application across managed care and fee‑for‑service environments. Attendees will leave with actionable strategies to use prepayment review as a foundational element of a prevention‑first approach to Medicaid claims payment and processing.
Anne Mcfarland
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Anne Mcfarland
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Anne Mcfarland
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Anne Mcfarland
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Cindy Beane
Owner/ CEO, Beane Medicaid & Health Solutions
Cindy Beane
Owner/ CEO, Beane Medicaid & Health Solutions
Cindy Beane is the Founder and CEO of Beane Medicaid and Health Solutions LLC, a consulting firm focused on strengthening Medicaid programs and advancing rural health transformation. She brings more than 30 years of healthcare and public service leadership, including 11 years as West Virginia’s Medicaid Director (Commissioner of the Bureau for Medical Services), where she led major modernization efforts, expanded home- and community-based services, implemented innovative payment reforms, and negotiated federal waivers.
Cindy is nationally recognized for her Medicaid expertise and collaborative leadership, having served as President of the National Association of Medicaid Directors (NAMD). A Licensed Certified Social Worker (LCSW) with a Master of Social Work, she now partners with states, health systems, and organizations to provide strategic guidance on Medicaid policy, program design, and system transformation.
Gary Call
Chief Medical Officer, HMS
Gary Call
Chief Medical Officer, HMS
Dr. Gary Call is a board-certified family physician and senior healthcare executive with extensive experience across managed Medicaid, Medicare Advantage, commercial health plans, and state employee health benefit programs. His background spans medical management, quality, pharmacy strategy, and risk adjustment, supported by deep clinical and operational expertise.
Dr. Call is nationally recognized for his leadership in payment integrity and fraud, waste, and abuse (FWA) prevention, including advanced analytics, clinical review strategies, and technology enabled solutions that protect both government and commercial payer programs from improper payments and emerging integrity risks.
As Chief Medical Officer at Gainwell Technologies, Dr. Call oversees Payment Integrity, Care Management, Clinical Analytics, and Population Health Solutions, driving innovation and clinical program development that improve outcomes, strengthen program integrity, and support the financial sustainability of state healthcare programs.
William O'Neill
VP, Product, FWA & Analytics, HMS
William O'Neill
VP, Product, FWA & Analytics, HMS
Will O’Neill joined Gainwell-HMS as Vice President of Cost Containment Analytics & Product, with an initial focus on Payment Integrity solutions. Will is responsible for managing the end-to-end lifecycle of the HMS analytic library and product roadmaps, which are strategic growth drivers of client value for HMS’ COB, Payment Integrity and Eligibility Verification product suite. Will brings 18 years of experience delivering innovative analytics and technology solutions across Payer and RCM markets.
10:10
Building on Success: Arizona’s Evolving Approach to Program Integrity (Alivia)
Building on Success: Arizona’s Evolving Approach to Program Integrity (Alivia)
Alivia Session
Matt Perryman
Chief Technology Officer, Alivia Analytics
Matt Perryman
Chief Technology Officer, Alivia Analytics
Matt brings deep expertise in fraud, waste, and abuse (FWA) and technology, enabling him to identify the right tools to solve complex business challenges across the healthcare industry. He leads Alivia’s advanced analytics, data science, and platform development initiatives, designing AI-powered solutions that help government agencies and commercial health plans prevent improper payments and uncover emerging fraud schemes.
His background spans actuarial science, risk modeling, and healthcare analytics, supporting pre- and post-payment capabilities used by Medicaid, Medicare, and commercial clients nationwide.
Matt is also a regular speaker at healthcare FWA conferences, including NHCAA and NAMPI, where he presents analytic strategies alongside health plan leaders. He holds degrees in biochemistry and philosophy from Boston College.
Lynne Emmons
Assistant Deputy Director of FFS Programs, AHCCCS
Lynne Emmons
Assistant Deputy Director of FFS Programs, AHCCCS
Lynne Emmons, LAMFT, PMP, LSSBB is Assistant Deputy Director for the Division of Fee-for-Service Management (DFSM) at AHCCCS, Arizona's Medicaid agency. In this role, Lynne provides executive leadership for $2.5 Billion FFS programs, stakeholder relations, strategic planning, and quality initiatives across Arizona's Medicaid program.
With two decades of experience spanning healthcare operations, process improvement, and stakeholder engagement, Lynne leads efforts to strengthen Medicaid program integrity through innovation, data-informed decision making, provider education, and cross-agency collaboration. She has been actively involved in modernization initiatives, including the integration of advanced analytics and artificial intelligence tools to support proactive fraud, waste, and abuse prevention while maintaining a strong human-centered approach to oversight and accountability.
Lynne is a Licensed Associate Marriage and Family Therapist, Project Management Professional, and Lean Six Sigma Black Belt. She is passionate about building trusted partnerships, improving system performance, and advancing sustainable solutions which support Medicaid members, providers, and taxpayers.
10:10
Transforming Medicaid Program Integrity with Generative AI+ Human Intelligence (Qlarant)
Transforming Medicaid Program Integrity with Generative AI+ Human Intelligence (Qlarant)
Qlarant Session
In today’s rapidly evolving healthcare landscape, organizations need a unified, intelligent AI approach to program integrity—one that moves seamlessly from insight to action. This session delves into the use of integrated data science ecosystems plus advanced AI-driven analytics platforms that enable organizations to identify, visualize, and resolve risks. By transforming disparate data into actionable intelligence, results can be dramatically improved. Attendees will hear about ‘Ethical AI’ as well as how to use sophisticated, customizable algorithms to analyze claims data at scale. Learn how to surface patterns, anomalies, and emerging fraud, waste, and abuse risks while supporting quality improvement efforts. Finally, hear how to bring the power of generative AI and workflow optimization to the review process, dramatically accelerating medical record analysis and amplifying reviewer efficiency—often by more than tenfold—while maintaining essential human oversight. Together, these AI solutions can create a closed-loop system that not only detects risks earlier but also streamlines decision-making. Learn how AI can enhance operational efficiency and enable organizations to proactively prevent improper payments and improve outcomes without increasing resources.
Bart Armstrong
Senior Director, Program Management., HMS/Gainwell Technologies
Bart Armstrong
Senior Director, Program Management., HMS/Gainwell Technologies
Bart is a Senior Director with Gainwell Technologies and has spent that last decade fighting Fraud, Waste, and Abuse within both Medicare and Medicaid, He was previously the FWA Division Director with the Colorado Medicaid Program and most recently a Project Director with Qlarant.
Holly Pu
Vice President Product Development, Qlarant
Holly Pu
Vice President Product Development, Qlarant
Ms. Pu is responsible for the strategic and operational leadership of Qlarant Capital. During her tenure, she has been instrumental in the creation of Qlarant’s predictive analytics and visualization software solutions.
Ms. Pu has successfully led large-scale implementations for both federal and state government program’s needs. Advanced analytics software built and sold by Pu has been used by over 800 Medicare Advantage health plans and state Medicaid agencies in the US.
Will Mapp, III
Chief Technology Officer, Qlarant
Will Mapp, III
Chief Technology Officer, Qlarant
As Chief Technology Officer, Will Mapp keeps a constant eye on the future and ensures Qlarant is at the forefront of the latest and emerging technologies. He has an extensive background in software product development and building new, innovative technologies. His focus is on delivering high customer value by using the right mix of human technique and advanced technology.
Will is a past Indus Entrepreneurs fellow of the RH Smith School of Business, has specializations in Gamification from the Wharton School of Business, and a proven experience using machine learning and artificial intelligence in media.
10:10
From AI-Generated Leads to MFCU Referrals: How Program Integrity Investigations Progress from Detection to Credible Allegations of Fraud (Codoxo)
From AI-Generated Leads to MFCU Referrals: How Program Integrity Investigations Progress from Detection to Credible Allegations of Fraud (Codoxo)
Codoxo Session
The Georgia Department of Community Health (DCHGA) will present real investigations that began with AI-generated leads and advanced through validation and referral to the Medicaid Fraud Control Unit (MFCU). Through multiple case studies spanning identity theft, uncredentialed providers, referring provider irregularities, medically unnecessary services, patient sharing, and other fraud schemes, attendees will examine the billing patterns, fraud indicators, and investigative methods behind each case. The session explores DCH's collaboration with MFCU and other agencies as cases progressed to state and federal law enforcement, highlighting the investigative strategies, interagency collaboration, and operational best practices that turned AI-generated leads into actionable referrals.
Derik Ciccarelli
Director of Operations, Fraud Scope, Codoxo
Derik Ciccarelli
Director of Operations, Fraud Scope, Codoxo
Derik Ciccarelli is the Director, Fraud Scope Operations for Codoxo. His experience investigating insurance fraud and insurance defense spans 30 years across healthcare, property and casualty, workman’s compensation, disability, and life insurance. At Codoxo, Derik assists healthcare payers and agencies with detecting fraud, waste, and abuse through AI models and data-driven business intelligence, which includes defining and refining business analytics and logic related to pattern-based and deterministic detectors. Derik’s collaborates with our partners through the implementation, Go Live, and investigative processes. His expertise is in conducting risk assessments of national, regional, and corporate healthcare policies along with providing exceptional service to clients to ensure compliance with all legal requirements and professional standards.
JOHNNY BROOKS
Director Program Integrity, Georgia Department of Community Health
JOHNNY BROOKS
Director Program Integrity, Georgia Department of Community Health
Johnny R. Brooks is the Director, Program Integrity for the Georgia Department of Community Health, Office of Inspector General. Johnny oversees the Medicaid agency’s Fraud, Waste, and Abuse (FWA) activities and coordinates audits and investigations of Medicaid providers. He also collaborates with law enforcement, regulatory agencies, and Managed Care Organizations to maintain a viable Medicaid program for the citizens of Georgia. Johnny is a retired U.S. Army veteran and holds a Master of Public Administration from Central Michigan University and is a Certified Inspector General. He has over 18 years’ experience investigating Medicaid fraud. Prior to joining the Department, he served as Chief Investigator, Georgia Medicaid Fraud Control Unit. In 2018, he received the U.S. Attorney’s Office Award (Northern District of Georgia) for his dedication and commitment to the pursuit of justice.
Sara Rodriguez
Healthcare Fraud Analyst, Codoxo
Sara Rodriguez
Healthcare Fraud Analyst, Codoxo
Sara Rodriguez is a Healthcare Fraud Analyst at Codoxo with more than 20 years of experience in healthcare fraud, waste and abuse investigations, program integrity, medical coding, healthcare consultant and compliance. Throughout her career, she has led complex investigations involving healthcare providers across multiple specialties, conducted coding and billing audits, analyzed healthcare claims data, and collaborated with government agencies and healthcare organizations to improve payment integrity and reduce improper payments.
Prior to joining Codoxo, Sara spent over a decade with the Idaho Medicaid Program Integrity Unit in investigative and leadership roles, including Program Supervisor, where she oversaw a team of investigators responsible for the prevention, detection, investigation and recovery of improper healthcare payments. She holds the Certified Professional Coder (CPC) and Certified Program Integrity Professional (CPIP) credentials and is recognized for her expertise in healthcare data analytics, fraud detection, and regulatory compliance.
11:25
Making the Case: Criminal Investigations and Indictments of Personal Assistant Fraud
Making the Case: Criminal Investigations and Indictments of Personal Assistant Fraud
Home services are a perennial area of concern for fraud, but what does a successful criminal investigation and prosecution of a personal assistant involve? The Office of Inspector General for the Illinois Department of Healthcare and Family Services (HFS OIG) will provide cases studies of several recent, successful criminal investigations of personal assistants. Through these cases HFS OIG will highlight common fraud schemes and areas of program vulnerability, as well as standard elements of various types of cases. HFS OIG will discuss investigatory and legal challenges encountered and how they were overcome.
Brian Dunn
Inspector General, IL HFS OIG
Brian Dunn
Inspector General, IL HFS OIG
Brian Dunn is the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state's Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago's Office of Inspector General. Before leading government oversight work, Brian's legal career included serving as General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Doloribus consequunt
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Doloribus consequunt
Anthony Florio
Deputy Inspector General, Illinois Department of Healthcare and Family Services - Office of Inspector General
Anthony Florio
Deputy Inspector General, Illinois Department of Healthcare and Family Services - Office of Inspector General
Tony joined the Office of Inspector General (OIG) at the Illinois Department of Healthcare and Family Services (HFS) in March 2022 as the Deputy Inspector General for Investigations, bringing extensive oversight and investigative experience from nearly 20 years with the City of Chicago’s Office of Inspector General. Over the course of his career the City of Chicago OIG, Tony advanced from Investigator I to Chief Investigator, leading teams in complex matters involving comprehensive data analysis, surveillance operations, extensive interviewing, and high-profile municipal investigations. At HFS OIG, Tony oversees statewide investigations into allegations of fraud, waste, abuse, and misconduct involving Medicaid providers and recipients, ensuring accountability within one of Illinois’s largest public programs. He guides investigative strategy, develops analytical methodologies, strengthens process integrity, and partners closely with federal, state, and local entities to safeguard public funds and improve program integrity across Medicaid operations. Tony also plays a key role in advancing OIG’s investigative standards, mentoring staff, and enhancing the office’s capacity to identify systemic vulnerabilities. Tony is a licensed attorney and a Certified Inspector General and Investigator through the Association of Inspectors General.
11:25
Sinking Your Teeth Into Dental Fraud
Sinking Your Teeth Into Dental Fraud
Washington Medicaid Fraud and Abuse Division (“MFAD”) Assistant Attorney General Naomi Smith and Data Scientist April Minton discuss their data driven approach to working dental cases, including collaboration with Washington Health Care Authority (HCA) staff in the dental program to identify fraud and assist with program/billing guide recommendations. Session would include discussion on Data scientists' data driven approach to initial case assessment, with a de-identified case example (from data to successful settlement). Focusing on dental codes with unambiguous and objective billing requirements, not requiring experts’ assessment, Minton and Smith have been moved multiple dental cases forward to resolution quickly and successfully, resulting in hundreds of thousands of dollars in recouped Medicaid funds. Examples of codes lending themselves to this approach include: D9110 (palliative treatment) and D0140 (limited oral evaluation). This approach has greatly reduced investigation to settlement time; Smith will discuss its benefits and disadvantages. The HCA dental program and MFA, have continued to communicate regarding codes that trend for fraud. Presenters will discuss situations for mutual benefit, including D9630, which HCA has successfully eliminated. MFAD is working on securing attendance of dental director Dr. Vander Beek, but cannot make any guarantees. Ms. Minton has executed a new and successful data driven approach to dental cases in WA MFAD. Focusing on dental codes with unambiguous and objective billing requirements, that do not require an experts assessment, Minton and Smith have been able to move multiple dental cases forward to resolution quickly and successfully, resulting in hundreds or thousands of dollars in recouped Medicaid funds. Examples of codes that lend themselves to this approach include: D9110 (palliative treatment) and D0140 (limited oral evaluation). The first investigation that took this approach resolved approximately 1 year from the decision to focus on the data-driven issues, most of that time was the negotiation phase. The most recent investigation with this approach took 8 months to agreement. Smith will discuss the benefits and disadvantages of this approach. Using the data driven approach, the HCA dental program and MFA, through Ms. Minton and Dr. Vander Beek, have continued to communicated regarding codes that trend for fraud. Presenters will discuss situations and examples for mutual benefit, including D9630, which HCA has successfully eliminated, and open communication resulting in MFA get quick answers to agency level questions, which frequently strengthen cases. MFC is working on securing attendance of HCA dental program director, but cannot make any guarantees
April Minton
Data Scientist, Washington State Medicaid Fraud Control
April Minton
Data Scientist, Washington State Medicaid Fraud Control
o April Minton is a Data Scientist with Washington State Medicaid Fraud and Abuse Division. April previously worked for Health Care Authority (our single state agency) in both the Program Integrity Unit as well as the Dental Authorization Unit. Prior to state service April worked in private practice as a certified dental assistant for 13 years.
Naomi Smith
Managing Assistant Attorney General, Washington Attorney General's Office
Naomi Smith
Managing Assistant Attorney General, Washington Attorney General's Office
Naomi Smith is a Managing Assistant Attorney General in the Civil Unit with the Washington State Medicaid Fraud and Abuse Division. Naomi earned her Juris Doctor from Seattle University School of Law in 2015. She has been with MFAD for 3 years, previously working as a criminal defense attorney.
11:25
Back to the Future: Care Management
Back to the Future: Care Management
April Minton
Data Scientist, Washington State Medicaid Fraud Control
April Minton
Data Scientist, Washington State Medicaid Fraud Control
o April Minton is a Data Scientist with Washington State Medicaid Fraud and Abuse Division. April previously worked for Health Care Authority (our single state agency) in both the Program Integrity Unit as well as the Dental Authorization Unit. Prior to state service April worked in private practice as a certified dental assistant for 13 years.
Naomi Smith
Managing Assistant Attorney General, Washington Attorney General's Office
Naomi Smith
Managing Assistant Attorney General, Washington Attorney General's Office
Naomi Smith is a Managing Assistant Attorney General in the Civil Unit with the Washington State Medicaid Fraud and Abuse Division. Naomi earned her Juris Doctor from Seattle University School of Law in 2015. She has been with MFAD for 3 years, previously working as a criminal defense attorney.
Jennifer Trussell
Fraud Prevention Consultant, SMP Resource Center
Jennifer Trussell
Fraud Prevention Consultant, SMP Resource Center
Jennifer Trussell is a Fraud Prevention Consultant with over 40 years’ experience in the industry. She served over 35 years with the Federal government, including Special Agent in Charge of the Investigations Branch and Senior Advisor with the U.S. Department of Health and Human Services – Office of Inspector General. She began her law enforcement career as an active-duty Special Agent with the Air Force Office of Special Investigations, and later served as a civilian Criminal Investigator for the U.S. Navy. Jennifer has a graduate degree in Policy Management from Georgetown University, and an undergraduate degree in Criminal Justice from Park University. She previously served on detail to the U.S. Senate Special Committee on Aging, and on the Board of Directors for the National Health Care Anti-Fraud Association. She currently works with the Senior Medicare Patrol (SMP) program and is a frequent guest presenter at national conferences.
Mike Cohen
Operations Officer, HHS Office of Inspector General
Mike Cohen
Operations Officer, HHS Office of Inspector General
Michael Cohen DHSc, JD, PA-C
Operations Officer, Office of Investigations, Office of Inspector General,
U.S. Department of Health and Human Services
As a Headquarters Operations Officer with the U.S. Department of Health and Human Services, Office of Inspector General (OIG), Office of Investigations, Dr. Michael Cohen is responsible for pharmaceutical fraud law-enforcement program oversight in Washington, D.C. He has been at OIG headquarters for the past sixteen years. He previously worked for the U.S. Attorney’s Office in Miami, Florida in the Healthcare Fraud division. Current work includes schemes and analysis of newly approved pharmaceuticals subject to diversion. Dr. Cohen also has 35 years’ experience in clinical health care. He received undergraduate degrees in biology and chemistry from the University of Richmond, physician assistant training from George Washington University, a law degree with a specialty in Health Law, and Doctor of Health Sciences from A.T. Still University.
11:25
Subpoenaed to Testify: What to Expect & How to Prepare
Subpoenaed to Testify: What to Expect & How to Prepare
Ann Kaperak
Assistant Chief, Florida Agency for Health Care Administration
Ann Kaperak
Assistant Chief, Florida Agency for Health Care Administration
With over 20 years of experience in the healthcare industry, Ms. Kaperak currently serves as the Assistant Bureau Chief for the Florida Agency for Health Care Administration’s Medicaid Program Integrity team. In this role, she leads dedicated teams focused on recovering overpayments and enforcing sanctions, all while working diligently to reduce fraud and abuse within the Medicaid program. Ms. Kaperak is a proud graduate of Florida State University and holds esteemed credentials including AHFI, CFE, and CIGA. She is a respected speaker, having presented at numerous conferences such as NHCAA, NAMPI, FIFEC, and the Medicaid Integrity Institute, where she shares her insights and expertise. Outside of her professional life, Ms. Kaperak enjoys giving back to her community, attending sporting events, and traveling.
Jose Marti
Assistant Attorney General, FL Office of the Attorney General - Medicaid Fraud Control Unit
Jose Marti
Assistant Attorney General, FL Office of the Attorney General - Medicaid Fraud Control Unit
Jose Marti is a prosecutor with the Florida Attorney General's Office, Medicaid Fraud Control Unit, where he helps direct investigations and prosecutes complex Medicaid fraud cases and cases involving the abuse and neglect of elderly and disabled adults. He began his public service career as a dependency attorney with the Florida Department of Children and Families before joining the Attorney General's Office in 2019. Jose is dedicated to protecting vulnerable populations and safeguarding public resources through the enforcement of Florida's healthcare fraud laws. Outside of work Jose enjoys coaching baseball, traveling and cooking for his family and friends.
12:25
Networking Lunch (Sponsored by Public Consulting Group)
Networking Lunch (Sponsored by Public Consulting Group)
13:25
Prepay Strategies for State Medicaid Program Integrity
Prepay Strategies for State Medicaid Program Integrity
Hosted by Deloitte
Mary Vanatta
Senior Advisor for Program Integrity, Centers for Medicare and Medicaid Services
Mary Vanatta
Senior Advisor for Program Integrity, Centers for Medicare and Medicaid Services
Mary Vanatta is Senior Advisor for Program Integrity at the Centers for Medicare & Medicaid Services (CMS), where she provides executive-level guidance on fraud mitigation, emerging vulnerabilities, and oversight initiatives across Medicare and Medicaid. With over two decades of experience in healthcare fraud investigations, oversight, and law enforcement, Ms. Vanatta has led industry engagement and stakeholder outreach efforts for CMS. She has also advanced cross-government collaboration with the Department of the Treasury, FinCEN, and major financial institutions to develop financial crime typologies that expose healthcare fraud as it moves through the financial system, strengthening CMS's ability to identify and prevent these schemes.
Prior to CMS, Ms. Vanatta retired as a Law Enforcement Lieutenant with the Florida Medicaid Fraud Control Unit, where she led complex investigations, supervised multidisciplinary teams, and implemented reforms that reduced inappropriate opioid prescribing. She has also supported the U.S. Attorney's Office on federal healthcare fraud investigations, as well as multi-state private sector casework involving the recovery of improper payments.
Her honors include the Prudential Davis Productivity Award, the Office of the Attorney General Distinguished Service Award, and the State of Florida Distinguished Service Award. She holds a Bachelor of Science in Criminal Justice from the University of Central Florida and is an Accredited Healthcare Fraud Investigator (AHFI).
Ricardo Carcas
Assistant Special Agent in Charge, HHS-OIG
Ricardo Carcas
Assistant Special Agent in Charge, HHS-OIG
Ricardo began his law enforcement career in 2008 as a Zone Program Integrity Contractor (ZPIC) investigator. In 2010, he transferred over to the Center for Program Integrity at the Centers for Medicare and Medicaid Services (CMS-CPI) Miami Field office, where he over saw the Zone 7 ZPIC investigations and Medi-Medi investigations for the state of Florida. Ricardo then joined HHS-OIG (US Dept. of Health and Human Services Office of Inspector General) Office of Investigation in 2015 as a Special Agent in the Miami Regional Office assigned to Miami’s Strike Force. Ricardo is currently an Assistant Special Agent in Charge (ASAC) for the Miami Regional Office.
Adam Thurston
Section Chief, Financial Crimes Enforcement Network
Adam Thurston
Section Chief, Financial Crimes Enforcement Network
Adam Thurston currently serves as the Section Chief for the Trade, Fraud, and Financial Facilitation Section of FinCEN’s Research and Analysis Division. Mr. Thurston has worked at FinCEN since 2005 in a variety of roles, most of which involved international financial crime issues.
Rosalind Abankwah
Health Insurance Specialist, Centers for Medicare & Medicaid Services
Rosalind Abankwah
Health Insurance Specialist, Centers for Medicare & Medicaid Services
Rosalind Abankwah is a Health Insurance Specialist at the Centers for Medicare & Medicaid Services (CMS), where she facilitates data analytics projects and studies to identify and mitigate fraud, waste, and abuse in the Medicare and Medicaid programs. With more than 12 years of experience in program integrity, her work has made a meaningful impact on several national programs.
Rosalind holds a Doctor of Pharmacy (Pharm.D.) from the University of Maryland School of Pharmacy, a foundation she has leveraged in the past to provide technical direction in developing medication-related models designed to combat fraud, waste, and abuse. Driven by a commitment to data-driven policy, Rosalind is eager to share her expertise and insights with today's audience.
Gary Cantrell
Program Integrity Lead, Deloitte
Gary Cantrell
Program Integrity Lead, Deloitte
Gary Cantrell has over 29 years of experience in health care fraud prevention, detection and investigations and is a nationally recognized leader in the health care program integrity community. Prior to joining Deloitte, he served for over 25 years at the U.S. Department of Health and Human Services, Office of Inspector General (HHS OIG) leading anti-fraud, waste, and abuse efforts. As Deputy IG for Investigations at HHS OIG for 10 years, he led collaboration with partner agencies such as the DOJ Criminal and Civil Divisions, FBI, DEA, state Medicaid Fraud Control Units, and the Centers for Medicare and Medicaid services resulting in numerous national health care fraud takedowns. Since joining Deloitte in 2022, Gary leads program integrity solutions for government health and human service programs and has supported the Centers for Medicare & Medicaid Services, Veterans Health Administration, DOJ Criminal Division-Health Care Fraud Unit, and Health Resources and Services Administration. In these roles, he leads fraud, waste, and abuse analytics, fraud detection, lead development, fraud risk assessment and management, and vulnerability identification to maximize impact for government clients.
