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The NAMPI Annual Conference is a national gathering focused exclusively on Medicaid program integrity. Each year, professionals from across the country come together to share strategies, explore emerging challenges, and strengthen efforts to prevent, detect, and address fraud, waste, and abuse in the Medicaid program.
NAMPI 2026 in Portland will bring together leaders from state and federal agencies, Managed Care Organizations, Medicaid Fraud Control Units, law enforcement, and industry partners for several days of practical learning and collaboration.
Attendees will gain insights through real-world case studies, emerging technologies, policy discussions, and peer-to-peer knowledge sharing — all designed to support stronger, more effective program integrity efforts nationwide.
Join the program integrity community in Portland, Oregon for a conference built on collaboration, innovation, and shared commitment to protecting Medicaid.
Registration for the NAMPI 2026 Annual Conference includes access to all conference sessions (unless otherwise noted), meals, and networking events, along with full access to the virtual platform, session recordings, and additional conference resources.
Each attendee will also receive a two-year NAMPI membership as part of their registration.
In-person registration is sold out
Virtual registration is still open, with full access to sessions, recordings, and networking. A waitlist is available, though additional in-person seats aren't expected.
We invite leaders, practitioners, and innovators in Medicaid program integrity to submit session proposals for the 2026 conference. This is an opportunity to share practical insights, emerging strategies, and real-world experiences that help strengthen efforts to detect, prevent, and address fraud, waste, and abuse.
NAMPI’s program is designed to highlight actionable approaches, cross-sector collaboration, and lessons learned from the field. We welcome proposals from state agencies, federal partners, managed care organizations, investigators, auditors, analysts, legal experts, and other professionals working in program integrity.
If you have a case study, innovative practice, policy insight, or operational strategy that could benefit the broader community, we encourage you to submit a proposal and contribute to this year’s program.
The NAMPI Annual Conference brings together over 1,000