14:30
Finding the Signals: Identifying & Managing Risk in High-Risk Medicaid Services (Public Consulting Group)
Finding the Signals: Identifying & Managing Risk in High-Risk Medicaid Services (Public Consulting Group)
Public Consulting Group Session
Sarah Kolar
Program Manager, Public Consulting Group
Sarah Kolar
Program Manager, Public Consulting Group
Sarah Kolar is a Program Manager with Public Consulting Group specializing in managed care oversight, health plan reporting, and data quality initiatives. She currently manages the Hawaiʻi Med-QUEST Division Health Plan Reporting and Data Quality Strategy program, supporting state efforts to strengthen oversight, improve reporting processes, and leverage data for performance monitoring and compliance. Prior to joining PCG, she supported federal healthcare initiatives at the U.S. Health Resources and Services Administration.
Hannah Trate
Senior Consultant, Public Consulting Grouo
Hannah Trate
Senior Consultant, Public Consulting Grouo
Hannah Trate is a Senior Consultant with Public Consulting Group specializing in Medicaid program integrity, operational analytics, provider oversight, and program management. She currently serves as Project Manager for Massachusetts' Predictive Modeling Managed Support Services contract in addition to supporting Medicaid agencies in Ohio, Indiana, and Massachusetts on initiatives involving compliance monitoring, stakeholder engagement, quality improvement, workforce development, and data-driven oversight strategies.
Jay Derby
Senior Consultant, Public consulting group
Jay Derby
Senior Consultant, Public consulting group
Jay Derby is a Senior Consultant and AI Architect at Public Consulting Group (PCG), where he leads the design and delivery of AI-enabled solutions for government health and human services programs. With expertise spanning product strategy, and compliance-driven technology, Jay focuses on helping public sector organizations modernize operations while maintaining the highest standards of security, transparency, and accountability.
14:30
Searching for Sasquatch: Discover Smarter Audits & Stronger Outcomes Through Proven Best Practices (Alliant Health Solutions)
Searching for Sasquatch: Discover Smarter Audits & Stronger Outcomes Through Proven Best Practices (Alliant Health Solutions)
Alliant Health Solutions Session
State Medicaid agencies face growing pressure to deliver effective program integrity outcomes while managing increasing audit volume, constrained resources, and rising administrative burden on both agencies and providers. This session explores practical program integrity audit best practices that help agencies address common pain points (inefficient workflows, inconsistent findings, prolonged corrective action cycles, and strained provider relationships) without sacrificing rigor or defensibility. Drawing on real world experience supporting state Program Integrity Units, this session highlights approaches that streamline audit operations, improve communication and transparency, increase future compliance, and strengthen end to end audit lifecycle management. Topics will include risk informed audit planning, policy centric and system driven reviews, efficient documentation and data request strategies, and effective corrective action plan follow up to drive sustained compliance improvements. Participants will gain insights into how thoughtful audit design, collaboration between program integrity and policy teams, and a focus on prevention not just post payment recovery, can enhance impact while reducing inefficiencies. Attendees will leave with actionable strategies they can apply to modernize audit processes, reduce internal and external administrative friction, and support stronger, more resilient Medicaid program integrity operations.
Katie Pass
Director, Stakeholder Engagement, Alliant Health Solutions
Katie Pass
Director, Stakeholder Engagement, Alliant Health Solutions
Katie Pass serves as Director of Stakeholder Engagement at Alliant Health Solutions, where she leads strategic partnerships and initiatives that advance quality, accountability, and healthcare transformation. With experience spanning long-term care, behavioral health, hospital operations, and CMS-funded programs, she has supported state and national efforts focused on patient safety, access to care, rural health improvement, care coordination, and performance improvement. Katie specializes in building collaborative relationships across healthcare, community, and government sectors to develop practical solutions that strengthen program effectiveness, improve outcomes, and support responsible stewardship of healthcare resources.
Davilyn Ariail
Deputy Director - Program Integrity and Medical Review, Alliant Health Solutions
Davilyn Ariail
Deputy Director - Program Integrity and Medical Review, Alliant Health Solutions
Davilyn Ariail has been with Alliant Health Solutions for more than 25 years. She is a Registered Nurse and Certified Professional Coder with more than 20 years of experience conducting and overseeing medical necessity reviews. Davilyn currently oversees multidisciplinary teams responsible for Program Integrity, SURS, Medical Claims, and Outlier reviews. She particularly values data analysis and program integrity work because of the complexity and impact of these reviews.
14:30
Beyond the Audit: Identifying Medicaid Program Vulnerabilities Before They Become Findings (Myers & Stauffer)
Beyond the Audit: Identifying Medicaid Program Vulnerabilities Before They Become Findings (Myers & Stauffer)
Myers & Stauffer Session
This session explores how States and Medicaid stakeholders can adopt proactive approaches to safeguard program integrity by addressing policy gaps and vulnerabilities before fraud, waste, and abuse (FWA) occur. With a focus on critical services such as Applied Behavior Analysis (ABA) therapy, Personal Care Services (PCS), and Non-Emergency Medical Transportation (NEMT), the discussion will demonstrate how a front-end strategy can minimize risks and enhance Medicaid program oversight. Participants will learn about the value of conducting policy evaluations to identify gaps or weaknesses and clarify compliance expectations. The session will also emphasize the importance of using data-driven approaches, such as encounter data analysis and claims testing, to forecast vulnerabilities and strengthen program integrity efforts. Additionally, the presentation will highlight the need to balance targeted exploratory audits with policy refinements to address potential fraud risks more effectively. Drawing on Myers and Stauffer's deep expertise in policy consulting, auditing, and innovative solutions, this session provides Medicaid program integrity leaders with practical insights and strategies to shift toward long-term, sustainable program improvements. By focusing on preventive measures and reducing reliance on reactive responses, stakeholders will gain actionable insights to create more robust Medicaid programs that prevent FWA before it takes hold.
John Lott
Senior Manager, Myers and Stauffer
John Lott
Senior Manager, Myers and Stauffer
Mr. Lott is a senior manager with Myers and Stauffer LC and brings 16 years of experience in SQL development and data analytics, including 13 years specializing in Medicare and Medicaid claims data. He has significant experience serving in technical leadership roles and as a Project Manager for Recovery Audit Contractor (RAC) engagements, where he has assisted multiple states and hospital stakeholders in identifying and addressing fraud, waste, and abuse in Medicaid claims data.
In addition to his work on RAC projects, Mr. Lott has contributed to program integrity efforts across four states, providing advanced technical and analytical support. He has developed specialized analyses to support Medicaid Fraud Control Unit (MFCU) investigations, collaborating with the U.S. Department of Justice and MFCU teams to deliver critical data and insights that have driven fraud investigations. Furthermore, he has provided expert opinions to support litigation for a state’s Office of the Attorney General.
Before joining Myers and Stauffer, Mr. Lott worked at a recovery audit firm supporting Medicare RAC operations across three regions. In this role, he developed processes to optimize revenue cycle management and ensure compliance with CMS requirements.
Kimberly Forrest
Director, Myers & Stauffer
Kimberly Forrest
Director, Myers & Stauffer
Ms. Forrest is a director with Myers and Stauffer, bringing more than 25 years of public
and private sector experience in various forms of Program Integrity (PI) work for the
state of Indiana, including contract implementation and oversight, evaluation and
implementation of data analytics, audit coordination, and provider/stakeholder relations
and education. Ms. Forrest also provided oversight of the development and
implementation of a comprehensive program integrity, case tracking, and analytics
system. With that experience, Ms. Forrest serves as a Subject Matter Expert to
incorporate the State PI perspective in the design and implementation of program
integrity case-tracking solutions.
Ms. Forrest provides oversight to multiple state Recovery Audit Contract (RAC)
operations – with responsibilities ranging from policy/procedure impact analysis to
evaluation of state guidelines to identify potential vulnerabilities. She has overseen the
independent review of inpatient, outpatient, professional, long-term care and other
provider type claims – with most recent focus on applied behavioral analysis and non-
emergency medical transportation services, as well as review of home and community-
based service providers. Ms. Forrest utilizes her extensive state PI experience to
provide fraud, waste, and abuse detection technical expertise to the firm’s Benefit
Program Integrity (BPI) unit and serves as a resource on false claims and litigation
support engagements.
Shilpi Goel
Senior Manager, Myers & Stauffer
Shilpi Goel
Senior Manager, Myers & Stauffer
Ms. Goel is a Senior Manager at Myers and Stauffer. She supports engagements
related to Medicaid program integrity and consulting review efforts. She manages
Recovery Audit Contractor (RAC) and Non-Emergency Medical Transportation (NEMT)
audits across multiple states. Additionally, she assists in overseeing state Procurement
Reviews of School Food Authorities under the School Lunch Program. Ms. Goel has
also managed various consulting projects focused on policy analysis.
In her role at the firm, she is responsible for project oversight alongside conducting
research, writing, data analysis, and documentation of policies and procedures. Her
program integrity experience includes performing post-payment reviews of credit
balances, Home and Community-Based Services (HCBS) audits, Non-Emergency
Medical Transportation (NEMT) audits, and various inpatient services.
Ms. Goel has contributed to the Medicaid and CHIP Payment and Access Commission
(MACPAC) project, focusing on performance measures and return on investment for
Medicaid program integrity. She also has experience working with Managed Care
Organizations (MCOs) data, including conducting data analysis and preparing reports
for transparency and external quality review (EQR) projects in multiple states.
Travis Melton
Senior Manager, Myers & Stauffer
Travis Melton
Senior Manager, Myers & Stauffer
Mr. Melton, a senior manager with Myers and Stauffer, is an experienced professional in healthcare auditing and consulting. Throughout his career, he has managed compliance and performance audits, financial audits, and bid pricing tool audits of Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs) on behalf of the Centers for Medicare & Medicaid Services (CMS). Additionally, he has served as the project manager for program integrity reviews conducted for the Department of Medical Assistance Services (DMAS) in the Commonwealth of Virginia.
Since 2003, Mr. Melton has worked closely with Medicaid agencies, primarily focusing on overseeing program integrity engagements. His responsibilities include reviewing completed engagements, supervising staff, engaging with providers and Medicaid agency personnel, preparing reports, and ensuring compliance with contract requirements.
In addition to his auditing expertise, Mr. Melton has worked on consulting engagements with state agencies to modernize child welfare rates. He has supported states in reforming child welfare payment methodologies to enhance service delivery and ensure fair, efficient allocation of resources.
Mr. Melton has also collaborated with several states on performance and administrative expense audits of Managed Care Organizations (MCOs) that participate in state insurance programs. His work with CMS includes audits of Medicare Advantage and Medicare Prescription Drug Plan bid pricing. His expertise spans audits related to Fraud, Waste, and Abuse (FWA), Part D Effectuation Timeliness, Part D Clinical Decision Making, Part D Grievances, Enrollment/Disenrollment, and Late Enrollment Penalty components of performance and compliance audits for plan sponsors. He has also overseen examinations of financial information for Medicare Advantage Organizations and Prescription Drug Plans.
14:30
Follow the Data: Protecting Medicaid Plans (SmartLight Analytics)
Follow the Data: Protecting Medicaid Plans (SmartLight Analytics)
SmartLight Analytics Session
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Doloribus consequunt
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
Doloribus consequunt
Marilyn Bartlett
Consultant, MJBartlett LLC Consulting
Marilyn Bartlett
Consultant, MJBartlett LLC Consulting
Marilyn has focused on health care financial management, serving as Controller for a national health insurance carrier, CFO for a regional health care Third Party Administrator, health management positions within the Montana State Government. As a consultant, she works with Patient Rights Advocate and various employers to “follow the money” in healthcare, with the goal of transparency and lower costs for the plan. As Senior Policy Fellow for the National Academy of State Policy (NASHP), she developed the NASHP Hospital Cost Tool, using hospital filed Medicare Cost Report data, focused on transparency of hospital financial performance.
As State of Montana Employee Benefit Plan Administrator, she moved the plan from projected reserves of -$9 million to $112 million in less than 3 years. She disrupted the status quo by implementing reference-based pricing contracts with all Montana hospitals. For her work, she was recognized as #13 of the World’s 50 Greatest Leaders in 2019.
Dave Gemmill
Director of Account Management, SmartLight Analytics
Dave Gemmill
Director of Account Management, SmartLight Analytics
David Gemmill leads SmartLight’s most complex and strategic accounts as a member of the Account Management team. With over 16 years of professional experience, Mr. Gemmill previously worked with clients and their outside counsel to resolve disputes, investigations, and regulatory compliance matters in the healthcare industry. His matters typically involved the quantification of overpayment by government healthcare programs due to violations of the False Claims Act. With expertise in the analysis and modeling of complex transactional datasets, Mr. Gemmill translates complex concepts to non-technical audiences and has presented directly to the Department of Justice and the Drug Enforcement Agency. Mr. Gemmill lives in Katonah, NY with his wife and two daughters.
15:30
Networking Break
Networking Break
16:00
Multi Engagement Audits: Advancing Program Integrity Across Fee for Service and Managed Care
Multi Engagement Audits: Advancing Program Integrity Across Fee for Service and Managed Care
This session highlights the New York State Office of the Medicaid Inspector General’s (OMIG) multi-engagement audit approach, a coordinated review of a single provider’s Medicaid Fee for Service claims and Managed Care Organization encounters conducted simultaneously. Traditionally, Fee for Service and managed care audits were handled separately. This approach brings them together in one streamlined process while, at the same time, maintaining separate audit universes, samples, and findings for each payor source. Attendees will learn how the model supports a more complete review of provider compliance across direct state billing and selected managed care plan activity. The session will also explain how the audit is structured, including provider notification, plan specific engagement, sampling methodology, and record review. In addition, presenters will discuss operational benefits, including stronger program integrity oversight, more efficient audit workflows, clearer allocation of findings, and reduced administrative burden on providers. Further, this session will offer attendees a practical example of how audit operations can evolve to better reflect the complexity of today’s Medicaid environment.
Laura Greene
Audit Manager, Office of the Medicaid Inspector General
Laura Greene
Audit Manager, Office of the Medicaid Inspector General
Laura Greene is an Audit Manager for the New York State Office of Medicaid Inspector General. Over her 11-year tenure with OMIG, Laura has transitioned from investigative roles to leading audit teams focused on FFS and Managed Care compliance, data analytics, and policy enforcement. She regularly serves as a Subject Matter Expert for outpatient and diagnostic services. Laura holds a B.S. in Finance from Adelphi University and has completed advanced coursework in Medical Billing and Coding.
Shavasya Jacob
Audit Supervisor, Office of the Medicaid Inspector General
Shavasya Jacob
Audit Supervisor, Office of the Medicaid Inspector General
Shavasya Jacob is an Audit Supervisor at the NYS Office of the Medicaid Inspector General. She is a seasoned healthcare compliance professional with over a decade of dedicated experience in Medicaid program integrity as well as other state oversight programs. She currently serves as a subject matter expert, leading an innovative audit approach defined by a unique, data-driven method to program integrity.
This idea was initiated by the regional audit director, but the methodology was designed and planned by Shavasya during a highly selective professional development program, where she conducted intensive research and development to optimize fraud, waste, and abuse detection in the multi-payor Medicaid landscape. A specialist in regulatory compliance and operational excellence, she holds a Master of Public Administration in Inspection and Oversight from John Jay College (CUNY). Shavasya is dedicated to safeguarding public healthcare resources through rigorous, forward-thinking oversight strategies.
16:00
EVV: Fixing the Holes in the Fence
EVV: Fixing the Holes in the Fence
Aaron Ziska
Provider Fraud Investigator, NE DHHS MLTC
Aaron Ziska
Provider Fraud Investigator, NE DHHS MLTC
Aaron Ziska is a fraud investigator with a broad background in data. Beginning in labor market economic research, then moving to Nebraska Medicaid analysis, Aaron joined Nebraska Program Integrity at the beginning of the COVID pandemic. He has spent sixteen years with the State, 10 of which have been with Medicaid. With a background in data analysis, he functions as a SME for data synthesis amongst Medicaid systems. He enjoys spending time outdoors exploring with his family, and spending time playing D&D and other board games with his friends.
Vernalisa Taylor
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
Vernalisa Taylor
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
With nearly 25 years of experience in Nebraska Medicaid, she has served in provider screening and enrollment, provider relations, appeals, and Program Integrity. Since joining Program Integrity in 2020, Vernalisa has conducted provider investigations, provider compliance activities, and administrative enforcement actions while partnering with state and federal agencies to safeguard the integrity of the Medicaid program. She enjoys collaborating with colleagues nationwide and sharing practical approaches to strengthening Medicaid program integrity.
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
I manage the Fraud, Waste, and Abuse Detection and Prevention Team in the Office of Program Integrity for the Oregon Health Authority. After studying Applied Mathematics as an undergraduate at Boise State University, I worked as a data analyst for a national power sports distributor. My passion for data and analytics led me to obtain my Master’s in Statistics from Oregon State University before joining Oregon’s Program Integrity as a research analyst in 2021. Now I lead a team of nine analysts, fraud examiners, and auditors to find and resolve issues of FWA. I enjoy being outside or on the lake, playing disc golf, and playing board games with friends and family in my free time.
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Leads the best team in Nebraska Medicaid to protect the program from fraud, waste, and abuse, and the clients from harm and exploitation. Educated at Creighton University and the University of Nebraska - Lincoln. Spends free time collecting craft supplies and making things.
Scott Jeffries
Lead Research Analyst, Oregon Health Authority, Office of Program Integrity
Scott Jeffries
Lead Research Analyst, Oregon Health Authority, Office of Program Integrity
Scott Jeffries is the lead research analyst at Oregon Health Authority's Office of Program Integrity. Scott has been with OPI for three years and worked as a research analyst and epidemiologist at OHA for 18 years. He holds a Master of Public Health in epidemiology and biostatistics from Oregon Health & Science University, lives right here in Portland, is a massive Timbers and Blazers fan, and is thrilled to welcome everyone to the city that he loves.
16:00
Tracing Fraud: How Financial Forensics Drives Medicaid Investigations
Tracing Fraud: How Financial Forensics Drives Medicaid Investigations
This session will walk through how our financial forensics team “follows the money” in complex Medicaid provider fraud investigations. We will outline our step‑by‑step process for tracing Medicaid funds from the initial payment streams into personal and business accounts, related entities, and ultimately into assets such as real estate, vehicles, investments, and luxury purchases. Along the way, we will show how bank records, wire transfers, corporate filings, and open‑source data are combined to uncover hidden ownership, shell companies, nominee owners, and circular payment schemes that indicate kickbacks and self‑dealing. We will also focus on why this work matters after a credible allegation of fraud is established. When providers claim they are insolvent or “judgment proof,” asset tracing and financial profiling help demonstrate the true flow of fraud proceeds and identify reachable assets for potential recovery. By documenting how Medicaid dollars were converted into equity, investments, and other property, our team supports enforcement actions, strengthens settlement posture, and improves the likelihood of meaningful recoveries that return funds to the Medicaid program.
Donna Knapp
Manager, Major Case Unit, Texas HHSC Office of the Inspector General
Donna Knapp
Manager, Major Case Unit, Texas HHSC Office of the Inspector General
Donna Knapp is a financial forensic investigator and manager with the Texas HHS OIG Major Case Unit, which handles complex financial fraud investigations. She has partnered with MFCU, the Medicaid Task Force, the FBI, and the Department of Justice on major Medicaid fraud matters, using her financial forensics expertise to follow the money in investigations and litigation.
With more than 30 years of experience, Donna is a licensed Certified Public Accountant, Certified Fraud Examiner, Certified Financial Forensic, and Certified Anti-Money Laundering Specialist. She has presented to professional groups on financial fraud investigations, asset identification, financial behavior profiling, hidden accounts, shell companies, and following the money.
Anne Mcfarland
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Anne Mcfarland
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Anne Mcfarland
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Anne Mcfarland
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16:00
CMS Medicaid & CHIP Eligibility Audits
CMS Medicaid & CHIP Eligibility Audits
CMS will outline its Medicaid and CHIP program integrity efforts pursued through the PERM eligibility reviews and CPI targeted eligibility audits, focusing on its oversight of states' unwinding from the flexibilities associated with the COVID-19 Public Health Emergency and other high-risk eligibility categories and processes, as well as encouraging states to prioritize these requirements, which will result in minimization of these types of errors in future measurements. CMS would also like to speak about innovations in the PERM program that lead to better reporting of improper payment data. CMS will also discuss its corrective action plan work with states and future program enhancements to promote Medicaid and CHIP program integrity.
Shirin Hormozi
Director Division of State Program Integrity, CMS
Shirin Hormozi
Director Division of State Program Integrity, CMS
Shirin recently starting serving as the Director of the Division of State Program Integrity (DSPI) at the Centers for Medicare & Medicaid Services (CMS), where she leads Medicaid program integrity oversight and works to strengthen accountability across state Medicaid programs. She oversees state program integrity and eligibility audits, medical loss ratio audits, and Recovery Audit Contractor (RAC) oversight.
Prior to becoming Director, Shirin served as Deputy Director in the Division of State Partnership within the Audits and Vulnerabilities Group. She also served as a Program Representative in CMS's Center for Clinical Standards & Quality, where she provided technical and professional expertise in applying Medicare and Medicaid laws, regulations, and policies related to long-term care certification, survey, and enforcement processes.
Shirin began her career at the Government Accountability Office (GAO), where she was a Senior Analyst prior to joining CMS. At GAO, Shirin worked on a number of high-profile engagements assessing federal oversight of healthcare programs. This included leading engagements examining oversight and regulations associated with assisted living facilities, advance directives, patient safety at hospitals, and providing numerous cost-saving recommendations to the Medicaid program.
Shirin holds a Master of Public Health from the University of Michigan and a Bachelor of Science in Community Health from the University of Illinois. Outside of work, she enjoys traveling, cooking, reading, and cheering on her two children at their soccer, flag football, and track events.
Chrissy Fowler
Director of Payment Accuracy & Reporting Group, Centers for Medicare and Medicaid Services/ Office of Financial Management
Chrissy Fowler
Director of Payment Accuracy & Reporting Group, Centers for Medicare and Medicaid Services/ Office of Financial Management
Chrissy Fowler is the Director of the Payment Accuracy & Reporting Group (PARG) within the Office of Financial Management at the Centers for Medicare & Medicaid Services (CMS). She has 25 years of experience at the Department of Health & Human Services (HHS), specializing in improper payments oversight of CMS’s programs.
As a senior leader she oversees the improper payment measurements for major programs, including Medicare Fee-for-Service, Parts C and D, Medicaid, Children’s Health Insurance Program, and the Advance Premium Tax Credit as required by Payment Integrity Information Act of 2019 (PIIA). These programs represent 56% of government-reported improper payments in 2025. She has brought innovation, accuracy, and data transparency to improper payment reporting, leading to significant reductions in CMS improper payments and making CMS a model of excellence across government agencies.
Her journey to this pivotal role began at the HHS/Office of Inspector General, where she spent a decade honing her auditing expertise through performance and financial statement audits —including the very improper payment measurement programs she now leads.
Chrissy graduated with a Bachelor of Science in Business Administration with a major in accounting from Samford University. Chrissy brings both technical precision and strategic vision to one of government's most challenging missions: ensuring every healthcare dollar reaches its intended destination.
Nicholas Bonomo
Supervisory Health Insurance Specialist, CMS
Nicholas Bonomo
Supervisory Health Insurance Specialist, CMS
Nick Bonomo is the director of the Centers for Medicare & Medicaid Services' (CMS's) Division of Payment Error Rate Measurement (DPERM), the federal entity responsible for measuring and reporting improper payments in Medicaid and the Children's Health Insurance Program (CHIP). He is a proud University of Maryland graduate with a Bachelor of Science in statistical mathematics and a Bachelor of Arts in criminology and criminal justice. Nick has been with CMS in the PERM program for almost 12 years and has seen the program evolve and improve over the years through changing policies and administrations with one constant overarching goal of protecting taxpayer dollars from misspending.
Camiel Rowe
Division Director, Center for Medicare and Medicaid Services
Camiel Rowe
Division Director, Center for Medicare and Medicaid Services
Camiel Rowe is the Director of the Division of State Partnership at the CMS Center for Program Integrity (CPI), where she leads the coordination and implementation of key Medicaid program integrity initiatives. These include the Medicaid Integrity Institute (MII), the Payment Error Rate Measurement Corrective Action Plan (PERM CAP), Medicaid Eligibility Quality Control (MEQC), and Single State Audits (SSA) — delivering critical training and technical support to states and territories nationwide.
With over 16 years of CMS experience in Medicaid policy and operations, Camiel has built a distinguished career dedicated to combating fraud, waste, and abuse and safeguarding the efficient operation of Medicaid programs. Prior to joining CPI in 2016, she served in the Center for Medicaid and CHIP Services (CMCS) as Project Manager for the Transformed Medicaid Statistical Information System (T-MSIS) and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) initiatives.
Camiel holds a Master of Business Administration (MBA) from Strayer University. Outside of work, she enjoys binge-worthy Netflix series, discovering hidden boutique restaurants, and painting — bringing the same sharp eye for detail to uncovering culinary gems as she does to identifying program vulnerabilities and protecting billions in Medicaid funding.
18:00
Monday Evening Reception (Sponsored by Deloitte)
Monday Evening Reception (Sponsored by Deloitte)
07:45
Networking Breakfast (Sponsored by PwC)
Networking Breakfast (Sponsored by PwC)
07:45
Exhibit Hall Open
Exhibit Hall Open
07:45
Registration Desk Open
Registration Desk Open
08:45
Day Two Welcome Remarks
Day Two Welcome Remarks
08:50
Two MFCUs’ Recent Experience with Substance Use Disorder Treatment & Urine Drug Testing Fraud
Two MFCUs’ Recent Experience with Substance Use Disorder Treatment & Urine Drug Testing Fraud
Investigators from the Massachusetts and North Carolina MFCUs present recent case studies involving substance use disorder (SUD) treatment and urine drug testing (UDT) providers. The session covers how each case developed, the red flags that surfaced, and the investigative approaches used, offering cross-state insight into how this fraud is presenting today.
Kevin Lownds
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
Kevin Lownds
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
Kevin Lownds is the Division Chief in the Office of Massachusetts Attorney General Andrea Joy Campbell, Medicaid Fraud Division, where he investigates and prosecutes health care fraud in federal and state court. Kevin has been in the Medicaid Fraud Division since May 2017 and has conducted investigations and led prosecutions of mental health providers and private equity investors, clinical laboratories, nursing homes, home health agencies, and physicians. Prior to this role, Kevin was at WilmerHale LLP in Washington, DC, where he practiced white-collar criminal defense and complex civil litigation. Kevin is a graduate of Georgetown University Law Center and Tufts University.
F. Edward (Eddie) Kirby, Jr.
Director, North Carolina Department of Justice, Medicaid Investigations Division
F. Edward (Eddie) Kirby, Jr.
Director, North Carolina Department of Justice, Medicaid Investigations Division
F. Edward (Eddie) Kirby, Jr. is the Director of the Medicaid Investigations Division (MID) at the North Carolina Department of Justice. He has served with MID since 2008 and has been the Director since 2018. MID is the Medicaid Fraud Control Unit (MFCU) for North Carolina. Eddie is appointed as a Special Assistant U.S. Attorney in all three federal districts of North Carolina. He currently serves as Vice President of the National Association of Medicaid Fraud Control Units (NAMFCU).
Michael Llabona
Financial Investigations Supervisor, NCDOJ - Medicaid Investigations Division
Michael Llabona
Financial Investigations Supervisor, NCDOJ - Medicaid Investigations Division
Michael has more than a decade of experience investigating healthcare provider fraud and financial crimes, contributing to cases resulting in more than $50 million in restitution. In 2022, he was nominated for the Financial Crimes Enforcement Network Director’s Law Enforcement Award for National Case of the Year.
He routinely works across all federal districts in North Carolina and collaborates with the Federal Bureau of Investigation, Internal Revenue Service, and U.S. Department of Health and Human Services Office of Inspector General to investigate some of North Carolina’s most complex healthcare fraud schemes.
Tasha Gardner
Special Deputy Attorney General, NC Department of Justice - Medicaid Investigations Division
Tasha Gardner
Special Deputy Attorney General, NC Department of Justice - Medicaid Investigations Division
Tasha Gardner is a Special Deputy Attorney General with the North Carolina Department of Justice - Medicaid Investigations Division (MID) and is cross-designated as a Special Assistant United States Attorney in the Eastern District of North Carolina. As a Medicaid criminal enforcement attorney, Tasha has been prosecuting Medicaid provider fraud in both federal and state courts since 2020. Prior to joining MID, Tasha served as an Assistant District Attorney for more than 16 years.
09:40
Networking Break
Networking Break
10:10
NAMFCU Deep Dives: Policy Recommendations & Changes
NAMFCU Deep Dives: Policy Recommendations & Changes
Lane Olson
Chief Investigator, Utah MFCU
Lane Olson
Chief Investigator, Utah MFCU
I am the Chief Investigator at the Utah MFCU at the Office of the Utah Attorney General. I have an MBA in Health Care Management, I am a Certified Fraud Examiner, and I have 30 years of experience as a sworn law enforcement officer. I worked as a Detective for the Ogden City Police Department for over 20 years. During that time, I had specialty assignments in Property, Crimes Against Children, Internet Crimes Against Children, Weber/Morgan Homicide Task Force, and Financial Crimes.
10:10
NAMFCU Deep Dives: Prosecution Considerations
NAMFCU Deep Dives: Prosecution Considerations
Fritz Jenkins
Administrator for Program Integrity, Oregon Health Authority
Fritz Jenkins
Administrator for Program Integrity, Oregon Health Authority
Fritz Jenkins is the Administrator for Program Integrity for the Oregon Health Authority (OHA). The Office of Program Integrity (OPI) is in the Fiscal and Operations Division of OHA, as a direct report to the OHA CFO. Fritz has been in the program integrity work in different capacities for nearly 30 years. Fritz and his staff are responsible for the development, implementation, operations, and ongoing advancements in the PI operations of OHA. Fritz has a background in behavioral health, substance abuse treatment, early childhood development, child abuse prevention, and basketball. Current interests are traveling, golf, motorcycle riding, and aging well.
Pamela Graham, AHFI, CPC
Investigator III, Oregon Department of Justice
Pamela Graham, AHFI, CPC
Investigator III, Oregon Department of Justice
Pamela Graham has been an Investigator with the Oregon Department of Justice Medicaid Fraud Control Unit (MFCU) since January 2020. Pam is an Accredited Health Care Fraud Investigator (AHFI) and a Certified Professional Coder (CPC).
Pam’s background is in health insurance: Customer Service, Claims Processing, Lead and Supervisor roles, and five years as an Investigator in the Special Investigations Unit (SIU) investigating fraud, waste and abuse (FWA).
Alex Hargrove
Senior Assistant Attorney General, Oregon Department of Justice
Alex Hargrove
Senior Assistant Attorney General, Oregon Department of Justice
Alex Hargrove has been a Senior Assistant Attorney General with the Oregon Department of Justice Medicaid Fraud Unit Since 2025. Prior to joining Oregon DOJ, Alex worked as a Deputy District Attorney in both the Douglas and Multnomah County District Attorney’s Offices in Oregon. During his time as a DDA, Alex handled a variety of case types, including fraud, drug offense, violent crimes, and sexual assault cases.
10:10
NAMFCU Deep Dives: Investigation Tactics & Challenges
NAMFCU Deep Dives: Investigation Tactics & Challenges
Come chat with Ohio and Arizona as we discuss key investigation considerations as part of the joint NAMFCU and NAMPI skills block training session.
Ben Karrasch
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
Ben Karrasch
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
Ben has served as the Section Chief of the Health Care Fraud Section and Director of the Ohio Medicaid Fraud Control Unit at the Ohio Attorney General’s Office since November of 2020. Ben began his career as an Assistant Prosecutor for the Columbus City Attorney’s Office in Columbus, Ohio. After spending 5 years as a courtroom prosecutor, Ben moved on to the world of Medicaid Fraud Control Units at both the Washington, D.C. Office of the Inspector General and eventually back home to Ohio at the Ohio Attorney General’s Office. Ben has handled both provider fraud cases as well as patient abuse and neglect cases. Ben is the current President of the National Association of Medicaid Fraud Control Units.
Ben is a graduate of Capital University Law School and received his bachelor’s degree from The Ohio State University. Ben lives in Columbus, Ohio with his wife and two boys.
Kaye Lynn Wootton
Director, Medicaid Fraud Control Unit (aka Medicaid Fraud and Patient Abuse Division), Utah Attorney General's Office
Kaye Lynn Wootton
Director, Medicaid Fraud Control Unit (aka Medicaid Fraud and Patient Abuse Division), Utah Attorney General's Office
Kaye Lynn Wootton is a prosecutor in the Utah Attorney General’s office and serves as Director of the Utah Medicaid Fraud and Patient Abuse Division. She began her career as a Registered Nurse over 35 years ago and now combines her nursing and attorney skills as she continues her mission to protect patients and safeguard the Medicaid program. Kaye Lynn also serves as President of the National Association of Medicaid Fraud Control Units (NAMFCU). Kaye Lynn regularly serves as a presenter and facilitator for state agencies, provider groups, NAMFCU and various national organizations. Kaye Lynn is currently serving as a member of the Board of Directors for the Healthcare Fraud Prevention Partnership.
Justin Gates
Chief Special Agent, Ohio Medicaid Fraud Control Unit
Justin Gates
Chief Special Agent, Ohio Medicaid Fraud Control Unit
Justin Gates is a Chief Special Agent in the Medicaid Fraud Control Unit (MFCU) of the Ohio Attorney General’s Health Care Fraud Section. In this capacity, he supervises the unit’s Intake Team, Evidence Team, and Three Investigative Teams. Justin has over twenty years of investigative experience with the Ohio Attorney General’s office where he has worked as an Economic Loss Investigator investigating claims against Ohio’s Crime Victim Compensation Program; and as a Special Agent and Special Agent Supervisor investigating health care providers accused of defrauding the state’s Medicaid program, as well as those who abuse or neglect individuals in long-term care facilities and assisted living facilities throughout the state of Ohio.
10:10
NAMFCU Deep Dives: Medicaid Agency/MFCU Fraud Referral Workflow
NAMFCU Deep Dives: Medicaid Agency/MFCU Fraud Referral Workflow
Kevin Lownds
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
Kevin Lownds
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
Kevin Lownds is the Division Chief in the Office of Massachusetts Attorney General Andrea Joy Campbell, Medicaid Fraud Division, where he investigates and prosecutes health care fraud in federal and state court. Kevin has been in the Medicaid Fraud Division since May 2017 and has conducted investigations and led prosecutions of mental health providers and private equity investors, clinical laboratories, nursing homes, home health agencies, and physicians. Prior to this role, Kevin was at WilmerHale LLP in Washington, DC, where he practiced white-collar criminal defense and complex civil litigation. Kevin is a graduate of Georgetown University Law Center and Tufts University.
Joan Senatore
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
Joan Senatore
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
Joan has worked at the Medicaid Agency for 20+ years and previously worked at the Massachusetts Office of the Attorney General in various roles. Joan earned a Bachelor’s and a Master’s in Business Administration at the University of Massachusetts Boston, and a Juris Doctorate from the New England School of Law. Joan is also a Certified Fraud Examiner, Certified in Healthcare Compliance, and a Licensed Attorney.
11:25
Hot Ones: Feel the Burn (Pulselight)
Hot Ones: Feel the Burn (Pulselight)
Ann Kaperak
Assistant Chief, Florida Agency for Health Care Administration
Ann Kaperak
Assistant Chief, Florida Agency for Health Care Administration
With over 20 years of experience in the healthcare industry, Ms. Kaperak currently serves as the Assistant Bureau Chief for the Florida Agency for Health Care Administration’s Medicaid Program Integrity team. In this role, she leads dedicated teams focused on recovering overpayments and enforcing sanctions, all while working diligently to reduce fraud and abuse within the Medicaid program. Ms. Kaperak is a proud graduate of Florida State University and holds esteemed credentials including AHFI, CFE, and CIGA. She is a respected speaker, having presented at numerous conferences such as NHCAA, NAMPI, FIFEC, and the Medicaid Integrity Institute, where she shares her insights and expertise. Outside of her professional life, Ms. Kaperak enjoys giving back to her community, attending sporting events, and traveling.
David Ward
Sr. Director, LTSS, Oklahoma Health Care Authority
David Ward
Sr. Director, LTSS, Oklahoma Health Care Authority
David Ward serves as the Senior Director of Long Term Services and Supports for the Oklahoma Health Care Authority, the State’s single Medicaid agency. In this role, he works in close partnership with Oklahoma Human Services and provides administrative oversight for the 1915(c) Home and Community‑Based Services waivers, State Plan Personal Care, PACE and the RHTP‑supported PACE expansion, Level of Care, TEFRA, Dual Eligible Care Coordination, and the Money Follows the Person program (Oklahoma’s Living Choice).
David was selected for and completed both the inaugural ADvancing States Next Gen Leadership Program (2022–2023) and the Milbank Memorial Fund Emerging Leaders Program (2022–2023). He currently serves as Chairman of the National EVV Association and is a former at‑large board member for ADvancing States.
Ben Karrasch
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
Ben Karrasch
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
Ben has served as the Section Chief of the Health Care Fraud Section and Director of the Ohio Medicaid Fraud Control Unit at the Ohio Attorney General’s Office since November of 2020. Ben began his career as an Assistant Prosecutor for the Columbus City Attorney’s Office in Columbus, Ohio. After spending 5 years as a courtroom prosecutor, Ben moved on to the world of Medicaid Fraud Control Units at both the Washington, D.C. Office of the Inspector General and eventually back home to Ohio at the Ohio Attorney General’s Office. Ben has handled both provider fraud cases as well as patient abuse and neglect cases. Ben is the current President of the National Association of Medicaid Fraud Control Units.
Ben is a graduate of Capital University Law School and received his bachelor’s degree from The Ohio State University. Ben lives in Columbus, Ohio with his wife and two boys.
Josh Porter
Health Bureau Chief, Nevada Health Authority
Josh Porter
Health Bureau Chief, Nevada Health Authority
Josh Porter is a native Nevadan with 14 years of Program Integrity experience within the Nevada Health Authority’s Surveillance and Utilization Review (SUR) Unit. Throughout his tenure with SUR, he served as a caseworker, analyst, project and data coordinator, and spent the past four years as the Northern SUR Manager. His work included leading projects, managing cases, and overseeing nearly 500 payment suspensions and referrals to the Attorney General’s Medicaid Fraud Control Unit for credible allegations of fraud—fortunately there have been far fewer administrative appeals. In July 2026, Josh became the Health Bureau Chief for the NVHA Office of the Inspector General. He currently oversees the SUR, Provider Enrollment, and the Nevada Recovery/Medicaid Estate Recovery Units.
Jason Helmandollar
VP Healthcare Solutions, Pulselight
Jason Helmandollar
VP Healthcare Solutions, Pulselight
As Vice President of Healthcare Solutions at Pulselight, Jason is responsible for driving the development of cutting-edge analysis techniques and investigation skills to be utilized in Pulselight’s software products. He is a nationally recognized expert on Medicaid fraud, having served prior to Pulselight as a Special Agent Supervisor with Ohio’s Medicaid Fraud Control Unit. During his twelve years there, Jason investigated and helped prosecute hundreds of criminal fraud cases, was instrumental in developing new data analysis strategies, and helped to dramatically increase the efficiency and effectiveness of operations.
11:25
Data-Driven Defense: Additional Data Sources & Connections Powering FWA Detection (Healthcare Fraud Shield)
Data-Driven Defense: Additional Data Sources & Connections Powering FWA Detection (Healthcare Fraud Shield)
Healthcare Fraud Shield Session
Karen Weintraub
Executive Vice President, Healthcare Fraud Shield
Karen Weintraub
Executive Vice President, Healthcare Fraud Shield
With 28 years of data and over 22 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, Certified Dental Coder (CDC) from the American Dental Association and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college.
11:25
Grow, Protect, Scale: Grassroots Investigations Powered by RapidFi & Safeguard (Peraton)
Grow, Protect, Scale: Grassroots Investigations Powered by RapidFi & Safeguard (Peraton)
Peraton Session
Mikhial Jerzak
Technical Architect, Peraton
Mikhial Jerzak
Technical Architect, Peraton
Mikhial Jerzak is a Technical Architect for Peraton, and the Innovation Lead on the CMS Fraud Prevention System (FPS) program. He has over 10 years of experience in software development, platform infrastructure, and enterprise solution architecture to drive continuous modernization of AI/ML systems. He operates as the lead technical architect for the Rapid Fraud Intelligence (Rapid FI) platform.
Throughout his career, Mikhial has demonstrated a consistent track record of bridging technical execution with strategic vision. He combines hands-on development experience as a software engineer with technical leadership to guide his cross-functional team of developers. His innovations have been recognized as a GovTech Connects Accelerate’25 Award Winner (Rapid FI), and 2025 FORUM Disruptive Tech Award Winner (CMS FPS). He and his innovation team have the overall aim of securely governing technology initiatives in support of program integrity.
During this session, he will discuss securely deploying analytics platforms at scale, using a flexible architecture to meet state infrastructures where they are on their AI and analytics journey.
Elizabeth Snavely
Chief Operating Officer, Safeguard Services, LLC a Peraton company
Elizabeth Snavely
Chief Operating Officer, Safeguard Services, LLC a Peraton company
Elizabeth Snavely is the Chief Operating Officer of SafeGuard Services LLC, a Peraton company, where she leads operations dedicated to safeguarding the integrity of billions of dollars in federal and state healthcare spend across Medicare, Medicaid, and commercial markets. With more than 25 years of experience, she has driven innovation and operational excellence across healthcare technology, program integrity, and business transformation.
Her career includes senior leadership roles at Cotiviti and General Dynamics Information Technology, where she advanced enterprise integrations, product strategies, and fraud, waste, and abuse solutions that continue to support CMS contractors today. She has guided large-scale mergers and acquisitions, led the development of healthcare analytics products, and partnered with federal and state agencies to strengthen program integrity through the application of AI, automation, and data analytics.
A recognized thought leader in healthcare program integrity and technology enablement, Elizabeth has been an invited speaker at national healthcare and program integrity conferences, published in the Journal of the American Medical Association (JAMA), and provided expert insights to Gartner and Porter Research.
11:25
Claims, Clues, & Culprits: The Program Integrity Challenge (IBM Consulting)
Claims, Clues, & Culprits: The Program Integrity Challenge (IBM Consulting)
IBM Consulting Session
Step into the role of a program integrity investigator in this interactive workshop. Participants will follow the clues across claims, provider behavior, and emerging risk patterns to uncover potential fraud, waste, and abuse. Through a guided case challenge, attendees will explore how integrated analytics, investigative workflows, and actionable insights can help teams move from detection to resolution more efficiently. The session will combine practical discussion, hands-on problem solving, and a look at how modern technology can strengthen Medicaid program integrity operations.
Lindsay Marsh
Senior Managing Consultant, IBM Consulting
Lindsay Marsh
Senior Managing Consultant, IBM Consulting
Lindsay Marsh is a Senior Managing Consultant with IBM Consulting, specializing in Medicaid program integrity, policy, and analytics. She works with state Medicaid agencies to design data-driven approaches for identifying fraud, waste, abuse, and improper payments. Her experience includes provider risk analysis, claims analytics, managed care oversight, and the development of practical solutions that help program integrity teams investigate and act on emerging risks.
Karen Shields
Strategic Advisor, Gainwell Technologies
Karen Shields
Strategic Advisor, Gainwell Technologies
Karen Shields is a transformative healthcare and technology executive with more than two decades of leadership across federal agencies, the private sector, and advisory boards. As Owner and Operator of K Shields Health Tech Consulting, she guides private‑sector organizations in aligning solutions with public‑sector health priorities through strategic consulting, systems integration expertise, and deep knowledge of Medicaid and ACA policy. She served as a Medicare Advantage and Duals Plan Board Director for Commonwealth Care Associates, providing governance, compliance oversight, and strategic partnership evaluation. Previously, as Chief Client Engagement Officer at Gainwell Technologies, she strengthened relationships across 30 states, shaped innovation strategy, and elevated thought leadership within the Medicaid ecosystem. During her tenure as Deputy Director for Medicaid and CHIP at CMS, she oversaw financial operations impacting 84 million beneficiaries, led a national workforce of over 1,500, and managed more than $700 billion in annual federal grants. Her earlier executive roles—including Vice President of Health Services at Serco and Chief Operations Officer for Healthcare.gov—demonstrate a consistent record of delivering mission‑critical programs, driving operational excellence, and leading high‑stakes technology implementations across large, complex organizations.
Kyle Walters
Managing Consultant, IBM
Kyle Walters
Managing Consultant, IBM
Kyle Walters is a seasoned Training Lead and Project Manager with over 13 years of experience specializing in large-scale healthcare software implementations, organizational change management, and analytics platforms. Currently serving as an Account Manager and Training Lead at IBM, Kyle excels in directing complex, multi-state health initiatives with a sharp focus on Program Integrity, data ecosystems, and robust project execution.
Combining deep analytical capabilities with extensive knowledge of Medicaid systems, Fraud/Waste and Abuse, and advanced data tools (such as Power BI, Cognos, Tableau, and Snowflake), Kyle bridges the gap between complex technical architectures and end-user proficiency.
12:25
Networking Lunch (Sponsored by Public Consulting Group)
Networking Lunch (Sponsored by Public Consulting Group)
Sponsored by Public Consulting Group
13:25
Partnerships Powering Performance
Partnerships Powering Performance
Acting Deputy Inspector General for Investigations Miranda L. Bennett will highlight how strong partnerships drive performance and protect federal healthcare programs. Her keynote will underscore that collaboration across agencies and stakeholders is central to achieving record‑breaking results, including the recent national healthcare fraud takedown. She will emphasize that unity, shared purpose, and accountability are essential to delivering outcomes worthy of the American taxpayer. Bennett’s remarks will serve as a call to action—reinforcing that when we work together, we amplify our impact, strengthen program integrity, and advance the mission to safeguard public resources.
Miranda Bennett
Acting Deputy Inspector General for Investigations, U.S. Health and Human Services, Office of Inspector General
Miranda Bennett
Acting Deputy Inspector General for Investigations, U.S. Health and Human Services, Office of Inspector General
Miranda Bennett currently serves as the Acting Deputy Inspector General for Investigations at the Department of Health and Human Services, Office of Inspector General. Ms. Bennett leads more than 500 federal law enforcement officers, investigators, and analysts responsible for conducting criminal and civil investigations of fraud, waste, and abuse affecting Health and Human Services programs. These efforts result in hundreds of criminal actions and indictments each year and produce significant financial recoveries that protect patients and safeguard federal health care funds.
Ms. Bennett began her career with HHS-OIG in 2005 as a Special Agent in the Dallas Regional Office. She later advanced into leadership roles, including serving as the Special Agent in Charge of the Dallas Region, where she oversaw enforcement operations across multiple Medicare Fraud Strike Force locations. Most recently, she served as an Assistant Inspector General for Investigations with oversight of three investigative regions and led national initiatives in cybersecurity, technology modernization, and the restructuring of administrative operations.
Ms. Bennett holds a Bachelor of Science in Political Science and Sociology from Texas A&M University. Ms. Bennett has been honored with the Inspector General’s Bronze Medal and recognized by the Women in Federal Law Enforcement Foundation as an Outstanding Law Enforcement Employee.
14:30
Beyond Fraud Detection: Building an Eligibility Determination Hub to Strengthen Program Integrity(CITIZ3N)
Beyond Fraud Detection: Building an Eligibility Determination Hub to Strengthen Program Integrity(CITIZ3N)
14:30
Practical Techniques for Using Large Language Models in Medicaid Fraud Detection (Optum)
Practical Techniques for Using Large Language Models in Medicaid Fraud Detection (Optum)
Optum Session
James Lukenbill
Analytics Strategic Product Manager, State Government Solutions, Optum
James Lukenbill
Analytics Strategic Product Manager, State Government Solutions, Optum
James Lukenbill serves as the Strategic Product Manager for Analytics at Optum State Government Solutions. In this role, he leads a team dedicated to the design and implementation of advanced healthcare data analytics, artificial intelligence, and machine learning solutions tailored for state government clients. With over two decades of experience in analytics, James brings deep expertise in Medicaid and health and human services data, driving innovation and actionable insights in public sector healthcare.
Kevin Hutchinson
VP, Business Development, State Government Solutions, Optum
Kevin Hutchinson
VP, Business Development, State Government Solutions, Optum
Kevin Hutchinson is VP of Growth and New Business Development of Optum State Government Solutions. He serves as the primary point of contact for state governments in the Southeast US. For more than two decades, he has served as a consultant, manager, and leader dedicated to innovation and transformation of state Medicaid and health and human services plans and programs. His background is in developing and delivering solutions using data, technology, and high-quality staff. His career has been recognized for bringing a data-driven approach, establishing baselines to make decisions, and measuring outcomes to evaluate effectiveness. He employs technology as needed to execute solutions, designing, developing, and implementing systems to drive performance. Mr. Hutchinson’s background includes the public sector, where he served in the North Carolina Office of the Governor, the private sector working with multiple consulting and technology firms, as well as the non-profit sector as a homeless outreach advocate. Kevin has a Bachelor of Arts in Government from the University of Notre Dame and a Master of Public Policy from the Sanford School of Public Policy at Duke University. He lives outside Raleigh, NC with his wife, two teenage children, and two dogs.
Ulyana Peychev
Senior Manager Data Analytics, State Government Solutions, Optum
Ulyana Peychev
Senior Manager Data Analytics, State Government Solutions, Optum
Ulyana Peychev, MPM, is a Senior Manager of Business Systems Analysis at Optum, specializing in Medicaid program integrity, fraud, waste and abuse (FWA) detection, healthcare analytics, and both prepay and post-pay payment integrity programs. With more than a decade of experience in healthcare IT and Medicaid operations, she leads cross-functional teams that support state agencies through advanced analytics, system modernization, claims review, and program integrity initiatives. Ulyana brings deep expertise in prepay claim editing and detection strategies, post-pay audit and recovery programs, FWA detection systems, CMS certification, business analysis, and stakeholder collaboration, helping states strengthen oversight, prevent improper payments before they occur, improve operational efficiency, and drive better healthcare outcomes.
14:30
Rewards & Digital Distribution: A Smarter Way to Deliver Value (InComm Healthcare)
Rewards & Digital Distribution: A Smarter Way to Deliver Value (InComm Healthcare)
InComm Healthcare Session
Dave Etling
SVP and GM, InComm Payments
Dave Etling
SVP and GM, InComm Payments
Dave Etling was InComm Payments' 40th employee and has held various leadership positions, including business development, sales, product management, and merchant services. Dave uses his broad knowledge of InComm Payments' technologies and services to establish deep and mutually beneficial business relationships with our customers that extend far beyond the basic delivery of stored-value cards into reward points redemption directly at retail POS, single-use digital coupons for specific retail SKU redemption and card-based, by-SKU affinity promotions. He has been a key asset to InComm Payments' growth over many years by improving product partner acquisition and successful retail launches of products for major industry leaders.
14:30
Running Medicaid Program Integrity as One System — Without Breaking Your Network (PwC)
Running Medicaid Program Integrity as One System — Without Breaking Your Network (PwC)
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
Leads the best team in Nebraska Medicaid to protect the program from fraud, waste, and abuse, and the clients from harm and exploitation. Educated at Creighton University and the University of Nebraska - Lincoln. Spends free time collecting craft supplies and making things.
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
As Deputy Inspector General, Tabitha Ramminger oversees a workforce of over 100 professionals dedicated to preventing fraud, waste, and abuse within public assistance programs at the Wisconsin Department of Health Services. Her extensive public service background includes serving as the state’s COVID-19 Vaccination Response Team Deputy Incident Commander and leading key Medicaid service authorization programs, including the design of the Autism Treatment Benefit. A Board Certified Behavior Analyst, Certified Inspector General, and Certified Welfare Fraud Investigator, Mrs. Ramminger holds an M.S. from the Florida Institute of Technology and actively volunteers with the local Scouts programs alongside her husband and three children.
Bharath Mamathambika
Principal, PwC
Bharath Mamathambika
Principal, PwC
Bharath Mamathambika is a Principal in PwC's Health Industries Advisory practice, where he leads work at the intersection of healthcare policy, affordability, program integrity, and large-scale transformation. He advises government health programs, payers, and providers on driving program integrity, fraud, waste, and abuse prevention as one integrated operating model — spanning governance, provider enrollment, data analytics, investigations, and managed-care oversight.
15:30
Networking Break
Networking Break
16:00
Not Your Normal Friends & Family Plan
Not Your Normal Friends & Family Plan
Andrea Rakes
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Andrea Rakes
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Andrea Rakes has been a Medicaid Provider Fraud and Abuse Investigator for the State of Nebraska since 2024. Her career with the State of Nebraska started in 2022 when she joined the Provider Screening and Enrollment team as an Administrative Programs Officer. She represented the Department in many appeals and gained an array of knowledge of the Medicaid Program requirements, provider enrollment rules, and compliance processes. That knowledge of the Medicaid Program has boosted her ability to find potential loopholes and patterns that providers use to commit fraud, waste, and abuse within the Medicaid Program. Outside of work, Andrea enjoys getting lost in a good book, spending time with her children, baking bread, and cooking.
Melinda Abbott
Provider Relations Administrator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Melinda Abbott
Provider Relations Administrator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Melinda Abbott: Provider Relations Administrator, Medicaid & Long-term Care, Nebraska Department of Health and Human Services
After graduating from Doane University with a double major in psychology and fine arts, I spent time exploring both for-profit and non-profit health professions. Ready for a new direction, I joined the State of Nebraska as a Juvenile Services Officer. Seven years later, I transitioned into resource development, focusing on enrolling HCBS providers. Over the last 15 years, I have grown from a team member to a supervisor, Program Manager, and finally to my current role as Administrator for Provider Relations. Outside of work, I enjoy gardening, painting, and spending time laughing with family and friends.
Betsie Steenson
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Betsie Steenson
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
After earning a Bachelor of Fine Arts in K – 12 Vocal & Instrumental Music Education and History, I taught for a year. When it became clear that the classroom was not for me, I started exploring other opportunities. I started working with DHHS in 2004 and I’ve been working in Program Integrity since 2005. In this position, I spend my time investigating allegations of Fraud, Waste, Abuse, and Erroneous payments, coordinating Nebraska’s involvement in the Payment Error Rate Measurement (PERM) reviews, working with the National Correct Coding Initiative (NCCI) code sets, and working with our Managed Care Plans. In my free time I enjoy reading, crafting and watching college football.
16:00
A Tale of Four States: How Colorado, Indiana, Maine, & Wisconsin Are Responding to Federal Findings of Improper Payments in Applied Behavior Analysis Services
A Tale of Four States: How Colorado, Indiana, Maine, & Wisconsin Are Responding to Federal Findings of Improper Payments in Applied Behavior Analysis Services
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
As Deputy Inspector General, Tabitha Ramminger oversees a workforce of over 100 professionals dedicated to preventing fraud, waste, and abuse within public assistance programs at the Wisconsin Department of Health Services. Her extensive public service background includes serving as the state’s COVID-19 Vaccination Response Team Deputy Incident Commander and leading key Medicaid service authorization programs, including the design of the Autism Treatment Benefit. A Board Certified Behavior Analyst, Certified Inspector General, and Certified Welfare Fraud Investigator, Mrs. Ramminger holds an M.S. from the Florida Institute of Technology and actively volunteers with the local Scouts programs alongside her husband and three children.
Casey Klippel
Director of Program Integrity, Indiana Medicaid
Casey Klippel
Director of Program Integrity, Indiana Medicaid
Casey Klippel serves as the Director of Program Integrity for Indiana’s Office of Medicaid Policy and Planning (OMPP), where he leads statewide initiatives to strengthen oversight, enhance compliance, and safeguard the integrity of Medicaid programs. Before joining OMPP, Casey served as Deputy Attorney General in the Indiana Attorney General’s Office’s Data Privacy Division, focusing on ransomware response, HIPAA compliance, and robocalling. He is a graduate of Belmont University College of Law and Indiana University, and brings a career long commitment to public service, integrity, and system-level improvement to his work advancing Indiana’s healthcare landscape.
Ashley Dirienzo
Fraud, Waste & Abuse Director, Colorado Medicaid
Ashley Dirienzo
Fraud, Waste & Abuse Director, Colorado Medicaid
Ashley has a Bachelor of Science Degree in Healthcare Management and Economics and a Master's Degree in Business Administration (MBA). She has worked for Colorado Medicaid for almost 16 years and has worked in healthcare for over 20 years. Ashley started at Colorado Medicaid working as Tort & Casualty Litigation Specialist. Over the years she transitioned to the Manager of Third Party Liability & Cost Avoidance (TPL&CA) and most recently became the Director of the Fraud, Waste & Abuse (FWA) Division within the Medicaid Operations Office (MOO). FWA is responsible for prepayment and post-payment audit operations, referrals to law enforcement and the Medicaid Fraud Control Unit (MFCU), data analytics and outlier modeling, TPL, and general program integrity and compliance oversight. Ashley is a native of Colorado and grew up in the mountain town of Breckenridge. She enjoys spending time outdoors hiking, camping and traveling with her husband and two dogs.
Sarah Geduldig
Provider Integrity Section Manager, Colorado Department of Health Care Policy and Financing
Sarah Geduldig
Provider Integrity Section Manager, Colorado Department of Health Care Policy and Financing
Sarah Geduldig is the Provider Integrity Section Manager at the Colorado Department of Health Care Policy and Financing. Sarah has worked for the last 10 years in Medicaid Program Integrity focusing on provider screening issues, provider terminations for cause, provider compliance with program rules, and preliminary fraud investigations. Prior to her work with Colorado Medicaid, Sarah worked with several different government and legal aid organizations focusing on issues surrounding consumer protection.
16:00
From Rule to Reality: Implementing Effective Program Integrity Oversight with Managed Care Partners
From Rule to Reality: Implementing Effective Program Integrity Oversight with Managed Care Partners
Duane Kimball
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
Duane Kimball
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
Duane has more than thirty years of experience in healthcare management. He served for 25 years as a Hospital Corpsman in the United States Navy, retiring in 2018 at the rank of Master Chief (E‑9). He began his work in Medicaid in August 2020 within the SCDHHS Division of Program Integrity.
As the Operations and Managed Care Oversight Manager, Duane leads a team of four staff responsible for overseeing contractual coordination and compliance of program integrity activities for the state’s five Managed Care Organizations (MCOs) and the Recovery Audit Contractor. His responsibilities include reviewing, enforcing, and lifting provider sanctions and administrative actions; ensuring accurate intake and recording of all program integrity‑related financial transactions; and conducting routine information‑sharing meetings with the MCOs, the Medicaid Fraud Control Unit, and Program Integrity leadership. Additionally, Duane manages the operational oversight of bureau-wide duties and the coordination of activities across teams and stakeholders.
Duane holds a bachelor’s degree in health sciences from Old Dominion University. He is also an avid long‑distance runner who has completed 27 marathons, including six world majors, and three ultramarathons.
Duane Kimball
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
Duane Kimball
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
Duane has more than thirty years of experience in healthcare management. He served for 25 years as a Hospital Corpsman in the United States Navy, retiring in 2018 at the rank of Master Chief (E‑9). He began his work in Medicaid in August 2020 within the SCDHHS Division of Program Integrity. As the Operations and Managed Care Oversight Manager, Duane leads a team of four staff responsible for overseeing contractual coordination and compliance of program integrity activities for the state’s five Managed Care Organizations (MCOs) and the Recovery Audit Contractor. His responsibilities include reviewing, enforcing, and lifting provider sanctions and administrative actions; ensuring accurate intake and recording of all program integrity‑related financial transactions; and conducting routine information‑sharing meetings with the MCOs, the Medicaid Fraud Control Unit, and Program Integrity leadership. Additionally, Duane manages the operational oversight of bureau-wide duties and the coordination of activities across teams and stakeholders. Duane holds a bachelor’s degree in health sciences from Old Dominion University. He is also an avid long‑distance runner who has completed 27 marathons, including six world majors, and three ultramarathons.
16:00
Pennies from Heaven: A Post-Mortem Capitation Recovery Review
Pennies from Heaven: A Post-Mortem Capitation Recovery Review
Kelly Waldhoff
Chief Operating Officer, Office of Inspector General for the Illinois Department of Healthcare and Family Services
Kelly Waldhoff
Chief Operating Officer, Office of Inspector General for the Illinois Department of Healthcare and Family Services
Kelly Waldhoff joined The State of Illinois Department of Healthcare and Family Services Office of Inspector General in 2025 as the OIG’s Chief Operating Officer. In this role, she oversees strategic planning, organizational development, and leads the execution of OIG’s data analytic strategy to prevent and detect fraud, waste, and abuse in the Illinois Medicaid program. Prior to her time with the State of Illinois, she spent nearly two decades leading federal reviews of fraud, waste, and abuse for the U.S. Department of Health & Human Services, Office of Inspector General. There she led national compliance assessments in complex regulatory areas including the Medicaid Drug Rebate Program, Medicaid TMSIS data quality, Medicaid provider enrollment, and the 340B Drug Discount Program. Kelly earned a BS from the Kelley School of Business at Indiana University and a MA in social work health administration and policy from the University of Chicago. She is a Certified Inspector General by the Associations of Inspector General and holds a Certification in Healthcare Compliance from the Healthcare Compliance Association.
Brian Dunn
Inspector General, IL HFS OIG
Brian Dunn
Inspector General, IL HFS OIG
Brian Dunn is the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state's Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago's Office of Inspector General. Before leading government oversight work, Brian's legal career included serving as General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.
18:00
Tuesday Networking Event (Sponsored by Health Management Systems, Inc. [HMS])
Tuesday Networking Event (Sponsored by Health Management Systems, Inc. [HMS])
07:30
Networking Breakfast (Sponsored by PwC)
Networking Breakfast (Sponsored by PwC)
07:30
Registration Desk Open
Registration Desk Open
07:30
Networking Breakfast (Sponsored by PwC)
Networking Breakfast (Sponsored by PwC)
08:15
NAMPI Business Meeting
NAMPI Business Meeting
08:40
Have You Seen Me Lately? Home & Community-Based Services from 10,000 Feet
Have You Seen Me Lately? Home & Community-Based Services from 10,000 Feet
Amanda Burrows
Subject Matter Expert Supervisor, HFPP-GDIT
Amanda Burrows
Subject Matter Expert Supervisor, HFPP-GDIT
Amanda Burrows is currently serving as a Subject Matter Expert Manager with the Healthcare Fraud Prevention Partnership (HFPP) Trusted Third Party (TTP) where she has been working since 2023. Ms. Burrows previously worked as a Fraud Lead Analyst with a pharmacy benefit manager, and several years as a Senior Investigator in the Missouri Attorney General’s Office Medicaid Fraud Control Unit.
Maricruz Bonfante
Deputy Director, Division of Vulnerability Strategy, Audits and Vulnerabilities Group, Center for Program Integrity, Centers for Medicare & Medicaid Services
Maricruz Bonfante
Deputy Director, Division of Vulnerability Strategy, Audits and Vulnerabilities Group, Center for Program Integrity, Centers for Medicare & Medicaid Services
Maricruz Bonfante serves as the Deputy Director for the Centers for Medicare & Medicaid for the Center for Program Integrity, where she leads the Division of Vulnerability Strategy in advancing efforts to prevent fraud, waste, and abuse across Medicare, Medicaid, and Marketplace programs. She brings extensive expertise in regulatory analysis, program risk assessment, and fraud prevention strategy, developed through years of service in senior roles across CMS. Her background includes significant leadership in reviewing healthcare regulations, managing high impact program integrity initiatives, and collaborating with federal, state, and private partners to strengthen fraud prevention efforts. A licensed attorney, she has deep experience in health law, policy development, and legal analysis supporting Medicare Advantage, Part D, and Marketplace programs. She has been recognized with numerous CMS and HHS awards for excellence, innovation, and mission impact throughout her career.
Richard Haines
Sr. Investigative Analyst, Healthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
Richard Haines
Sr. Investigative Analyst, Healthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
Richard Haines is currently a Senior Investigative Analyst with the Healthcare Fraud Prevention Partnership (“HFPP”). Richard began his career in healthcare fraud investigations in 1995 working for CIGNA Healthcare as a financial analyst. In 1997, he was hired by the United States Attorney’s Office in the Middle District of Tennessee as an auditor position in their Affirmative Civil Enforcement Unit. Richard retired as a Special Agent from the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations in January 2022, after 20 years wherein he led healthcare related civil and criminal investigations spanning multiple federal districts and state jurisdictions. Richard recently obtained his Certified Fraud Examiner certification and has 30 years of experience with healthcare investigations. Richard has presented at numerous healthcare events including the National Health Care Anti-Fraud Association (NHCAA), Association of Certified Fraud Examiners (ACFE) and National Association of Medicaid Fraud Control Units (NAMFCU).
09:45
Effective Partnerships to Prevent & Address Fraud, Waste, & Abuse
Effective Partnerships to Prevent & Address Fraud, Waste, & Abuse
Medicaid program integrity is deliberately designed with firewalls, including legal and structural separations between the state Medicaid agency, the office of inspector general, and the Medicaid Fraud Control Unit (MFCU), to protect the integrity of criminal investigations. Yet effective prevention and detection of fraud, waste, and abuse require close collaboration across those same boundaries. How can these partners share information, coordinate investigations, and align their activities without compromising the independence of the program integrity teams? This panel brings together Medicaid leaders from programs and policy, program integrity, and Medicaid Fraud Control Units to explore what effective collaboration looks like in practice. Panelists will discuss where collaboration works well, where it breaks down, and how shared goals around protecting taxpayer dollars and maintaining access to quality care for Medicaid members can drive continuous improvement in policy design and operations. Panelists will discuss real-world strategies for navigating referral processes, data sharing constraints, and parallel administrative and criminal tracks, along with cultural dynamics that shape day-to-day partnerships.
Neda Jasemi
Senior Policy Analyst, The National Association of Medicaid Directors (NAMD)
Neda Jasemi
Senior Policy Analyst, The National Association of Medicaid Directors (NAMD)
Neda is a Senior Policy Analyst at the National Association of Medicaid Directors (NAMD), supporting state and territory learning. She has led learning programs on an array of emerging issues and trends including but not limited to program integrity, applied behavioral analysis, and financing issues. Before joining NAMD, Neda worked in Medicaid managed care consulting, supporting procurement, strategy, and implementation projects. She received her Master of Science in Public Health in health policy from Johns Hopkins University and a Bachelor of Science in Political Science and Biology from the University of Wisconsin, Madison.
Kevin O'Donnell
Director: Division of Program Integrity, Department of Health Care Finance
Kevin O'Donnell
Director: Division of Program Integrity, Department of Health Care Finance
Kevin O’Donnell is the Director of the Division of Program Integrity for the D.C. Department of Health Care Finance, the District’s Medicaid agency. He has served in that role since November 2021. In that capacity, he oversees the Medicaid agency’s Fraud, Waste, and Abuse activities, coordinating and supervising audits and investigations of Medicaid enrolled providers. To ensure the Medicaid program is effectively rooting out FWA, Mr. O’Donnell collaborates with public and private partners, including law enforcement agencies, regulatory agencies, Managed Care Organizations, and others.
Prior to becoming the Director of the DPI, Mr. O’Donnell spent 7 years as an Attorney-Advisor in DHCF’s Office of the General Counsel, where he defended the agency in administrative appeals before the D.C. Office of Administrative Hearings. Mr. O’Donnell is a graduate of the George Washington University School of Law and a native Washingtonian.
Lee Grossman
Medicaid Director, Iowa Health and Human Services
Lee Grossman
Medicaid Director, Iowa Health and Human Services
Lee Grossman is the Medicaid Director for the Iowa Department of Health and Human Services (HHS).
Prior to joining Iowa HHS, he served as Wyoming’s Medicaid Director for two and a half years. He has more than 14 years of experience in state government, working in Medicaid executive leadership and home and community-based services. Mr. Grossman is passionate about rural health care and supporting thriving rural communities.
He holds a Bachelor of Arts degree from the University of Nebraska–Lincoln and a master’s degree in public administration from the University of Wyoming.
Iowa Medicaid provides health coverage to over 700,000 Iowans each year, including children, low-income individuals, pregnant women, older adults, and people with disabilities.
09:45
The Crossroads of Curative Care, Palliative Care, & Care Coordination in Pediatric Hospice
The Crossroads of Curative Care, Palliative Care, & Care Coordination in Pediatric Hospice
Patrick Smith
Audit Director, Texas Office of Inspector General
Patrick Smith
Audit Director, Texas Office of Inspector General
Patrick Smith has 11 years of audit experience conducting financial, compliance, performance, and Medicaid audits. Patrick has a Bachelor of Business Management from the University of Texas at San Antonio and is a Certified Internal Auditor and Certified in Risk Management Assurance. Patrick has been with the OIG Audit Division for 6 years and has previously worked as an internal auditor in the financial services field. While at OIG, Patrick has managed and overseen audits in the managed care environment, including audits of substance use disorder and therapy providers, financial statistical report audits over Managed Care Organizations, pharmacies, long term care facilities, independent living services, and local mental health authorities.
Anton Dutchover
Deputy Inspector General of Audit and Inspections, Texas HHSC OIG
Anton Dutchover
Deputy Inspector General of Audit and Inspections, Texas HHSC OIG
Anton Dutchover is the Deputy Inspector General of Audit and Inspections at the Texas Health and Human Services Office of Inspector General. He is a Certified Public Accountant (CPA) and a Certified Inspector General Inspector/Evaluator (CIGE) with nearly 20 years of auditing experience. Over the past 10 years, he has specialized in identifying and addressing fraud, waste, and abuse through audits and inspections of Medicaid providers, managed care organizations, and Texas Health and Human Services programs. His expertise includes strengthening program integrity, evaluating compliance, and improving oversight to help ensure public resources are used effectively.
09:45
Fraud, Money Laundering, & Racketeering: The Full-Service Illegal Package
Fraud, Money Laundering, & Racketeering: The Full-Service Illegal Package
Cori Ellis
Assistant Special Agent in Charge, Investigations, Louisiana Department of Justice/Medicaid Fraud Control Unit
Cori Ellis
Assistant Special Agent in Charge, Investigations, Louisiana Department of Justice/Medicaid Fraud Control Unit
Cori Ellis is employed with the Louisiana Department of Justice, Medicaid Fraud Control Unit as the Assistant Special Agent in Charge of Investigations. She began her law enforcement career in 2007. Her passion is in training and she became a firearms instructor in 2014.
Erin McAlister
Assistant Special Agent in Charge, Louisiana Department of Justice/MFCU
Erin McAlister
Assistant Special Agent in Charge, Louisiana Department of Justice/MFCU
Erin McAlister is employed at the Louisiana Department of Justice, Medicaid Fraud Control Unit as the Assistant Special Agent in Charge of Operations. She began her law enforcement career in 2006, and prior to that spent 10 years in the healthcare field. Her main interest is data analytics.
09:45
Strengthening Medicaid Managed Care Fraud Referrals: Insights & Promising Practices from OIG Reviews
Strengthening Medicaid Managed Care Fraud Referrals: Insights & Promising Practices from OIG Reviews
Michael Henry
Director of the Medicaid Fraud Control Unit Oversight Division, HHS/OIG
Michael Henry
Director of the Medicaid Fraud Control Unit Oversight Division, HHS/OIG
Michael started his career with the OIG in 2002 with the Office of Evaluation and Inspections and has primarily focused on conducting oversight of Medicaid Fraud Control Units.
Savanna Thielbar
Team Leader and Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General, Office of Evaluation and Inspections
Savanna Thielbar
Team Leader and Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General, Office of Evaluation and Inspections
Savanna Thielbar is a team leader and social science analyst in the Office of Evaluation and Inspections within the U.S. Department of Health and Human Services Office of Inspector General. Savanna most recently led an evaluation examining States’ practices to improve Medicaid managed care organizations’ provider fraud referrals. She previously led evaluations of the COVID‑19 response and pandemic relief funding, as well as of Indian Health Service programs. Savanna holds a Master of Public Service and Administration from Texas A&M University’s Bush School of Government and Public Service.
Craig Diena
Team Leader & Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General
Craig Diena
Team Leader & Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General
Craig Diena is a team leader and social science analyst in the Office of Evaluation and Inspections of the U.S. Department of Health and Human Services Office of Inspector General. In this role, he has contributed to evaluations on a range of topics in Medicaid, including the referral of fraud in Medicaid managed care. He holds a Master of Public Administration from the University of Pennsylvania.
10:45
Break
Break
11:00
CMS Session TBA
CMS Session TBA
11:30
NAMFCU Session TBA
NAMFCU Session TBA
12:00
The Caring Con
The Caring Con
In The Caring Con, you will see an interview with an anonymous former fraudster who exploited Medicaid, walking through how the schemes worked and the lessons learned along the way.
Daniel Miller
Assistant Chief Special Agent, Arizona Attorney General's Office
Daniel Miller
Assistant Chief Special Agent, Arizona Attorney General's Office
Daniel Miller has been with the AZ AGO for several years. Prior to that Daniel was a sworn officer with the Arizona State University Police department. He has served in a variety of roles including health care fraud and abuse, Major Fraud, and ICAC. He is currently the Assistant Chief Special Agent at the AZAGO.
Jeneen Iwugo
Acting Director, Center for Program Integrity (CPI), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
Jeneen Iwugo
Acting Director, Center for Program Integrity (CPI), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
Jeneen Iwugo drives strategic program integrity operations as Acting Director of the Center for Program Integrity at the Centers for Medicare & Medicaid Services (CMS). Leveraging 20+ years of government leadership expertise, she architects policy frameworks and orchestrates transformative change management initiatives across the nation's largest healthcare programs.
As Acting Director of CPI, Jeneen commands executive oversight of fraud, waste, and abuse prevention across Medicare, Medicaid, and the Marketplace. She directs enterprise-wide enforcement operations including Risk Adjustment Data Validation (RADV) audits of Part C plan sponsors, Medicaid program integrity enforcement across all 50 states, agent and broker fraud elimination in Federally Facilitated Marketplace exchanges and she oversees the Medicare provider enrollment, suspension, and revocation processes.
In 2025, Jeneen's leadership delivered unprecedented results:
• Prevented $5 billion in fraudulent claims from being paid from CMS
• Revoked over 5,000 providers and suppliers for inappropriate conduct
Prior to this role, Jeneen commanded operational excellence as Deputy Director of the CMS Center for Clinical Standards and Quality (CCSQ), directing 800 FTEs, managing 200 contracts, and executing a $1.5 billion annual budget. She engineered comprehensive legislative, regulatory, and contractual reforms that fundamentally restructured the QIO program.
Throughout her distinguished career, Jeneen has championed innovation and executed large-scale transformation initiatives across national quality programs, medical case review operations, and beneficiary protection services.
A dynamic public speaker, Jeneen strategically aligns program objectives and data analytics with agency priorities, consistently surpassing strategic goals. Known for her energy, candor, authenticity, and transparency, she resolves complex budgetary, implementation, and collaboration challenges affecting national programs.
Education:
• Master’s degree in public administration, University of Baltimore
• Bachelor's degree in Speech Communication, Temple University
Vanessa Templeman
Inspector General, AHCCCS OIG
Vanessa Templeman
Inspector General, AHCCCS OIG
Ms. Vanessa Templeman is the current Inspector General for the Office of Inspector General (OIG) of AHCCCS and has been in this role since March 2022. She has been with AHCCCS since 2011. The OIG exists to prevent, detect, and recover improper payments due to Medicaid fraud, waste and abuse. Ms. Templeman has 22 years of experience in the health insurance industry spanning both private and government sectors. During her tenure with AHCCCS, Ms. Templeman has served in a variety of roles, a few of which include; Regional Representative for the Centers for Medicare and Medicaid (CMS) Technical Advisory Group regarding fraud, waste, and abuse, Instructor at the Medicaid Integrity Institute through the National Advocacy Center, Advisory Committee Member for the ASU Health Care Compliance and Regulations Program and is currently the President of the National Association of Medicaid Program Integrity (NAMPI).
12:40
Closing Remarks
Closing Remarks
12:45
Lunch On-the-Go
Lunch On-the-Go
Hotel & Travel
Hilton Portland Downtown – Conference Hotel
Address: 921 SW 6th Ave, Portland, OR 97204
The Hilton Portland Downtown is proud to host NAMPI 2026! Located in the heart of downtown, it’s steps from restaurants, shopping, and iconic landmarks like Pioneer Courthouse Square, Powell’s City of Books, and the Pearl District—perfect for conference activities and exploring the city.
Room Block:
- NAMPI has reserved a limited block of rooms. Rooms are subject to availability, so book early!
- Room Rate: $159/night + taxes and fees
- Cut-Off Date: July 31, 2026
Speakers
Bharath Mamathambika
Principal, PwC
READ BIOBharath Mamathambika
PwC
Bharath Mamathambika is a Principal in PwC's Health Industries Advisory practice, where he leads work at the intersection of healthcare policy, affordability, program integrity, and large-scale transformation. He advises government health programs, payers, and providers on driving program integrity, fraud, waste, and abuse prevention as one integrated operating model — spanning governance, provider enrollment, data analytics, investigations, and managed-care oversight.
Jay Derby
Senior Consultant, Public consulting group
READ BIOJay Derby
Public consulting group
Jay Derby is a Senior Consultant and AI Architect at Public Consulting Group (PCG), where he leads the design and delivery of AI-enabled solutions for government health and human services programs. With expertise spanning product strategy, and compliance-driven technology, Jay focuses on helping public sector organizations modernize operations while maintaining the highest standards of security, transparency, and accountability.
Kyle Walters
Managing Consultant, IBM
READ BIOKyle Walters
IBM
Kyle Walters is a seasoned Training Lead and Project Manager with over 13 years of experience specializing in large-scale healthcare software implementations, organizational change management, and analytics platforms. Currently serving as an Account Manager and Training Lead at IBM, Kyle excels in directing complex, multi-state health initiatives with a sharp focus on Program Integrity, data ecosystems, and robust project execution.
Combining deep analytical capabilities with extensive knowledge of Medicaid systems, Fraud/Waste and Abuse, and advanced data tools (such as Power BI, Cognos, Tableau, and Snowflake), Kyle bridges the gap between complex technical architectures and end-user proficiency.
Alex Hargrove
Senior Assistant Attorney General, Oregon Department of Justice
READ BIOAlex Hargrove
Oregon Department of Justice
Alex Hargrove has been a Senior Assistant Attorney General with the Oregon Department of Justice Medicaid Fraud Unit Since 2025. Prior to joining Oregon DOJ, Alex worked as a Deputy District Attorney in both the Douglas and Multnomah County District Attorney’s Offices in Oregon. During his time as a DDA, Alex handled a variety of case types, including fraud, drug offense, violent crimes, and sexual assault cases.
William O'Neill
VP, Product, FWA & Analytics, HMS
READ BIOWilliam O'Neill
HMS
Will O’Neill joined Gainwell-HMS as Vice President of Cost Containment Analytics & Product, with an initial focus on Payment Integrity solutions. Will is responsible for managing the end-to-end lifecycle of the HMS analytic library and product roadmaps, which are strategic growth drivers of client value for HMS’ COB, Payment Integrity and Eligibility Verification product suite. Will brings 18 years of experience delivering innovative analytics and technology solutions across Payer and RCM markets.
Lori Stiles
Manager, Medicaid Program Integrity Unit, Idaho Department of Health & Welfare
READ BIOLori Stiles
Idaho Department of Health & Welfare
Lori Stiles is the manager of Medicaid Program Integrity for the Idaho Department of Health & Welfare. She has worked in Medicaid program integrity for over 20 years.
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Frank Walsh, Jr.
Acting Medicaid Inspector General, New York State Office of the Medicaid Inspector General
READ BIOFrank Walsh, Jr.
New York State Office of the Medicaid Inspector General
Frank has led OMIG since February 2021 and is committed to enhancing the Medicaid program integrity through education, transparency, and collaborative engagements with health care stakeholders. In this capacity, he provides executive direction and oversight of a professional staff of more than 500 dedicated public servants who are responsible for completing approximately 3,000 audits and investigations annually. Frank has been a NAMPI member since 2022, serving as a Regional Representative, and was appointed to the NAMPI Board in 2024.
Gary Cantrell
Program Integrity Lead, Deloitte
READ BIOGary Cantrell
Deloitte
Gary Cantrell has over 29 years of experience in health care fraud prevention, detection and investigations and is a nationally recognized leader in the health care program integrity community. Prior to joining Deloitte, he served for over 25 years at the U.S. Department of Health and Human Services, Office of Inspector General (HHS OIG) leading anti-fraud, waste, and abuse efforts. As Deputy IG for Investigations at HHS OIG for 10 years, he led collaboration with partner agencies such as the DOJ Criminal and Civil Divisions, FBI, DEA, state Medicaid Fraud Control Units, and the Centers for Medicare and Medicaid services resulting in numerous national health care fraud takedowns. Since joining Deloitte in 2022, Gary leads program integrity solutions for government health and human service programs and has supported the Centers for Medicare & Medicaid Services, Veterans Health Administration, DOJ Criminal Division-Health Care Fraud Unit, and Health Resources and Services Administration. In these roles, he leads fraud, waste, and abuse analytics, fraud detection, lead development, fraud risk assessment and management, and vulnerability identification to maximize impact for government clients.
Tasha Gardner
Special Deputy Attorney General, NC Department of Justice - Medicaid Investigations Division
READ BIOTasha Gardner
NC Department of Justice - Medicaid Investigations Division
Tasha Gardner is a Special Deputy Attorney General with the North Carolina Department of Justice - Medicaid Investigations Division (MID) and is cross-designated as a Special Assistant United States Attorney in the Eastern District of North Carolina. As a Medicaid criminal enforcement attorney, Tasha has been prosecuting Medicaid provider fraud in both federal and state courts since 2020. Prior to joining MID, Tasha served as an Assistant District Attorney for more than 16 years.
Rosalind Abankwah
Health Insurance Specialist, Centers for Medicare & Medicaid Services
READ BIORosalind Abankwah
Centers for Medicare & Medicaid Services
Rosalind Abankwah is a Health Insurance Specialist at the Centers for Medicare & Medicaid Services (CMS), where she facilitates data analytics projects and studies to identify and mitigate fraud, waste, and abuse in the Medicare and Medicaid programs. With more than 12 years of experience in program integrity, her work has made a meaningful impact on several national programs.
Rosalind holds a Doctor of Pharmacy (Pharm.D.) from the University of Maryland School of Pharmacy, a foundation she has leveraged in the past to provide technical direction in developing medication-related models designed to combat fraud, waste, and abuse. Driven by a commitment to data-driven policy, Rosalind is eager to share her expertise and insights with today's audience.
Karen Shields
Strategic Advisor, Gainwell Technologies
READ BIOKaren Shields
Gainwell Technologies
Karen Shields is a transformative healthcare and technology executive with more than two decades of leadership across federal agencies, the private sector, and advisory boards. As Owner and Operator of K Shields Health Tech Consulting, she guides private‑sector organizations in aligning solutions with public‑sector health priorities through strategic consulting, systems integration expertise, and deep knowledge of Medicaid and ACA policy. She served as a Medicare Advantage and Duals Plan Board Director for Commonwealth Care Associates, providing governance, compliance oversight, and strategic partnership evaluation. Previously, as Chief Client Engagement Officer at Gainwell Technologies, she strengthened relationships across 30 states, shaped innovation strategy, and elevated thought leadership within the Medicaid ecosystem. During her tenure as Deputy Director for Medicaid and CHIP at CMS, she oversaw financial operations impacting 84 million beneficiaries, led a national workforce of over 1,500, and managed more than $700 billion in annual federal grants. Her earlier executive roles—including Vice President of Health Services at Serco and Chief Operations Officer for Healthcare.gov—demonstrate a consistent record of delivering mission‑critical programs, driving operational excellence, and leading high‑stakes technology implementations across large, complex organizations.
Will Mapp, III
Chief Technology Officer, Qlarant
READ BIOWill Mapp, III
Qlarant
As Chief Technology Officer, Will Mapp keeps a constant eye on the future and ensures Qlarant is at the forefront of the latest and emerging technologies. He has an extensive background in software product development and building new, innovative technologies. His focus is on delivering high customer value by using the right mix of human technique and advanced technology.
Will is a past Indus Entrepreneurs fellow of the RH Smith School of Business, has specializations in Gamification from the Wharton School of Business, and a proven experience using machine learning and artificial intelligence in media.
Holly Pu
Vice President Product Development, Qlarant
READ BIOHolly Pu
Qlarant
Ms. Pu is responsible for the strategic and operational leadership of Qlarant Capital. During her tenure, she has been instrumental in the creation of Qlarant’s predictive analytics and visualization software solutions.
Ms. Pu has successfully led large-scale implementations for both federal and state government program’s needs. Advanced analytics software built and sold by Pu has been used by over 800 Medicare Advantage health plans and state Medicaid agencies in the US.
Jason Helmandollar
VP Healthcare Solutions, Pulselight
READ BIOJason Helmandollar
Pulselight
As Vice President of Healthcare Solutions at Pulselight, Jason is responsible for driving the development of cutting-edge analysis techniques and investigation skills to be utilized in Pulselight’s software products. He is a nationally recognized expert on Medicaid fraud, having served prior to Pulselight as a Special Agent Supervisor with Ohio’s Medicaid Fraud Control Unit. During his twelve years there, Jason investigated and helped prosecute hundreds of criminal fraud cases, was instrumental in developing new data analysis strategies, and helped to dramatically increase the efficiency and effectiveness of operations.
Michael Llabona
Financial Investigations Supervisor, NCDOJ - Medicaid Investigations Division
READ BIOMichael Llabona
NCDOJ - Medicaid Investigations Division
Michael has more than a decade of experience investigating healthcare provider fraud and financial crimes, contributing to cases resulting in more than $50 million in restitution. In 2022, he was nominated for the Financial Crimes Enforcement Network Director’s Law Enforcement Award for National Case of the Year.
He routinely works across all federal districts in North Carolina and collaborates with the Federal Bureau of Investigation, Internal Revenue Service, and U.S. Department of Health and Human Services Office of Inspector General to investigate some of North Carolina’s most complex healthcare fraud schemes.
Jeneen Iwugo
Acting Director, Center for Program Integrity (CPI), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
READ BIOJeneen Iwugo
Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
Jeneen Iwugo drives strategic program integrity operations as Acting Director of the Center for Program Integrity at the Centers for Medicare & Medicaid Services (CMS). Leveraging 20+ years of government leadership expertise, she architects policy frameworks and orchestrates transformative change management initiatives across the nation's largest healthcare programs.
As Acting Director of CPI, Jeneen commands executive oversight of fraud, waste, and abuse prevention across Medicare, Medicaid, and the Marketplace. She directs enterprise-wide enforcement operations including Risk Adjustment Data Validation (RADV) audits of Part C plan sponsors, Medicaid program integrity enforcement across all 50 states, agent and broker fraud elimination in Federally Facilitated Marketplace exchanges and she oversees the Medicare provider enrollment, suspension, and revocation processes.
In 2025, Jeneen's leadership delivered unprecedented results:
• Prevented $5 billion in fraudulent claims from being paid from CMS
• Revoked over 5,000 providers and suppliers for inappropriate conduct
Prior to this role, Jeneen commanded operational excellence as Deputy Director of the CMS Center for Clinical Standards and Quality (CCSQ), directing 800 FTEs, managing 200 contracts, and executing a $1.5 billion annual budget. She engineered comprehensive legislative, regulatory, and contractual reforms that fundamentally restructured the QIO program.
Throughout her distinguished career, Jeneen has championed innovation and executed large-scale transformation initiatives across national quality programs, medical case review operations, and beneficiary protection services.
A dynamic public speaker, Jeneen strategically aligns program objectives and data analytics with agency priorities, consistently surpassing strategic goals. Known for her energy, candor, authenticity, and transparency, she resolves complex budgetary, implementation, and collaboration challenges affecting national programs.
Education:
• Master’s degree in public administration, University of Baltimore
• Bachelor's degree in Speech Communication, Temple University
Lindsay Marsh
Senior Managing Consultant, IBM Consulting
READ BIOLindsay Marsh
IBM Consulting
Lindsay Marsh is a Senior Managing Consultant with IBM Consulting, specializing in Medicaid program integrity, policy, and analytics. She works with state Medicaid agencies to design data-driven approaches for identifying fraud, waste, abuse, and improper payments. Her experience includes provider risk analysis, claims analytics, managed care oversight, and the development of practical solutions that help program integrity teams investigate and act on emerging risks.
F. Edward (Eddie) Kirby, Jr.
Director, North Carolina Department of Justice, Medicaid Investigations Division
READ BIOF. Edward (Eddie) Kirby, Jr.
North Carolina Department of Justice, Medicaid Investigations Division
F. Edward (Eddie) Kirby, Jr. is the Director of the Medicaid Investigations Division (MID) at the North Carolina Department of Justice. He has served with MID since 2008 and has been the Director since 2018. MID is the Medicaid Fraud Control Unit (MFCU) for North Carolina. Eddie is appointed as a Special Assistant U.S. Attorney in all three federal districts of North Carolina. He currently serves as Vice President of the National Association of Medicaid Fraud Control Units (NAMFCU).
Camiel Rowe
Division Director, Center for Medicare and Medicaid Services
READ BIOCamiel Rowe
Center for Medicare and Medicaid Services
Camiel Rowe is the Director of the Division of State Partnership at the CMS Center for Program Integrity (CPI), where she leads the coordination and implementation of key Medicaid program integrity initiatives. These include the Medicaid Integrity Institute (MII), the Payment Error Rate Measurement Corrective Action Plan (PERM CAP), Medicaid Eligibility Quality Control (MEQC), and Single State Audits (SSA) — delivering critical training and technical support to states and territories nationwide.
With over 16 years of CMS experience in Medicaid policy and operations, Camiel has built a distinguished career dedicated to combating fraud, waste, and abuse and safeguarding the efficient operation of Medicaid programs. Prior to joining CPI in 2016, she served in the Center for Medicaid and CHIP Services (CMCS) as Project Manager for the Transformed Medicaid Statistical Information System (T-MSIS) and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) initiatives.
Camiel holds a Master of Business Administration (MBA) from Strayer University. Outside of work, she enjoys binge-worthy Netflix series, discovering hidden boutique restaurants, and painting — bringing the same sharp eye for detail to uncovering culinary gems as she does to identifying program vulnerabilities and protecting billions in Medicaid funding.
Sara Rodriguez
Healthcare Fraud Analyst, Codoxo
READ BIOSara Rodriguez
Codoxo
Sara Rodriguez is a Healthcare Fraud Analyst at Codoxo with more than 20 years of experience in healthcare fraud, waste and abuse investigations, program integrity, medical coding, healthcare consultant and compliance. Throughout her career, she has led complex investigations involving healthcare providers across multiple specialties, conducted coding and billing audits, analyzed healthcare claims data, and collaborated with government agencies and healthcare organizations to improve payment integrity and reduce improper payments.
Prior to joining Codoxo, Sara spent over a decade with the Idaho Medicaid Program Integrity Unit in investigative and leadership roles, including Program Supervisor, where she oversaw a team of investigators responsible for the prevention, detection, investigation and recovery of improper healthcare payments. She holds the Certified Professional Coder (CPC) and Certified Program Integrity Professional (CPIP) credentials and is recognized for her expertise in healthcare data analytics, fraud detection, and regulatory compliance.
Lynne Emmons
Assistant Deputy Director of FFS Programs, AHCCCS
READ BIOLynne Emmons
AHCCCS
Lynne Emmons, LAMFT, PMP, LSSBB is Assistant Deputy Director for the Division of Fee-for-Service Management (DFSM) at AHCCCS, Arizona's Medicaid agency. In this role, Lynne provides executive leadership for $2.5 Billion FFS programs, stakeholder relations, strategic planning, and quality initiatives across Arizona's Medicaid program.
With two decades of experience spanning healthcare operations, process improvement, and stakeholder engagement, Lynne leads efforts to strengthen Medicaid program integrity through innovation, data-informed decision making, provider education, and cross-agency collaboration. She has been actively involved in modernization initiatives, including the integration of advanced analytics and artificial intelligence tools to support proactive fraud, waste, and abuse prevention while maintaining a strong human-centered approach to oversight and accountability.
Lynne is a Licensed Associate Marriage and Family Therapist, Project Management Professional, and Lean Six Sigma Black Belt. She is passionate about building trusted partnerships, improving system performance, and advancing sustainable solutions which support Medicaid members, providers, and taxpayers.
Matt Perryman
Chief Technology Officer, Alivia Analytics
READ BIOMatt Perryman
Alivia Analytics
Matt brings deep expertise in fraud, waste, and abuse (FWA) and technology, enabling him to identify the right tools to solve complex business challenges across the healthcare industry. He leads Alivia’s advanced analytics, data science, and platform development initiatives, designing AI-powered solutions that help government agencies and commercial health plans prevent improper payments and uncover emerging fraud schemes.
His background spans actuarial science, risk modeling, and healthcare analytics, supporting pre- and post-payment capabilities used by Medicaid, Medicare, and commercial clients nationwide.
Matt is also a regular speaker at healthcare FWA conferences, including NHCAA and NAMPI, where he presents analytic strategies alongside health plan leaders. He holds degrees in biochemistry and philosophy from Boston College.
Scott Jeffries
Lead Research Analyst, Oregon Health Authority, Office of Program Integrity
READ BIOScott Jeffries
Oregon Health Authority, Office of Program Integrity
Scott Jeffries is the lead research analyst at Oregon Health Authority's Office of Program Integrity. Scott has been with OPI for three years and worked as a research analyst and epidemiologist at OHA for 18 years. He holds a Master of Public Health in epidemiology and biostatistics from Oregon Health & Science University, lives right here in Portland, is a massive Timbers and Blazers fan, and is thrilled to welcome everyone to the city that he loves.
Pamela Graham, AHFI, CPC
Investigator III, Oregon Department of Justice
READ BIOPamela Graham, AHFI, CPC
Oregon Department of Justice
Pamela Graham has been an Investigator with the Oregon Department of Justice Medicaid Fraud Control Unit (MFCU) since January 2020. Pam is an Accredited Health Care Fraud Investigator (AHFI) and a Certified Professional Coder (CPC).
Pam’s background is in health insurance: Customer Service, Claims Processing, Lead and Supervisor roles, and five years as an Investigator in the Special Investigations Unit (SIU) investigating fraud, waste and abuse (FWA).
Daniel Miller
Assistant Chief Special Agent, Arizona Attorney General's Office
READ BIODaniel Miller
Arizona Attorney General's Office
Daniel Miller has been with the AZ AGO for several years. Prior to that Daniel was a sworn officer with the Arizona State University Police department. He has served in a variety of roles including health care fraud and abuse, Major Fraud, and ICAC. He is currently the Assistant Chief Special Agent at the AZAGO.
Vanessa Templeman
Inspector General, AHCCCS OIG
READ BIOVanessa Templeman
AHCCCS OIG
Ms. Vanessa Templeman is the current Inspector General for the Office of Inspector General (OIG) of AHCCCS and has been in this role since March 2022. She has been with AHCCCS since 2011. The OIG exists to prevent, detect, and recover improper payments due to Medicaid fraud, waste and abuse. Ms. Templeman has 22 years of experience in the health insurance industry spanning both private and government sectors. During her tenure with AHCCCS, Ms. Templeman has served in a variety of roles, a few of which include; Regional Representative for the Centers for Medicare and Medicaid (CMS) Technical Advisory Group regarding fraud, waste, and abuse, Instructor at the Medicaid Integrity Institute through the National Advocacy Center, Advisory Committee Member for the ASU Health Care Compliance and Regulations Program and is currently the President of the National Association of Medicaid Program Integrity (NAMPI).
Adam Thurston
Section Chief, Financial Crimes Enforcement Network
READ BIOAdam Thurston
Financial Crimes Enforcement Network
Adam Thurston currently serves as the Section Chief for the Trade, Fraud, and Financial Facilitation Section of FinCEN’s Research and Analysis Division. Mr. Thurston has worked at FinCEN since 2005 in a variety of roles, most of which involved international financial crime issues.
Richard Haines
Sr. Investigative Analyst, Healthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
READ BIORichard Haines
Healthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
Richard Haines is currently a Senior Investigative Analyst with the Healthcare Fraud Prevention Partnership (“HFPP”). Richard began his career in healthcare fraud investigations in 1995 working for CIGNA Healthcare as a financial analyst. In 1997, he was hired by the United States Attorney’s Office in the Middle District of Tennessee as an auditor position in their Affirmative Civil Enforcement Unit. Richard retired as a Special Agent from the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations in January 2022, after 20 years wherein he led healthcare related civil and criminal investigations spanning multiple federal districts and state jurisdictions. Richard recently obtained his Certified Fraud Examiner certification and has 30 years of experience with healthcare investigations. Richard has presented at numerous healthcare events including the National Health Care Anti-Fraud Association (NHCAA), Association of Certified Fraud Examiners (ACFE) and National Association of Medicaid Fraud Control Units (NAMFCU).
Justin Gates
Chief Special Agent, Ohio Medicaid Fraud Control Unit
READ BIOJustin Gates
Ohio Medicaid Fraud Control Unit
Justin Gates is a Chief Special Agent in the Medicaid Fraud Control Unit (MFCU) of the Ohio Attorney General’s Health Care Fraud Section. In this capacity, he supervises the unit’s Intake Team, Evidence Team, and Three Investigative Teams. Justin has over twenty years of investigative experience with the Ohio Attorney General’s office where he has worked as an Economic Loss Investigator investigating claims against Ohio’s Crime Victim Compensation Program; and as a Special Agent and Special Agent Supervisor investigating health care providers accused of defrauding the state’s Medicaid program, as well as those who abuse or neglect individuals in long-term care facilities and assisted living facilities throughout the state of Ohio.
VERA POE
Senior Assistant Attorney General, Department of Justice, State of Oregon
READ BIOVERA POE
Department of Justice, State of Oregon
Vera Poe, an attorney licensed in Texas and Oregon, has advised and represented Oregon's Office of Program Integrity (OPI) since 2018. Ms. Poe assists OPI in creating legally sufficient notices and forms for its audit program, and represents the office when a provider appeals audit findings and associated overpayments, along with a myriad of other legal work.
Gary Call
Chief Medical Officer, HMS
READ BIOGary Call
HMS
Dr. Gary Call is a board-certified family physician and senior healthcare executive with extensive experience across managed Medicaid, Medicare Advantage, commercial health plans, and state employee health benefit programs. His background spans medical management, quality, pharmacy strategy, and risk adjustment, supported by deep clinical and operational expertise.
Dr. Call is nationally recognized for his leadership in payment integrity and fraud, waste, and abuse (FWA) prevention, including advanced analytics, clinical review strategies, and technology enabled solutions that protect both government and commercial payer programs from improper payments and emerging integrity risks.
As Chief Medical Officer at Gainwell Technologies, Dr. Call oversees Payment Integrity, Care Management, Clinical Analytics, and Population Health Solutions, driving innovation and clinical program development that improve outcomes, strengthen program integrity, and support the financial sustainability of state healthcare programs.
Lane Olson
Chief Investigator, Utah MFCU
READ BIOLane Olson
Utah MFCU
I am the Chief Investigator at the Utah MFCU at the Office of the Utah Attorney General. I have an MBA in Health Care Management, I am a Certified Fraud Examiner, and I have 30 years of experience as a sworn law enforcement officer. I worked as a Detective for the Ogden City Police Department for over 20 years. During that time, I had specialty assignments in Property, Crimes Against Children, Internet Crimes Against Children, Weber/Morgan Homicide Task Force, and Financial Crimes.
Joan Senatore
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
READ BIOJoan Senatore
Commonwealth of Massachusetts
Joan has worked at the Medicaid Agency for 20+ years and previously worked at the Massachusetts Office of the Attorney General in various roles. Joan earned a Bachelor’s and a Master’s in Business Administration at the University of Massachusetts Boston, and a Juris Doctorate from the New England School of Law. Joan is also a Certified Fraud Examiner, Certified in Healthcare Compliance, and a Licensed Attorney.
Davilyn Ariail
Deputy Director - Program Integrity and Medical Review, Alliant Health Solutions
READ BIODavilyn Ariail
Alliant Health Solutions
Davilyn Ariail has been with Alliant Health Solutions for more than 25 years. She is a Registered Nurse and Certified Professional Coder with more than 20 years of experience conducting and overseeing medical necessity reviews. Davilyn currently oversees multidisciplinary teams responsible for Program Integrity, SURS, Medical Claims, and Outlier reviews. She particularly values data analysis and program integrity work because of the complexity and impact of these reviews.
Hannah Trate
Senior Consultant, Public Consulting Grouo
READ BIOHannah Trate
Public Consulting Grouo
Hannah Trate is a Senior Consultant with Public Consulting Group specializing in Medicaid program integrity, operational analytics, provider oversight, and program management. She currently serves as Project Manager for Massachusetts' Predictive Modeling Managed Support Services contract in addition to supporting Medicaid agencies in Ohio, Indiana, and Massachusetts on initiatives involving compliance monitoring, stakeholder engagement, quality improvement, workforce development, and data-driven oversight strategies.
Bart Armstrong
Senior Director, Program Management., HMS/Gainwell Technologies
READ BIOBart Armstrong
HMS/Gainwell Technologies
Bart is a Senior Director with Gainwell Technologies and has spent that last decade fighting Fraud, Waste, and Abuse within both Medicare and Medicaid, He was previously the FWA Division Director with the Colorado Medicaid Program and most recently a Project Director with Qlarant.
Josh Porter
Health Bureau Chief, Nevada Health Authority
READ BIOJosh Porter
Nevada Health Authority
Josh Porter is a native Nevadan with 14 years of Program Integrity experience within the Nevada Health Authority’s Surveillance and Utilization Review (SUR) Unit. Throughout his tenure with SUR, he served as a caseworker, analyst, project and data coordinator, and spent the past four years as the Northern SUR Manager. His work included leading projects, managing cases, and overseeing nearly 500 payment suspensions and referrals to the Attorney General’s Medicaid Fraud Control Unit for credible allegations of fraud—fortunately there have been far fewer administrative appeals. In July 2026, Josh became the Health Bureau Chief for the NVHA Office of the Inspector General. He currently oversees the SUR, Provider Enrollment, and the Nevada Recovery/Medicaid Estate Recovery Units.
Fritz Jenkins
Administrator for Program Integrity, Oregon Health Authority
READ BIOFritz Jenkins
Oregon Health Authority
Fritz Jenkins is the Administrator for Program Integrity for the Oregon Health Authority (OHA). The Office of Program Integrity (OPI) is in the Fiscal and Operations Division of OHA, as a direct report to the OHA CFO. Fritz has been in the program integrity work in different capacities for nearly 30 years. Fritz and his staff are responsible for the development, implementation, operations, and ongoing advancements in the PI operations of OHA. Fritz has a background in behavioral health, substance abuse treatment, early childhood development, child abuse prevention, and basketball. Current interests are traveling, golf, motorcycle riding, and aging well.
Sarah Geduldig
Provider Integrity Section Manager, Colorado Department of Health Care Policy and Financing
READ BIOSarah Geduldig
Colorado Department of Health Care Policy and Financing
Sarah Geduldig is the Provider Integrity Section Manager at the Colorado Department of Health Care Policy and Financing. Sarah has worked for the last 10 years in Medicaid Program Integrity focusing on provider screening issues, provider terminations for cause, provider compliance with program rules, and preliminary fraud investigations. Prior to her work with Colorado Medicaid, Sarah worked with several different government and legal aid organizations focusing on issues surrounding consumer protection.
Tom Mueller
investigative journalist, (self-employed)
READ BIOTom Mueller
(self-employed)
I am a free-lance writer of non-fiction and fiction, currently a Senior Researcher at The New School and a Senior Research Fellow at the Institute for Futures Studies (Stockholm) and the Vienna Centre for Societal Security. I studied at Oxford (DPhil, Rhodes Scholar), Harvard (BA, summa cum laude), and Alief Hastings High School in rural east Texas, home of the Fighting Bears. After that, I worked as an associate in M&A at Goldman Sachs in their London and Frankfurt offices, and I studied classical guitar in Seville, Spain with América Martínez, a disciple of Andrés Segovia. I've lived or worked in 48 countries.
My most recent book, How to Make a Killing, is a look at the world of the US healthcare through the lens of the dialysis industry, where a miracle cure has become a nightmare for many patients. My previous books are: Crisis of Conscience (Penguin Random House, 2019), a cultural history of whistleblowing and fraud; and Extra Virginity (W W Norton, 2013), a New York Times best-selling account of olive oil culture, history, and crime. My articles have appeared in the New Yorker, National Geographic Magazine, New York Times Magazine, Atlantic Monthly, and elsewhere, and have been included in anthologies like Best American Science Writing and Best American Travel Writing.
I am currently performing research supported by the Robert Wood Johnson Foundation to improve dialysis and chronic kidney disease treatment in Los Angeles, Chicago and New York City.
Kevin Lownds
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
READ BIOKevin Lownds
Office of the Massachusetts Attorney General, Medicaid Fraud Division
Kevin Lownds is the Division Chief in the Office of Massachusetts Attorney General Andrea Joy Campbell, Medicaid Fraud Division, where he investigates and prosecutes health care fraud in federal and state court. Kevin has been in the Medicaid Fraud Division since May 2017 and has conducted investigations and led prosecutions of mental health providers and private equity investors, clinical laboratories, nursing homes, home health agencies, and physicians. Prior to this role, Kevin was at WilmerHale LLP in Washington, DC, where he practiced white-collar criminal defense and complex civil litigation. Kevin is a graduate of Georgetown University Law Center and Tufts University.
Ricardo Carcas
Assistant Special Agent in Charge, HHS-OIG
READ BIORicardo Carcas
HHS-OIG
Ricardo began his law enforcement career in 2008 as a Zone Program Integrity Contractor (ZPIC) investigator. In 2010, he transferred over to the Center for Program Integrity at the Centers for Medicare and Medicaid Services (CMS-CPI) Miami Field office, where he over saw the Zone 7 ZPIC investigations and Medi-Medi investigations for the state of Florida. Ricardo then joined HHS-OIG (US Dept. of Health and Human Services Office of Inspector General) Office of Investigation in 2015 as a Special Agent in the Miami Regional Office assigned to Miami’s Strike Force. Ricardo is currently an Assistant Special Agent in Charge (ASAC) for the Miami Regional Office.
Lee Grossman
Medicaid Director, Iowa Health and Human Services
READ BIOLee Grossman
Iowa Health and Human Services
Lee Grossman is the Medicaid Director for the Iowa Department of Health and Human Services (HHS).
Prior to joining Iowa HHS, he served as Wyoming’s Medicaid Director for two and a half years. He has more than 14 years of experience in state government, working in Medicaid executive leadership and home and community-based services. Mr. Grossman is passionate about rural health care and supporting thriving rural communities.
He holds a Bachelor of Arts degree from the University of Nebraska–Lincoln and a master’s degree in public administration from the University of Wyoming.
Iowa Medicaid provides health coverage to over 700,000 Iowans each year, including children, low-income individuals, pregnant women, older adults, and people with disabilities.
Mary Vanatta
Senior Advisor for Program Integrity, Centers for Medicare and Medicaid Services
READ BIOMary Vanatta
Centers for Medicare and Medicaid Services
Mary Vanatta is Senior Advisor for Program Integrity at the Centers for Medicare & Medicaid Services (CMS), where she provides executive-level guidance on fraud mitigation, emerging vulnerabilities, and oversight initiatives across Medicare and Medicaid. With over two decades of experience in healthcare fraud investigations, oversight, and law enforcement, Ms. Vanatta has led industry engagement and stakeholder outreach efforts for CMS. She has also advanced cross-government collaboration with the Department of the Treasury, FinCEN, and major financial institutions to develop financial crime typologies that expose healthcare fraud as it moves through the financial system, strengthening CMS's ability to identify and prevent these schemes.
Prior to CMS, Ms. Vanatta retired as a Law Enforcement Lieutenant with the Florida Medicaid Fraud Control Unit, where she led complex investigations, supervised multidisciplinary teams, and implemented reforms that reduced inappropriate opioid prescribing. She has also supported the U.S. Attorney's Office on federal healthcare fraud investigations, as well as multi-state private sector casework involving the recovery of improper payments.
Her honors include the Prudential Davis Productivity Award, the Office of the Attorney General Distinguished Service Award, and the State of Florida Distinguished Service Award. She holds a Bachelor of Science in Criminal Justice from the University of Central Florida and is an Accredited Healthcare Fraud Investigator (AHFI).
Fariborz Pakseresht
Interim Director, Oregon Health Authority
READ BIOFariborz Pakseresht
Oregon Health Authority
Fariborz Pakseresht currently serves as Interim Director of the Oregon Health Authority (OHA), having returned to public service at the request of Governor Tina Kotek to lead the agency during a period of transition.
Previously, he served as Director of the Oregon Department of Human Services (ODHS), Oregon's largest state agency, following five years as Director of the Oregon Youth Authority (OYA). He retired from state service in 2025 as the longest-serving Director in ODHS's 35-year history.
Over a 35-year career in public service, Fariborz has led large-scale organizational and systems transformation with a focus on stewardship, leadership development, operational excellence, and improving outcomes for children, families, and communities. He is recognized for advancing evidence-informed decision-making, data analytics, technology modernization, and cross-sector collaboration while fostering organizational cultures grounded in trust, learning, and continuous improvement.
Fariborz also serves as Senior Advisor to the Center for Civic Futures. He is a Fellow of the American Leadership Forum, former Chair of the Leadership Council for the American Public Human Services Association (APHSA), and recipient of APHSA's 2025 Jerry W. Friedman Human Services Impact Award.
His interests include public stewardship, leadership, systems thinking, organizational transformation, human potential, and the conditions that enable people and communities to flourish.
Dave Gemmill
Director of Account Management, SmartLight Analytics
READ BIODave Gemmill
SmartLight Analytics
David Gemmill leads SmartLight’s most complex and strategic accounts as a member of the Account Management team. With over 16 years of professional experience, Mr. Gemmill previously worked with clients and their outside counsel to resolve disputes, investigations, and regulatory compliance matters in the healthcare industry. His matters typically involved the quantification of overpayment by government healthcare programs due to violations of the False Claims Act. With expertise in the analysis and modeling of complex transactional datasets, Mr. Gemmill translates complex concepts to non-technical audiences and has presented directly to the Department of Justice and the Drug Enforcement Agency. Mr. Gemmill lives in Katonah, NY with his wife and two daughters.
Marilyn Bartlett
Consultant, MJBartlett LLC Consulting
READ BIOMarilyn Bartlett
MJBartlett LLC Consulting
Marilyn has focused on health care financial management, serving as Controller for a national health insurance carrier, CFO for a regional health care Third Party Administrator, health management positions within the Montana State Government. As a consultant, she works with Patient Rights Advocate and various employers to “follow the money” in healthcare, with the goal of transparency and lower costs for the plan. As Senior Policy Fellow for the National Academy of State Policy (NASHP), she developed the NASHP Hospital Cost Tool, using hospital filed Medicare Cost Report data, focused on transparency of hospital financial performance.
As State of Montana Employee Benefit Plan Administrator, she moved the plan from projected reserves of -$9 million to $112 million in less than 3 years. She disrupted the status quo by implementing reference-based pricing contracts with all Montana hospitals. For her work, she was recognized as #13 of the World’s 50 Greatest Leaders in 2019.
Sarah Kolar
Program Manager, Public Consulting Group
READ BIOSarah Kolar
Public Consulting Group
Sarah Kolar is a Program Manager with Public Consulting Group specializing in managed care oversight, health plan reporting, and data quality initiatives. She currently manages the Hawaiʻi Med-QUEST Division Health Plan Reporting and Data Quality Strategy program, supporting state efforts to strengthen oversight, improve reporting processes, and leverage data for performance monitoring and compliance. Prior to joining PCG, she supported federal healthcare initiatives at the U.S. Health Resources and Services Administration.
Erin McAlister
Assistant Special Agent in Charge, Louisiana Department of Justice/MFCU
READ BIOErin McAlister
Louisiana Department of Justice/MFCU
Erin McAlister is employed at the Louisiana Department of Justice, Medicaid Fraud Control Unit as the Assistant Special Agent in Charge of Operations. She began her law enforcement career in 2006, and prior to that spent 10 years in the healthcare field. Her main interest is data analytics.
Kevin O'Donnell
Director: Division of Program Integrity, Department of Health Care Finance
READ BIOKevin O'Donnell
Department of Health Care Finance
Kevin O’Donnell is the Director of the Division of Program Integrity for the D.C. Department of Health Care Finance, the District’s Medicaid agency. He has served in that role since November 2021. In that capacity, he oversees the Medicaid agency’s Fraud, Waste, and Abuse activities, coordinating and supervising audits and investigations of Medicaid enrolled providers. To ensure the Medicaid program is effectively rooting out FWA, Mr. O’Donnell collaborates with public and private partners, including law enforcement agencies, regulatory agencies, Managed Care Organizations, and others.
Prior to becoming the Director of the DPI, Mr. O’Donnell spent 7 years as an Attorney-Advisor in DHCF’s Office of the General Counsel, where he defended the agency in administrative appeals before the D.C. Office of Administrative Hearings. Mr. O’Donnell is a graduate of the George Washington University School of Law and a native Washingtonian.
JOHNNY BROOKS
Director Program Integrity, Georgia Department of Community Health
READ BIOJOHNNY BROOKS
Georgia Department of Community Health
Johnny R. Brooks is the Director, Program Integrity for the Georgia Department of Community Health, Office of Inspector General. Johnny oversees the Medicaid agency’s Fraud, Waste, and Abuse (FWA) activities and coordinates audits and investigations of Medicaid providers. He also collaborates with law enforcement, regulatory agencies, and Managed Care Organizations to maintain a viable Medicaid program for the citizens of Georgia. Johnny is a retired U.S. Army veteran and holds a Master of Public Administration from Central Michigan University and is a Certified Inspector General. He has over 18 years’ experience investigating Medicaid fraud. Prior to joining the Department, he served as Chief Investigator, Georgia Medicaid Fraud Control Unit. In 2018, he received the U.S. Attorney’s Office Award (Northern District of Georgia) for his dedication and commitment to the pursuit of justice.
Derik Ciccarelli
Director of Operations, Fraud Scope, Codoxo
READ BIODerik Ciccarelli
Codoxo
Derik Ciccarelli is the Director, Fraud Scope Operations for Codoxo. His experience investigating insurance fraud and insurance defense spans 30 years across healthcare, property and casualty, workman’s compensation, disability, and life insurance. At Codoxo, Derik assists healthcare payers and agencies with detecting fraud, waste, and abuse through AI models and data-driven business intelligence, which includes defining and refining business analytics and logic related to pattern-based and deterministic detectors. Derik’s collaborates with our partners through the implementation, Go Live, and investigative processes. His expertise is in conducting risk assessments of national, regional, and corporate healthcare policies along with providing exceptional service to clients to ensure compliance with all legal requirements and professional standards.
Kaye Lynn Wootton
Director, Medicaid Fraud Control Unit (aka Medicaid Fraud and Patient Abuse Division), Utah Attorney General's Office
READ BIOKaye Lynn Wootton
Utah Attorney General's Office
Kaye Lynn Wootton is a prosecutor in the Utah Attorney General’s office and serves as Director of the Utah Medicaid Fraud and Patient Abuse Division. She began her career as a Registered Nurse over 35 years ago and now combines her nursing and attorney skills as she continues her mission to protect patients and safeguard the Medicaid program. Kaye Lynn also serves as President of the National Association of Medicaid Fraud Control Units (NAMFCU). Kaye Lynn regularly serves as a presenter and facilitator for state agencies, provider groups, NAMFCU and various national organizations. Kaye Lynn is currently serving as a member of the Board of Directors for the Healthcare Fraud Prevention Partnership.
Katie Pass
Director, Stakeholder Engagement, Alliant Health Solutions
READ BIOKatie Pass
Alliant Health Solutions
Katie Pass serves as Director of Stakeholder Engagement at Alliant Health Solutions, where she leads strategic partnerships and initiatives that advance quality, accountability, and healthcare transformation. With experience spanning long-term care, behavioral health, hospital operations, and CMS-funded programs, she has supported state and national efforts focused on patient safety, access to care, rural health improvement, care coordination, and performance improvement. Katie specializes in building collaborative relationships across healthcare, community, and government sectors to develop practical solutions that strengthen program effectiveness, improve outcomes, and support responsible stewardship of healthcare resources.
Elizabeth Snavely
Chief Operating Officer, Safeguard Services, LLC a Peraton company
READ BIOElizabeth Snavely
Safeguard Services, LLC a Peraton company
Elizabeth Snavely is the Chief Operating Officer of SafeGuard Services LLC, a Peraton company, where she leads operations dedicated to safeguarding the integrity of billions of dollars in federal and state healthcare spend across Medicare, Medicaid, and commercial markets. With more than 25 years of experience, she has driven innovation and operational excellence across healthcare technology, program integrity, and business transformation.
Her career includes senior leadership roles at Cotiviti and General Dynamics Information Technology, where she advanced enterprise integrations, product strategies, and fraud, waste, and abuse solutions that continue to support CMS contractors today. She has guided large-scale mergers and acquisitions, led the development of healthcare analytics products, and partnered with federal and state agencies to strengthen program integrity through the application of AI, automation, and data analytics.
A recognized thought leader in healthcare program integrity and technology enablement, Elizabeth has been an invited speaker at national healthcare and program integrity conferences, published in the Journal of the American Medical Association (JAMA), and provided expert insights to Gartner and Porter Research.
Maricruz Bonfante
Deputy Director, Division of Vulnerability Strategy, Audits and Vulnerabilities Group, Center for Program Integrity, Centers for Medicare & Medicaid Services
READ BIOMaricruz Bonfante
Centers for Medicare & Medicaid Services
Maricruz Bonfante serves as the Deputy Director for the Centers for Medicare & Medicaid for the Center for Program Integrity, where she leads the Division of Vulnerability Strategy in advancing efforts to prevent fraud, waste, and abuse across Medicare, Medicaid, and Marketplace programs. She brings extensive expertise in regulatory analysis, program risk assessment, and fraud prevention strategy, developed through years of service in senior roles across CMS. Her background includes significant leadership in reviewing healthcare regulations, managing high impact program integrity initiatives, and collaborating with federal, state, and private partners to strengthen fraud prevention efforts. A licensed attorney, she has deep experience in health law, policy development, and legal analysis supporting Medicare Advantage, Part D, and Marketplace programs. She has been recognized with numerous CMS and HHS awards for excellence, innovation, and mission impact throughout her career.
Neda Jasemi
Senior Policy Analyst, The National Association of Medicaid Directors (NAMD)
READ BIONeda Jasemi
The National Association of Medicaid Directors (NAMD)
Neda is a Senior Policy Analyst at the National Association of Medicaid Directors (NAMD), supporting state and territory learning. She has led learning programs on an array of emerging issues and trends including but not limited to program integrity, applied behavioral analysis, and financing issues. Before joining NAMD, Neda worked in Medicaid managed care consulting, supporting procurement, strategy, and implementation projects. She received her Master of Science in Public Health in health policy from Johns Hopkins University and a Bachelor of Science in Political Science and Biology from the University of Wisconsin, Madison.
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
READ BIOAnne Harvey
Nebraska Medicaid
Leads the best team in Nebraska Medicaid to protect the program from fraud, waste, and abuse, and the clients from harm and exploitation. Educated at Creighton University and the University of Nebraska - Lincoln. Spends free time collecting craft supplies and making things.
Cindy Beane
Owner/ CEO, Beane Medicaid & Health Solutions
READ BIOCindy Beane
Beane Medicaid & Health Solutions
Cindy Beane is the Founder and CEO of Beane Medicaid and Health Solutions LLC, a consulting firm focused on strengthening Medicaid programs and advancing rural health transformation. She brings more than 30 years of healthcare and public service leadership, including 11 years as West Virginia’s Medicaid Director (Commissioner of the Bureau for Medical Services), where she led major modernization efforts, expanded home- and community-based services, implemented innovative payment reforms, and negotiated federal waivers.
Cindy is nationally recognized for her Medicaid expertise and collaborative leadership, having served as President of the National Association of Medicaid Directors (NAMD). A Licensed Certified Social Worker (LCSW) with a Master of Social Work, she now partners with states, health systems, and organizations to provide strategic guidance on Medicaid policy, program design, and system transformation.
Ben Karrasch
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
READ BIOBen Karrasch
Ohio Attorney General's Office
Ben has served as the Section Chief of the Health Care Fraud Section and Director of the Ohio Medicaid Fraud Control Unit at the Ohio Attorney General’s Office since November of 2020. Ben began his career as an Assistant Prosecutor for the Columbus City Attorney’s Office in Columbus, Ohio. After spending 5 years as a courtroom prosecutor, Ben moved on to the world of Medicaid Fraud Control Units at both the Washington, D.C. Office of the Inspector General and eventually back home to Ohio at the Ohio Attorney General’s Office. Ben has handled both provider fraud cases as well as patient abuse and neglect cases. Ben is the current President of the National Association of Medicaid Fraud Control Units.
Ben is a graduate of Capital University Law School and received his bachelor’s degree from The Ohio State University. Ben lives in Columbus, Ohio with his wife and two boys.
Karen Weintraub
Executive Vice President, Healthcare Fraud Shield
READ BIOKaren Weintraub
Healthcare Fraud Shield
With 28 years of data and over 22 years of healthcare experience, Ms. Weintraub is currently responsible for the design and development of the company’s healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, managed SIUs on various healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Ms. Weintraub received a BA in Criminal Justice from the University of Delaware and an MA in Criminal Justice from Rutgers University. Ms. Weintraub is a Certified Professional Coder for Payers (CPC-P), a Certified Professional Medical Auditor (CPMA) from the American Academy of Professional Coders, Certified Dental Coder (CDC) from the American Dental Association and the founder of the Hamilton, NJ AAPC chapter. She is also an Accredited Healthcare Fraud Investigator (AHFI) from the National Healthcare Anti-Fraud Association (NHCAA). Ms. Weintraub Taught CPT Coding, Fraud & Audits, and Medical Billing, Laws and Ethics and the local community college.
Miranda Bennett
Acting Deputy Inspector General for Investigations, U.S. Health and Human Services, Office of Inspector General
READ BIOMiranda Bennett
U.S. Health and Human Services, Office of Inspector General
Miranda Bennett currently serves as the Acting Deputy Inspector General for Investigations at the Department of Health and Human Services, Office of Inspector General. Ms. Bennett leads more than 500 federal law enforcement officers, investigators, and analysts responsible for conducting criminal and civil investigations of fraud, waste, and abuse affecting Health and Human Services programs. These efforts result in hundreds of criminal actions and indictments each year and produce significant financial recoveries that protect patients and safeguard federal health care funds.
Ms. Bennett began her career with HHS-OIG in 2005 as a Special Agent in the Dallas Regional Office. She later advanced into leadership roles, including serving as the Special Agent in Charge of the Dallas Region, where she oversaw enforcement operations across multiple Medicare Fraud Strike Force locations. Most recently, she served as an Assistant Inspector General for Investigations with oversight of three investigative regions and led national initiatives in cybersecurity, technology modernization, and the restructuring of administrative operations.
Ms. Bennett holds a Bachelor of Science in Political Science and Sociology from Texas A&M University. Ms. Bennett has been honored with the Inspector General’s Bronze Medal and recognized by the Women in Federal Law Enforcement Foundation as an Outstanding Law Enforcement Employee.
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
READ BIOCaleb Richards
Oregon Health Authority
I manage the Fraud, Waste, and Abuse Detection and Prevention Team in the Office of Program Integrity for the Oregon Health Authority. After studying Applied Mathematics as an undergraduate at Boise State University, I worked as a data analyst for a national power sports distributor. My passion for data and analytics led me to obtain my Master’s in Statistics from Oregon State University before joining Oregon’s Program Integrity as a research analyst in 2021. Now I lead a team of nine analysts, fraud examiners, and auditors to find and resolve issues of FWA. I enjoy being outside or on the lake, playing disc golf, and playing board games with friends and family in my free time.
Betsie Steenson
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
READ BIOBetsie Steenson
Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
After earning a Bachelor of Fine Arts in K – 12 Vocal & Instrumental Music Education and History, I taught for a year. When it became clear that the classroom was not for me, I started exploring other opportunities. I started working with DHHS in 2004 and I’ve been working in Program Integrity since 2005. In this position, I spend my time investigating allegations of Fraud, Waste, Abuse, and Erroneous payments, coordinating Nebraska’s involvement in the Payment Error Rate Measurement (PERM) reviews, working with the National Correct Coding Initiative (NCCI) code sets, and working with our Managed Care Plans. In my free time I enjoy reading, crafting and watching college football.
Melinda Abbott
Provider Relations Administrator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
READ BIOMelinda Abbott
Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Melinda Abbott: Provider Relations Administrator, Medicaid & Long-term Care, Nebraska Department of Health and Human Services
After graduating from Doane University with a double major in psychology and fine arts, I spent time exploring both for-profit and non-profit health professions. Ready for a new direction, I joined the State of Nebraska as a Juvenile Services Officer. Seven years later, I transitioned into resource development, focusing on enrolling HCBS providers. Over the last 15 years, I have grown from a team member to a supervisor, Program Manager, and finally to my current role as Administrator for Provider Relations. Outside of work, I enjoy gardening, painting, and spending time laughing with family and friends.
Andrea Rakes
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
READ BIOAndrea Rakes
Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Andrea Rakes has been a Medicaid Provider Fraud and Abuse Investigator for the State of Nebraska since 2024. Her career with the State of Nebraska started in 2022 when she joined the Provider Screening and Enrollment team as an Administrative Programs Officer. She represented the Department in many appeals and gained an array of knowledge of the Medicaid Program requirements, provider enrollment rules, and compliance processes. That knowledge of the Medicaid Program has boosted her ability to find potential loopholes and patterns that providers use to commit fraud, waste, and abuse within the Medicaid Program. Outside of work, Andrea enjoys getting lost in a good book, spending time with her children, baking bread, and cooking.
David Ward
Sr. Director, LTSS, Oklahoma Health Care Authority
READ BIODavid Ward
Oklahoma Health Care Authority
David Ward serves as the Senior Director of Long Term Services and Supports for the Oklahoma Health Care Authority, the State’s single Medicaid agency. In this role, he works in close partnership with Oklahoma Human Services and provides administrative oversight for the 1915(c) Home and Community‑Based Services waivers, State Plan Personal Care, PACE and the RHTP‑supported PACE expansion, Level of Care, TEFRA, Dual Eligible Care Coordination, and the Money Follows the Person program (Oklahoma’s Living Choice).
David was selected for and completed both the inaugural ADvancing States Next Gen Leadership Program (2022–2023) and the Milbank Memorial Fund Emerging Leaders Program (2022–2023). He currently serves as Chairman of the National EVV Association and is a former at‑large board member for ADvancing States.
Ulyana Peychev
Senior Manager Data Analytics, State Government Solutions, Optum
READ BIOUlyana Peychev
Optum
Ulyana Peychev, MPM, is a Senior Manager of Business Systems Analysis at Optum, specializing in Medicaid program integrity, fraud, waste and abuse (FWA) detection, healthcare analytics, and both prepay and post-pay payment integrity programs. With more than a decade of experience in healthcare IT and Medicaid operations, she leads cross-functional teams that support state agencies through advanced analytics, system modernization, claims review, and program integrity initiatives. Ulyana brings deep expertise in prepay claim editing and detection strategies, post-pay audit and recovery programs, FWA detection systems, CMS certification, business analysis, and stakeholder collaboration, helping states strengthen oversight, prevent improper payments before they occur, improve operational efficiency, and drive better healthcare outcomes.
Kevin Hutchinson
VP, Business Development, State Government Solutions, Optum
READ BIOKevin Hutchinson
Optum
Kevin Hutchinson is VP of Growth and New Business Development of Optum State Government Solutions. He serves as the primary point of contact for state governments in the Southeast US. For more than two decades, he has served as a consultant, manager, and leader dedicated to innovation and transformation of state Medicaid and health and human services plans and programs. His background is in developing and delivering solutions using data, technology, and high-quality staff. His career has been recognized for bringing a data-driven approach, establishing baselines to make decisions, and measuring outcomes to evaluate effectiveness. He employs technology as needed to execute solutions, designing, developing, and implementing systems to drive performance. Mr. Hutchinson’s background includes the public sector, where he served in the North Carolina Office of the Governor, the private sector working with multiple consulting and technology firms, as well as the non-profit sector as a homeless outreach advocate. Kevin has a Bachelor of Arts in Government from the University of Notre Dame and a Master of Public Policy from the Sanford School of Public Policy at Duke University. He lives outside Raleigh, NC with his wife, two teenage children, and two dogs.
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
READ BIOTamara McNatt
Oregon Health Authority
Tamara has been with the Oregon Health Authority for 10 years, currently managing the Program Integrity Audit Unit at Oregon’s Office of Program Integrity. While at OHA, Tamara has held various positions in behavioral health licensing and certification, Medicaid provider services and quality assurance and compliance and Medicaid behavioral health policy. Tamara holds a Master of Arts degree in Communication and Leadership Studies, emphasis in strategic and organizational communication and a Bachelor of Science degree in Behavioral Science, emphasis in psychology. Outside of work, Tamara enjoys relaxing at home, cooking, reading, writing, quilting (her newest hobby), shopping and eating out.
James Lukenbill
Analytics Strategic Product Manager, State Government Solutions, Optum
READ BIOJames Lukenbill
Optum
James Lukenbill serves as the Strategic Product Manager for Analytics at Optum State Government Solutions. In this role, he leads a team dedicated to the design and implementation of advanced healthcare data analytics, artificial intelligence, and machine learning solutions tailored for state government clients. With over two decades of experience in analytics, James brings deep expertise in Medicaid and health and human services data, driving innovation and actionable insights in public sector healthcare.
Nicholas Bonomo
Supervisory Health Insurance Specialist, CMS
READ BIONicholas Bonomo
CMS
Nick Bonomo is the director of the Centers for Medicare & Medicaid Services' (CMS's) Division of Payment Error Rate Measurement (DPERM), the federal entity responsible for measuring and reporting improper payments in Medicaid and the Children's Health Insurance Program (CHIP). He is a proud University of Maryland graduate with a Bachelor of Science in statistical mathematics and a Bachelor of Arts in criminology and criminal justice. Nick has been with CMS in the PERM program for almost 12 years and has seen the program evolve and improve over the years through changing policies and administrations with one constant overarching goal of protecting taxpayer dollars from misspending.
Anthony Florio
Deputy Inspector General, Illinois Department of Healthcare and Family Services - Office of Inspector General
READ BIOAnthony Florio
Illinois Department of Healthcare and Family Services - Office of Inspector General
Tony joined the Office of Inspector General (OIG) at the Illinois Department of Healthcare and Family Services (HFS) in March 2022 as the Deputy Inspector General for Investigations, bringing extensive oversight and investigative experience from nearly 20 years with the City of Chicago’s Office of Inspector General. Over the course of his career the City of Chicago OIG, Tony advanced from Investigator I to Chief Investigator, leading teams in complex matters involving comprehensive data analysis, surveillance operations, extensive interviewing, and high-profile municipal investigations. At HFS OIG, Tony oversees statewide investigations into allegations of fraud, waste, abuse, and misconduct involving Medicaid providers and recipients, ensuring accountability within one of Illinois’s largest public programs. He guides investigative strategy, develops analytical methodologies, strengthens process integrity, and partners closely with federal, state, and local entities to safeguard public funds and improve program integrity across Medicaid operations. Tony also plays a key role in advancing OIG’s investigative standards, mentoring staff, and enhancing the office’s capacity to identify systemic vulnerabilities. Tony is a licensed attorney and a Certified Inspector General and Investigator through the Association of Inspectors General.
Vernalisa Taylor
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
READ BIOVernalisa Taylor
Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
With nearly 25 years of experience in Nebraska Medicaid, she has served in provider screening and enrollment, provider relations, appeals, and Program Integrity. Since joining Program Integrity in 2020, Vernalisa has conducted provider investigations, provider compliance activities, and administrative enforcement actions while partnering with state and federal agencies to safeguard the integrity of the Medicaid program. She enjoys collaborating with colleagues nationwide and sharing practical approaches to strengthening Medicaid program integrity.
Aaron Ziska
Provider Fraud Investigator, NE DHHS MLTC
READ BIOAaron Ziska
NE DHHS MLTC
Aaron Ziska is a fraud investigator with a broad background in data. Beginning in labor market economic research, then moving to Nebraska Medicaid analysis, Aaron joined Nebraska Program Integrity at the beginning of the COVID pandemic. He has spent sixteen years with the State, 10 of which have been with Medicaid. With a background in data analysis, he functions as a SME for data synthesis amongst Medicaid systems. He enjoys spending time outdoors exploring with his family, and spending time playing D&D and other board games with his friends.
Mikhial Jerzak
Technical Architect, Peraton
READ BIOMikhial Jerzak
Peraton
Mikhial Jerzak is a Technical Architect for Peraton, and the Innovation Lead on the CMS Fraud Prevention System (FPS) program. He has over 10 years of experience in software development, platform infrastructure, and enterprise solution architecture to drive continuous modernization of AI/ML systems. He operates as the lead technical architect for the Rapid Fraud Intelligence (Rapid FI) platform.
Throughout his career, Mikhial has demonstrated a consistent track record of bridging technical execution with strategic vision. He combines hands-on development experience as a software engineer with technical leadership to guide his cross-functional team of developers. His innovations have been recognized as a GovTech Connects Accelerate’25 Award Winner (Rapid FI), and 2025 FORUM Disruptive Tech Award Winner (CMS FPS). He and his innovation team have the overall aim of securely governing technology initiatives in support of program integrity.
During this session, he will discuss securely deploying analytics platforms at scale, using a flexible architecture to meet state infrastructures where they are on their AI and analytics journey.
Craig Diena
Team Leader & Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General
READ BIOCraig Diena
U.S. Department of Health and Human Services Office of Inspector General
Craig Diena is a team leader and social science analyst in the Office of Evaluation and Inspections of the U.S. Department of Health and Human Services Office of Inspector General. In this role, he has contributed to evaluations on a range of topics in Medicaid, including the referral of fraud in Medicaid managed care. He holds a Master of Public Administration from the University of Pennsylvania.
Savanna Thielbar
Team Leader and Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General, Office of Evaluation and Inspections
READ BIOSavanna Thielbar
U.S. Department of Health and Human Services Office of Inspector General, Office of Evaluation and Inspections
Savanna Thielbar is a team leader and social science analyst in the Office of Evaluation and Inspections within the U.S. Department of Health and Human Services Office of Inspector General. Savanna most recently led an evaluation examining States’ practices to improve Medicaid managed care organizations’ provider fraud referrals. She previously led evaluations of the COVID‑19 response and pandemic relief funding, as well as of Indian Health Service programs. Savanna holds a Master of Public Service and Administration from Texas A&M University’s Bush School of Government and Public Service.
Michael Henry
Director of the Medicaid Fraud Control Unit Oversight Division, HHS/OIG
READ BIOMichael Henry
HHS/OIG
Michael started his career with the OIG in 2002 with the Office of Evaluation and Inspections and has primarily focused on conducting oversight of Medicaid Fraud Control Units.
Cori Ellis
Assistant Special Agent in Charge, Investigations, Louisiana Department of Justice/Medicaid Fraud Control Unit
READ BIOCori Ellis
Louisiana Department of Justice/Medicaid Fraud Control Unit
Cori Ellis is employed with the Louisiana Department of Justice, Medicaid Fraud Control Unit as the Assistant Special Agent in Charge of Investigations. She began her law enforcement career in 2007. Her passion is in training and she became a firearms instructor in 2014.
Ashley Dirienzo
Fraud, Waste & Abuse Director, Colorado Medicaid
READ BIOAshley Dirienzo
Colorado Medicaid
Ashley has a Bachelor of Science Degree in Healthcare Management and Economics and a Master's Degree in Business Administration (MBA). She has worked for Colorado Medicaid for almost 16 years and has worked in healthcare for over 20 years. Ashley started at Colorado Medicaid working as Tort & Casualty Litigation Specialist. Over the years she transitioned to the Manager of Third Party Liability & Cost Avoidance (TPL&CA) and most recently became the Director of the Fraud, Waste & Abuse (FWA) Division within the Medicaid Operations Office (MOO). FWA is responsible for prepayment and post-payment audit operations, referrals to law enforcement and the Medicaid Fraud Control Unit (MFCU), data analytics and outlier modeling, TPL, and general program integrity and compliance oversight. Ashley is a native of Colorado and grew up in the mountain town of Breckenridge. She enjoys spending time outdoors hiking, camping and traveling with her husband and two dogs.
Casey Klippel
Director of Program Integrity, Indiana Medicaid
READ BIOCasey Klippel
Indiana Medicaid
Casey Klippel serves as the Director of Program Integrity for Indiana’s Office of Medicaid Policy and Planning (OMPP), where he leads statewide initiatives to strengthen oversight, enhance compliance, and safeguard the integrity of Medicaid programs. Before joining OMPP, Casey served as Deputy Attorney General in the Indiana Attorney General’s Office’s Data Privacy Division, focusing on ransomware response, HIPAA compliance, and robocalling. He is a graduate of Belmont University College of Law and Indiana University, and brings a career long commitment to public service, integrity, and system-level improvement to his work advancing Indiana’s healthcare landscape.
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
READ BIOTabitha Ramminger
Wisconsin Department of Health Services
As Deputy Inspector General, Tabitha Ramminger oversees a workforce of over 100 professionals dedicated to preventing fraud, waste, and abuse within public assistance programs at the Wisconsin Department of Health Services. Her extensive public service background includes serving as the state’s COVID-19 Vaccination Response Team Deputy Incident Commander and leading key Medicaid service authorization programs, including the design of the Autism Treatment Benefit. A Board Certified Behavior Analyst, Certified Inspector General, and Certified Welfare Fraud Investigator, Mrs. Ramminger holds an M.S. from the Florida Institute of Technology and actively volunteers with the local Scouts programs alongside her husband and three children.
Chrissy Fowler
Director of Payment Accuracy & Reporting Group, Centers for Medicare and Medicaid Services/ Office of Financial Management
READ BIOChrissy Fowler
Centers for Medicare and Medicaid Services/ Office of Financial Management
Chrissy Fowler is the Director of the Payment Accuracy & Reporting Group (PARG) within the Office of Financial Management at the Centers for Medicare & Medicaid Services (CMS). She has 25 years of experience at the Department of Health & Human Services (HHS), specializing in improper payments oversight of CMS’s programs.
As a senior leader she oversees the improper payment measurements for major programs, including Medicare Fee-for-Service, Parts C and D, Medicaid, Children’s Health Insurance Program, and the Advance Premium Tax Credit as required by Payment Integrity Information Act of 2019 (PIIA). These programs represent 56% of government-reported improper payments in 2025. She has brought innovation, accuracy, and data transparency to improper payment reporting, leading to significant reductions in CMS improper payments and making CMS a model of excellence across government agencies.
Her journey to this pivotal role began at the HHS/Office of Inspector General, where she spent a decade honing her auditing expertise through performance and financial statement audits —including the very improper payment measurement programs she now leads.
Chrissy graduated with a Bachelor of Science in Business Administration with a major in accounting from Samford University. Chrissy brings both technical precision and strategic vision to one of government's most challenging missions: ensuring every healthcare dollar reaches its intended destination.
Kimberly Forrest
Director, Myers & Stauffer
READ BIOKimberly Forrest
Myers & Stauffer
Ms. Forrest is a director with Myers and Stauffer, bringing more than 25 years of public
and private sector experience in various forms of Program Integrity (PI) work for the
state of Indiana, including contract implementation and oversight, evaluation and
implementation of data analytics, audit coordination, and provider/stakeholder relations
and education. Ms. Forrest also provided oversight of the development and
implementation of a comprehensive program integrity, case tracking, and analytics
system. With that experience, Ms. Forrest serves as a Subject Matter Expert to
incorporate the State PI perspective in the design and implementation of program
integrity case-tracking solutions.
Ms. Forrest provides oversight to multiple state Recovery Audit Contract (RAC)
operations – with responsibilities ranging from policy/procedure impact analysis to
evaluation of state guidelines to identify potential vulnerabilities. She has overseen the
independent review of inpatient, outpatient, professional, long-term care and other
provider type claims – with most recent focus on applied behavioral analysis and non-
emergency medical transportation services, as well as review of home and community-
based service providers. Ms. Forrest utilizes her extensive state PI experience to
provide fraud, waste, and abuse detection technical expertise to the firm’s Benefit
Program Integrity (BPI) unit and serves as a resource on false claims and litigation
support engagements.
Travis Melton
Senior Manager, Myers & Stauffer
READ BIOTravis Melton
Myers & Stauffer
Mr. Melton, a senior manager with Myers and Stauffer, is an experienced professional in healthcare auditing and consulting. Throughout his career, he has managed compliance and performance audits, financial audits, and bid pricing tool audits of Medicare Advantage Organizations (MAOs) and Prescription Drug Plans (PDPs) on behalf of the Centers for Medicare & Medicaid Services (CMS). Additionally, he has served as the project manager for program integrity reviews conducted for the Department of Medical Assistance Services (DMAS) in the Commonwealth of Virginia.
Since 2003, Mr. Melton has worked closely with Medicaid agencies, primarily focusing on overseeing program integrity engagements. His responsibilities include reviewing completed engagements, supervising staff, engaging with providers and Medicaid agency personnel, preparing reports, and ensuring compliance with contract requirements.
In addition to his auditing expertise, Mr. Melton has worked on consulting engagements with state agencies to modernize child welfare rates. He has supported states in reforming child welfare payment methodologies to enhance service delivery and ensure fair, efficient allocation of resources.
Mr. Melton has also collaborated with several states on performance and administrative expense audits of Managed Care Organizations (MCOs) that participate in state insurance programs. His work with CMS includes audits of Medicare Advantage and Medicare Prescription Drug Plan bid pricing. His expertise spans audits related to Fraud, Waste, and Abuse (FWA), Part D Effectuation Timeliness, Part D Clinical Decision Making, Part D Grievances, Enrollment/Disenrollment, and Late Enrollment Penalty components of performance and compliance audits for plan sponsors. He has also overseen examinations of financial information for Medicare Advantage Organizations and Prescription Drug Plans.
Shilpi Goel
Senior Manager, Myers & Stauffer
READ BIOShilpi Goel
Myers & Stauffer
Ms. Goel is a Senior Manager at Myers and Stauffer. She supports engagements
related to Medicaid program integrity and consulting review efforts. She manages
Recovery Audit Contractor (RAC) and Non-Emergency Medical Transportation (NEMT)
audits across multiple states. Additionally, she assists in overseeing state Procurement
Reviews of School Food Authorities under the School Lunch Program. Ms. Goel has
also managed various consulting projects focused on policy analysis.
In her role at the firm, she is responsible for project oversight alongside conducting
research, writing, data analysis, and documentation of policies and procedures. Her
program integrity experience includes performing post-payment reviews of credit
balances, Home and Community-Based Services (HCBS) audits, Non-Emergency
Medical Transportation (NEMT) audits, and various inpatient services.
Ms. Goel has contributed to the Medicaid and CHIP Payment and Access Commission
(MACPAC) project, focusing on performance measures and return on investment for
Medicaid program integrity. She also has experience working with Managed Care
Organizations (MCOs) data, including conducting data analysis and preparing reports
for transparency and external quality review (EQR) projects in multiple states.
Shirin Hormozi
Director Division of State Program Integrity, CMS
READ BIOShirin Hormozi
CMS
Shirin recently starting serving as the Director of the Division of State Program Integrity (DSPI) at the Centers for Medicare & Medicaid Services (CMS), where she leads Medicaid program integrity oversight and works to strengthen accountability across state Medicaid programs. She oversees state program integrity and eligibility audits, medical loss ratio audits, and Recovery Audit Contractor (RAC) oversight.
Prior to becoming Director, Shirin served as Deputy Director in the Division of State Partnership within the Audits and Vulnerabilities Group. She also served as a Program Representative in CMS's Center for Clinical Standards & Quality, where she provided technical and professional expertise in applying Medicare and Medicaid laws, regulations, and policies related to long-term care certification, survey, and enforcement processes.
Shirin began her career at the Government Accountability Office (GAO), where she was a Senior Analyst prior to joining CMS. At GAO, Shirin worked on a number of high-profile engagements assessing federal oversight of healthcare programs. This included leading engagements examining oversight and regulations associated with assisted living facilities, advance directives, patient safety at hospitals, and providing numerous cost-saving recommendations to the Medicaid program.
Shirin holds a Master of Public Health from the University of Michigan and a Bachelor of Science in Community Health from the University of Illinois. Outside of work, she enjoys traveling, cooking, reading, and cheering on her two children at their soccer, flag football, and track events.
Mike Cohen
Operations Officer, HHS Office of Inspector General
READ BIOMike Cohen
HHS Office of Inspector General
Michael Cohen DHSc, JD, PA-C
Operations Officer, Office of Investigations, Office of Inspector General,
U.S. Department of Health and Human Services
As a Headquarters Operations Officer with the U.S. Department of Health and Human Services, Office of Inspector General (OIG), Office of Investigations, Dr. Michael Cohen is responsible for pharmaceutical fraud law-enforcement program oversight in Washington, D.C. He has been at OIG headquarters for the past sixteen years. He previously worked for the U.S. Attorney’s Office in Miami, Florida in the Healthcare Fraud division. Current work includes schemes and analysis of newly approved pharmaceuticals subject to diversion. Dr. Cohen also has 35 years’ experience in clinical health care. He received undergraduate degrees in biology and chemistry from the University of Richmond, physician assistant training from George Washington University, a law degree with a specialty in Health Law, and Doctor of Health Sciences from A.T. Still University.
Jennifer Trussell
Fraud Prevention Consultant, SMP Resource Center
READ BIOJennifer Trussell
SMP Resource Center
Jennifer Trussell is a Fraud Prevention Consultant with over 40 years’ experience in the industry. She served over 35 years with the Federal government, including Special Agent in Charge of the Investigations Branch and Senior Advisor with the U.S. Department of Health and Human Services – Office of Inspector General. She began her law enforcement career as an active-duty Special Agent with the Air Force Office of Special Investigations, and later served as a civilian Criminal Investigator for the U.S. Navy. Jennifer has a graduate degree in Policy Management from Georgetown University, and an undergraduate degree in Criminal Justice from Park University. She previously served on detail to the U.S. Senate Special Committee on Aging, and on the Board of Directors for the National Health Care Anti-Fraud Association. She currently works with the Senior Medicare Patrol (SMP) program and is a frequent guest presenter at national conferences.
Anton Dutchover
Deputy Inspector General of Audit and Inspections, Texas HHSC OIG
READ BIOAnton Dutchover
Texas HHSC OIG
Anton Dutchover is the Deputy Inspector General of Audit and Inspections at the Texas Health and Human Services Office of Inspector General. He is a Certified Public Accountant (CPA) and a Certified Inspector General Inspector/Evaluator (CIGE) with nearly 20 years of auditing experience. Over the past 10 years, he has specialized in identifying and addressing fraud, waste, and abuse through audits and inspections of Medicaid providers, managed care organizations, and Texas Health and Human Services programs. His expertise includes strengthening program integrity, evaluating compliance, and improving oversight to help ensure public resources are used effectively.
Brian Dunn
Inspector General, IL HFS OIG
READ BIOBrian Dunn
IL HFS OIG
Brian Dunn is the Inspector General for the Illinois Department of Healthcare and Family Services, where he oversees program integrity efforts for the state's Medicaid program. In this role, he directs criminal and civil investigations, audits, and compliance reviews, and the data analysis that supports this work. Prior to this, Brian served as First Deputy Inspector General and General Counsel for the City of Chicago's Office of Inspector General. Before leading government oversight work, Brian's legal career included serving as General Counsel for the Illinois Department of Human Services and the Illinois Department of Commerce and Economic Opportunity, a litigation associate for a global law firm, and a law clerk for a federal district judge.
Duane Kimball
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
READ BIODuane Kimball
South Carolina Department of Health and Human Services (SCDHHS)
Duane has more than thirty years of experience in healthcare management. He served for 25 years as a Hospital Corpsman in the United States Navy, retiring in 2018 at the rank of Master Chief (E‑9). He began his work in Medicaid in August 2020 within the SCDHHS Division of Program Integrity. As the Operations and Managed Care Oversight Manager, Duane leads a team of four staff responsible for overseeing contractual coordination and compliance of program integrity activities for the state’s five Managed Care Organizations (MCOs) and the Recovery Audit Contractor. His responsibilities include reviewing, enforcing, and lifting provider sanctions and administrative actions; ensuring accurate intake and recording of all program integrity‑related financial transactions; and conducting routine information‑sharing meetings with the MCOs, the Medicaid Fraud Control Unit, and Program Integrity leadership. Additionally, Duane manages the operational oversight of bureau-wide duties and the coordination of activities across teams and stakeholders. Duane holds a bachelor’s degree in health sciences from Old Dominion University. He is also an avid long‑distance runner who has completed 27 marathons, including six world majors, and three ultramarathons.
Kelly Waldhoff
Chief Operating Officer, Office of Inspector General for the Illinois Department of Healthcare and Family Services
READ BIOKelly Waldhoff
Office of Inspector General for the Illinois Department of Healthcare and Family Services
Kelly Waldhoff joined The State of Illinois Department of Healthcare and Family Services Office of Inspector General in 2025 as the OIG’s Chief Operating Officer. In this role, she oversees strategic planning, organizational development, and leads the execution of OIG’s data analytic strategy to prevent and detect fraud, waste, and abuse in the Illinois Medicaid program. Prior to her time with the State of Illinois, she spent nearly two decades leading federal reviews of fraud, waste, and abuse for the U.S. Department of Health & Human Services, Office of Inspector General. There she led national compliance assessments in complex regulatory areas including the Medicaid Drug Rebate Program, Medicaid TMSIS data quality, Medicaid provider enrollment, and the 340B Drug Discount Program. Kelly earned a BS from the Kelley School of Business at Indiana University and a MA in social work health administration and policy from the University of Chicago. She is a Certified Inspector General by the Associations of Inspector General and holds a Certification in Healthcare Compliance from the Healthcare Compliance Association.
Jose Marti
Assistant Attorney General, FL Office of the Attorney General - Medicaid Fraud Control Unit
READ BIOJose Marti
FL Office of the Attorney General - Medicaid Fraud Control Unit
Jose Marti is a prosecutor with the Florida Attorney General's Office, Medicaid Fraud Control Unit, where he helps direct investigations and prosecutes complex Medicaid fraud cases and cases involving the abuse and neglect of elderly and disabled adults. He began his public service career as a dependency attorney with the Florida Department of Children and Families before joining the Attorney General's Office in 2019. Jose is dedicated to protecting vulnerable populations and safeguarding public resources through the enforcement of Florida's healthcare fraud laws. Outside of work Jose enjoys coaching baseball, traveling and cooking for his family and friends.
Dave Etling
SVP and GM, InComm Payments
READ BIODave Etling
InComm Payments
Dave Etling was InComm Payments' 40th employee and has held various leadership positions, including business development, sales, product management, and merchant services. Dave uses his broad knowledge of InComm Payments' technologies and services to establish deep and mutually beneficial business relationships with our customers that extend far beyond the basic delivery of stored-value cards into reward points redemption directly at retail POS, single-use digital coupons for specific retail SKU redemption and card-based, by-SKU affinity promotions. He has been a key asset to InComm Payments' growth over many years by improving product partner acquisition and successful retail launches of products for major industry leaders.
Ann Kaperak
Assistant Chief, Florida Agency for Health Care Administration
READ BIOAnn Kaperak
Florida Agency for Health Care Administration
With over 20 years of experience in the healthcare industry, Ms. Kaperak currently serves as the Assistant Bureau Chief for the Florida Agency for Health Care Administration’s Medicaid Program Integrity team. In this role, she leads dedicated teams focused on recovering overpayments and enforcing sanctions, all while working diligently to reduce fraud and abuse within the Medicaid program. Ms. Kaperak is a proud graduate of Florida State University and holds esteemed credentials including AHFI, CFE, and CIGA. She is a respected speaker, having presented at numerous conferences such as NHCAA, NAMPI, FIFEC, and the Medicaid Integrity Institute, where she shares her insights and expertise. Outside of her professional life, Ms. Kaperak enjoys giving back to her community, attending sporting events, and traveling.
Heather Laudico
Medicaid Integrity Specialist 2 (Financial Analysis), New York State Office of the Medicaid Inspector General
READ BIOHeather Laudico
New York State Office of the Medicaid Inspector General
Heather Laudico is an Audit Supervisor within the Division of Medicaid Audit at the NYS Office of the Medicaid Inspector General. In this role, she collaborates with subject matter experts across the state, actively facilitating the audit protocol development and revision process. By applying proactive problem-solving to operational nuances, she effectively assesses program vulnerabilities and strengthens the defensibility of audit findings to support and promote regulatory compliance. Dedicated to expanding her professional knowledge and fostering continuous improvement practices, she values exchanging insights with fellow professionals committed to elevating operational quality and program integrity.
Laura Greene
Audit Manager, Office of the Medicaid Inspector General
READ BIOLaura Greene
Office of the Medicaid Inspector General
Laura Greene is an Audit Manager for the New York State Office of Medicaid Inspector General. Over her 11-year tenure with OMIG, Laura has transitioned from investigative roles to leading audit teams focused on FFS and Managed Care compliance, data analytics, and policy enforcement. She regularly serves as a Subject Matter Expert for outpatient and diagnostic services. Laura holds a B.S. in Finance from Adelphi University and has completed advanced coursework in Medical Billing and Coding.
Lindsay Foote
Audit Manager, OMIG
READ BIOLindsay Foote
OMIG
Lindsay Foote serves as an Audit Manager at the New York State Office of the Medicaid Inspector General. She joined OMIG in 2014, bringing over a decade of prior pharmacy experience in retail and at the New York State Office of Mental Health. In her current capacity, Lindsay is the subject matter expert (SME) in pharmacy-related matters for the Division of Medicaid Audit, reviewing all pharmacy audits performed across the division’s seven regions. She also oversees OMIG’s protocol development process, guiding SMEs through revisions and reviewing content for quality and consistency across project types. When appropriate, she engages with stakeholders to inform the final product. Additionally, she supports the audit reporting process, developing and maintaining templates that help communicate audit results to providers accurately and efficiently. Lindsay welcomes the opportunity to collaborate with others working in pharmacy audit and protocol development.
Donna Knapp
Manager, Major Case Unit, Texas HHSC Office of the Inspector General
READ BIODonna Knapp
Texas HHSC Office of the Inspector General
Donna Knapp is a financial forensic investigator and manager with the Texas HHS OIG Major Case Unit, which handles complex financial fraud investigations. She has partnered with MFCU, the Medicaid Task Force, the FBI, and the Department of Justice on major Medicaid fraud matters, using her financial forensics expertise to follow the money in investigations and litigation.
With more than 30 years of experience, Donna is a licensed Certified Public Accountant, Certified Fraud Examiner, Certified Financial Forensic, and Certified Anti-Money Laundering Specialist. She has presented to professional groups on financial fraud investigations, asset identification, financial behavior profiling, hidden accounts, shell companies, and following the money.
Amanda Burrows
Subject Matter Expert Supervisor, HFPP-GDIT
READ BIOAmanda Burrows
HFPP-GDIT
Amanda Burrows is currently serving as a Subject Matter Expert Manager with the Healthcare Fraud Prevention Partnership (HFPP) Trusted Third Party (TTP) where she has been working since 2023. Ms. Burrows previously worked as a Fraud Lead Analyst with a pharmacy benefit manager, and several years as a Senior Investigator in the Missouri Attorney General’s Office Medicaid Fraud Control Unit.
John Lott
Senior Manager, Myers and Stauffer
READ BIOJohn Lott
Myers and Stauffer
Mr. Lott is a senior manager with Myers and Stauffer LC and brings 16 years of experience in SQL development and data analytics, including 13 years specializing in Medicare and Medicaid claims data. He has significant experience serving in technical leadership roles and as a Project Manager for Recovery Audit Contractor (RAC) engagements, where he has assisted multiple states and hospital stakeholders in identifying and addressing fraud, waste, and abuse in Medicaid claims data.
In addition to his work on RAC projects, Mr. Lott has contributed to program integrity efforts across four states, providing advanced technical and analytical support. He has developed specialized analyses to support Medicaid Fraud Control Unit (MFCU) investigations, collaborating with the U.S. Department of Justice and MFCU teams to deliver critical data and insights that have driven fraud investigations. Furthermore, he has provided expert opinions to support litigation for a state’s Office of the Attorney General.
Before joining Myers and Stauffer, Mr. Lott worked at a recovery audit firm supporting Medicare RAC operations across three regions. In this role, he developed processes to optimize revenue cycle management and ensure compliance with CMS requirements.
Anne Mcfarland
Et magna occaecat at, Estrada and Norman Plc
READ BIOAnne Mcfarland
Estrada and Norman Plc
Doloribus consequunt
Duane Kimball
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
READ BIODuane Kimball
South Carolina Department of Health and Human Services (SCDHHS)
Duane has more than thirty years of experience in healthcare management. He served for 25 years as a Hospital Corpsman in the United States Navy, retiring in 2018 at the rank of Master Chief (E‑9). He began his work in Medicaid in August 2020 within the SCDHHS Division of Program Integrity.
As the Operations and Managed Care Oversight Manager, Duane leads a team of four staff responsible for overseeing contractual coordination and compliance of program integrity activities for the state’s five Managed Care Organizations (MCOs) and the Recovery Audit Contractor. His responsibilities include reviewing, enforcing, and lifting provider sanctions and administrative actions; ensuring accurate intake and recording of all program integrity‑related financial transactions; and conducting routine information‑sharing meetings with the MCOs, the Medicaid Fraud Control Unit, and Program Integrity leadership. Additionally, Duane manages the operational oversight of bureau-wide duties and the coordination of activities across teams and stakeholders.
Duane holds a bachelor’s degree in health sciences from Old Dominion University. He is also an avid long‑distance runner who has completed 27 marathons, including six world majors, and three ultramarathons.
Shavasya Jacob
Audit Supervisor, Office of the Medicaid Inspector General
READ BIOShavasya Jacob
Office of the Medicaid Inspector General
Shavasya Jacob is an Audit Supervisor at the NYS Office of the Medicaid Inspector General. She is a seasoned healthcare compliance professional with over a decade of dedicated experience in Medicaid program integrity as well as other state oversight programs. She currently serves as a subject matter expert, leading an innovative audit approach defined by a unique, data-driven method to program integrity.
This idea was initiated by the regional audit director, but the methodology was designed and planned by Shavasya during a highly selective professional development program, where she conducted intensive research and development to optimize fraud, waste, and abuse detection in the multi-payor Medicaid landscape. A specialist in regulatory compliance and operational excellence, she holds a Master of Public Administration in Inspection and Oversight from John Jay College (CUNY). Shavasya is dedicated to safeguarding public healthcare resources through rigorous, forward-thinking oversight strategies.
April Minton
Data Scientist, Washington State Medicaid Fraud Control
READ BIOApril Minton
Washington State Medicaid Fraud Control
o April Minton is a Data Scientist with Washington State Medicaid Fraud and Abuse Division. April previously worked for Health Care Authority (our single state agency) in both the Program Integrity Unit as well as the Dental Authorization Unit. Prior to state service April worked in private practice as a certified dental assistant for 13 years.
Naomi Smith
Managing Assistant Attorney General, Washington Attorney General's Office
READ BIONaomi Smith
Washington Attorney General's Office
Naomi Smith is a Managing Assistant Attorney General in the Civil Unit with the Washington State Medicaid Fraud and Abuse Division. Naomi earned her Juris Doctor from Seattle University School of Law in 2015. She has been with MFAD for 3 years, previously working as a criminal defense attorney.
Patrick Smith
Audit Director, Texas Office of Inspector General
READ BIOPatrick Smith
Texas Office of Inspector General
Patrick Smith has 11 years of audit experience conducting financial, compliance, performance, and Medicaid audits. Patrick has a Bachelor of Business Management from the University of Texas at San Antonio and is a Certified Internal Auditor and Certified in Risk Management Assurance. Patrick has been with the OIG Audit Division for 6 years and has previously worked as an internal auditor in the financial services field. While at OIG, Patrick has managed and overseen audits in the managed care environment, including audits of substance use disorder and therapy providers, financial statistical report audits over Managed Care Organizations, pharmacies, long term care facilities, independent living services, and local mental health authorities.
Hilton Portland Downtown – Conference Hotel
Address: 921 SW 6th Ave, Portland, OR 97204
The Hilton Portland Downtown is proud to host NAMPI 2026! Located in the heart of downtown, it’s steps from restaurants, shopping, and iconic landmarks like Pioneer Courthouse Square, Powell’s City of Books, and the Pearl District—perfect for conference activities and exploring the city.
Room Block:
- NAMPI has reserved a limited block of rooms. Rooms are subject to availability, so book early!
- Room Rate: $159/night + taxes and fees
- Cut-Off Date: July 31, 2026
- Book Now: Hilton Portland Downtown Passkey Link
Hotel Amenities:
- Complimentary Wi-Fi in rooms and public areas
- On-site restaurant & bar/lounge
- 24-hour fitness center
- Indoor pool and spa services
- Business center and meeting facilities
- Room service & concierge
- Valet and self-parking options
- Accessible rooms and services for guests with disabilities
Getting There:
Portland International Airport (PDX) is approximately 25–30 minutes from downtown. Options to reach the hotel:
- Rideshare / Taxi / Rental Car – Convenient direct routes to downtown
- Airport Shuttle – Check if Hilton offers shuttle service during the conference
- Public Transit – MAX Light Rail (Red Line) connects PDX to downtown; short walk or rideshare to hotel from nearest station
Nearby Attractions:
- Tom McCall Waterfront Park
- Portland Art Museum
- Pearl District & Old Town Chinatown
- Local restaurants, breweries, coffee shops, and boutiques
Questions? Email contact@nampi.net
Event Sponsors
InComm Healthcare
InComm Healthcare helps Medicaid health plans drive healthier behaviors and improve member engagement through modern rewards and incentive solutions built for scale. Our platform enables plans to distribute rewards and benefits digitally or physically, making it easy to reach members, reduce fulfillment friction, and support preventive care and care gap closure. With configurable reward and benefit design, robust spend controls, real-time visibility, and comprehensive reporting, plans maintain accountability while minimizing administrative burden. InComm Healthcare supports Medicaid plans in advancing health equity, addressing SDOH, and delivering measurable outcomes through rewards and benefits that are simple for members.
Splunk/Cisco
Splunk is the data platform leader for security and observability. Our extensible data platform powers enterprise observability, unified security and limitless custom applications. Splunk helps tens of thousands of organizations turn data into doing so they can unlock innovation, enhance security and drive resilience.
NCCI
NCCI is a certified Small Disadvantaged Business and Minority-Owned Enterprise specializing in unannounced pre-enrollment and post-enrollment site visits for moderate- and high-risk Medicaid providers. Founded in 1992, NCCI has performed over 60,000 field inspections under the CMS Provider Enrollment & Oversight (PEO) IDIQ contract in the last 5 years. With SOC I Type II certified operations and rapid-deployment field inspectors across all 50 states, NCCI closes the compliance gap between provider enrollment systems and the physical verification required under 42 CFR § 455.432, protecting Federal Financial Participation and preventing fraud before it starts.
Integrity Advantage
Integrity Advantage is a small woman-owned professional services firm dedicated to helping health payers combat fraud, waste, and abuse (FWA) and improve payment integrity. We offer specialized expertise through FWA program assessments, Special Investigations Unit outsourcing, investigations, medical record reviews, tailored training programs and more. Our team brings decades of hands-on experience across commercial and government lines of business, providing vendor-neutral, technology-enabled solutions that enhance compliance and boost ROI. Certified as a Women's Business Enterprise (WBE) and Economically Disadvantaged Woman-Owned Small Business (EDWOSB), we pride ourselves on delivering best in class support to elevate FWA and Payment Integrity programs.
Dun & Bradstreet, Inc.
Dun & Bradstreet delivers trusted data and analytics to help public sector organizations manage risk, strengthen program integrity, and make confident decisions. We enable agencies to validate, monitor, and better understand businesses and providers across the full lifecycle, supporting enrollment accuracy, oversight, and compliance. By combining a global business database with advanced analytics and actionable insights, D&B helps Medicaid and program integrity teams improve visibility, reduce risk, and ensure resources reach the right constituents.
Commence
At Commence, we build healthcare solutions that change lives. Our approach combines clinical expertise, AI-powered strategy, and scalable technology to deliver outcomes that matter for those who matter most.
SmartLight Analytics
SmartLight Analytics helps self-funded plans reduce wasteful healthcare costs and enhance fiduciary oversight through advanced claims analysis and deep industry expertise. We combine proprietary AI with expert clinical review to uncover waste, errors, and overpayments across medical, pharmacy, and dental billing and payments. Our transparent, result-driven approach protects healthcare dollars without disrupting member benefits. We deliver measurable savings and data-driven guidance to help plans manage healthcare costs more effectively.
Qlarant
Qlarant delivers leading-edge solutions that help our government and commercial clients uncover risks, seize opportunities, and optimize performance. As a leader in identifying and attacking fraud, waste, and abuse, our team of highly skilled experts uses state-of-the-art technologies and techniques for some of the nation's most important programs in health, human services, government, and insurance and financial services. The range of services Qlarant offers for detecting fraudulent activity includes predictive modeling and analytics, investigations, audits, record and claims review, compliance and due diligence, and enrollment monitoring and analysis.
PwC
PwC’s Health Industries practice helps payers, providers, pharmaceutical and life sciences companies, and medical device organizations navigate a rapidly evolving healthcare landscape. The team advises clients on challenges such as rising costs, AI adoption, regulatory change, and shifting patient expectations, enabling them to move faster, build resilience, and deliver trusted outcomes. Backed by PwC’s Health Policy and Intelligence Institute, the practice also provides data-driven insights on medical cost trends, consumer behavior, and policy developments to guide leaders’ most critical decisions.
Pulselight
Pulselight leverages advanced data analytics, AI, and integrated case management to detect and prevent fraud, waste, and abuse across Medicaid programs. Our platform provides instant insights that typically take weeks to uncover, enabling teams to examine more cases and allocate resources effectively. We accelerate investigations, audits, and data analysis for fraud teams, making detection faster and more efficient. Our technology identifies risky providers and potential fraud in real time, offering actionable intelligence to reduce waste and protect funding. Amid record demand and limited resources, our technology empowers organizations to maximize impact per dollar spent and enhance public sector efficiency.
Performant, a Machinify company
Machinify is the healthcare intelligence company that makes claims simple, accurate, and intelligent through one platform operating system. Our responsible AI synthesizes complex policies, gathers and integrates evidence, and supports our subject matter experts so that payers have higher accuracy and consistency at speed, with full transparency and control.
Peraton
Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As one of the world's leading mission capability integrators and transformative enterprise IT providers, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies from threats across the digital and physical domains. Peraton supports every branch of the U.S. Armed Forces, and we serve as a valued partner to essential government agencies that sustain our way of life.
Optum
At Optum, we are bringing simplicity and precision to government health programs. Learn how we can partner with your state at optum.com/stategov.
Myers & Stauffer
For nearly 50 years, Myers and Stauffer has supported our state and federal clients in achieving better care, healthier people, and smarter spending in their health care systems. Our team is focused on protecting the integrity of Medicaid payments, processes, and systems. We draw on our work in various engagements such as eligibility reviews, claims audits and testing, estate recovery, PMB overpayments, provider cost audits, managed care audits and other compliance initiatives. Our services are based on three areas: improving the quality and efficiency of health care, preventing fraud, waste, and abuse, and recovering inappropriately made payments.
Health Management Systems, Inc. (HMS)
Health Management Systems, Inc. (HMS) provides a broad range of payment accuracy solutions that help move the healthcare system forward. Our experts, practitioners, and clinicians are uniquely positioned at the intersection of technology and healthcare, providing unmatched value through our suite of innovative products and solutions created to solve our clients' most complex challenges. We are committed to delivering results beyond the expected. Learn more at www.gainwelltechnologies.com.
Federal Hearings and Appeals Services
Federal Hearings and Appeals Services (FHAS) is a trusted national leader in independent medical review, utilization management, legal adjudication, and dispute resolution. FHAS delivers human-centric, technology-enabled solutions ensuring fairness, integrity, and accountability across healthcare delivery, public policy, and government oversight. With over 30 years of experience, FHAS supports complex healthcare programs at scale, partnering with federal and state agencies, commercial health plans, and programs including Medicare, Medicaid, and FEHBP across 30+ states. As a URAC-accredited Independent Review Organization with Health Utilization Management accreditation and ISO 9001:2015 certification, FHAS maintains a longstanding commitment to quality and operational excellence.
Codoxo
Codoxo empowers healthcare payers with its Generative AI-driven Unified Cost Containment Platform, delivering intelligent, end-to-end payment integrity and fraud, waste, and abuse (FWA) solutions, from pre-claim to prepay and postpay. At the earliest intervention point, Codoxo's Point Zero Payment Integrity solutions identify and prevent payment errors before claims are even submitted, stopping issues at their source. The platform's comprehensive AI capabilities span across provider education, data mining, clinical chart and medical record reviews, no-code concept ideation, fraud detection, audit workflow and case management, and provider contract and medical policy compliance. These help payers achieve unmatched accuracy across the entire claim lifecycle. Codoxo's platform transforms payment integrity by shifting payers from reactive detection to proactive prevention, reducing costs and improving provider relationships. Codoxo has been recognized with a Fierce Healthcare Innovation Award and named to the Inc. 5000 list for its rapid growth. All Codoxo solutions operate in a HITRUST-certified environment. For more information, visit www.codoxo.com.
America's Health Insurance Plans
America's Health Insurance Plans (AHIP) is the national trade association representing the health insurance industry. Designed for busy professionals at all career levels, AHIP's online courses, designations, and on-demand webinars focus on such areas as Medicaid, Medicare, and programs for those who are dually eligible, as well as long-term care, disability, fraud detection and prevention, health care management, and much more. Learn more at ahip.org/courses.
Alivia Analyics
Alivia Analytics helps health plans and government agencies address complex claims challenges, combining AI-powered technology, expert services, and integrated analytics to reduce improper payments and recover more, faster. Our Alivia 360™ platform uncovers what rules-based systems miss, identifying hidden risks in the “Gray Zone” between error, fraud, waste, and abuse to deliver earlier detection and stronger results across the pre- and post-pay spectrum. Backed by data and IT transformation services, we help clients achieve faster results, greater savings, and reduced provider and member abrasion. At NAMPI, we support State Medicaid Agencies with trusted Fraud analytics for Payment Integrity and RAC programs.
Acentra Health
Acentra Health is a leading provider of technology-enabled solutions that help state Medicaid agencies improve program performance and reduce costs. From modular Medicaid Enterprise Systems to person-centered care management and assessment programs, Acentra Health's solutions are trusted by over 40 states. Program integrity is built into every facet of our business: advanced provider screening and enrollment, eligibility and clinical assessments, utilization management, care coordination and case management, and claims processing with pre- and post-payment reviews. Our modular and configurable platform helps agencies meet federal requirements, reduce administrative burden, streamline workflows, and accelerate better health outcomes.
4L Data Intelligence
4L is the patented Integr8 AI™ platform company equipping health plans, self-insured companies, TPAs, workers comp plans, and government health programs with immediate-impact solutions to optimize operations, compliance, care management, and payment performance while controlling operating costs. Our focus is on three interconnected operational areas with Integr8 AI-powered solutions that add layers of performance improvement while driving out unnecessary operational costs and performance inefficiencies – so your plan can experience The Power Of NOW.
IBM
IBM Consulting helps businesses create better and faster outcomes, at scale through the science of consulting. As the only global consultancy within a major technology company, we approach our clients' mission-critical challenges as a science, with trusted expertise supercharged by our AI-powered delivery platform, IBM Consulting Advantage, and our proven co-creation method, IBM Garage. Our 160,000 consultants test, iterate and collaborate openly with clients across major industries and a rich ecosystem of strategic partners because we are dedicated to fast-tracking business value. Learn more at https://www.ibm.com/consulting/state-local-government.
Healthcare Fraud Shield
Healthcare Fraud Shield provides new and unique Fraud, Waste, Abuse & Error (FWAE) automated solutions to the healthcare industry. Our exclusive data solutions and investigative expertise deliver maximum results in the detection and prevention against fraud. Leveraging our comprehensive fraud experience, we deliver fresh insights and new approaches to combat the largest challenge of our time, the delivery of honest, efficient and compassionate healthcare.
Deloitte
Government and Public Services Program Integrity Solutions deliver integrity, innovation, and experience grounded in proven program integrity work. As cyberattacks, identity theft, and improper payments grow more complex, agencies face rising fraud, waste, and abuse (FWA). Our scalable, tech-led, and tailored solutions balance mission goals and program protection to help secure your programs from evolving threats. Leveraging advanced technology and trusted standards, our experienced team supports seamless service delivery while helping monitor, detect, and investigate FWA. AI-driven insights strengthen oversight, improve decision-making, and build integrity and trust at every step.
Public Consulting Group
Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S., all committed to delivering solutions that change lives for the better. PCG offers in-depth programmatic knowledge and regulatory expertise to help state and municipal health agencies and providers respond to regulatory change, improve access to health care, optimize reimbursement, maximize program revenue, improve business processes, and achieve regulatory compliance. Using industry best practices, PCG helps health organizations deliver quality services with constrained resources.
Alliant Health Solutions
Clinically led, data informed, and customer service oriented, Alliant Health Solutions delivers services, expertise, and information systems necessary to increase the effectiveness, accessibility, value and quality of health care. Leveraging expertise and insights gained in more than 50 years supporting local, state and federal health care programs, Alliant program management activities accelerate program impact, ensure successful program integration, and derive greater value from and to our partners. As a non-profit, Alliant provides services for the administration of public and private health care programs, including care management, program integrity/compliance and quality management & improvement. For more information, visit www.allianthealth.org.
CITIZ3N
CITIZ3N is a premier provider of integrated, modular platforms specifically tailored for government agencies overseeing Affordable Care Act (ACA) Marketplaces, Medicaid, Health & Human Services (HHS) and Government Health Benefits for Employees. The collaboration between CITIZ3N and SOFTHEON epitomizes a shared vision of promoting innovative solutions that enhance affordability, accessibility, and efficiency, thereby fostering healthier citizens.
BerryDunn
Improving organizational and programmatic outcomes in the modern Medicaid enterprise BerryDunn Medicaid Consulting and Assurance teams are passionate about helping clients adapt to regulatory changes, improve systems, verify compliance of Medicaid funded programs and eligibility, and streamline processes. Our clients gain value from our deep understanding of the challenges facing state agencies. Our expertise includes: Certification Medicaid Enterprise Systems modernization and planning Organization development services Project Management Office, project management, and system implementation services Data architecture and governance Program Integrity and Payment Error Rate Measurement support Compliance reviews of Medicaid funding programs Medicaid eligibility verification assessments Learn more at berrydunn.com/medicaid.
Hotel Amenities:
- Complimentary Wi-Fi in rooms and public areas
- On-site restaurant & bar/lounge
- 24-hour fitness center
- Indoor pool and spa services
- Business center and meeting facilities
- Room service & concierge
- Valet and self-parking options
- Accessible rooms and services for guests with disabilities
Getting There:
Portland International Airport (PDX) is approximately 25–30 minutes from downtown. Options to reach the hotel:
- Rideshare / Taxi / Rental Car – Convenient direct routes to downtown
- Public Transit – MAX Light Rail (Red Line) connects PDX to downtown; short walk or rideshare to hotel from nearest station
Nearby Attractions:
- Tom McCall Waterfront Park
- Portland Art Museum
- Pearl District & Old Town Chinatown
- Local restaurants, breweries, coffee shops, and boutiques
Questions? Email contact@nampi.net
Frequently Asked Questions
Membership is not required to register for the 2026 annual conference. Your registration is your membership—providing you with 2 years of NAMPI membership beginning at the commencement of the event.
Breakfast, lunch, and evening networking events on August 23, 24, 25, & 26 are included in your registration fee.
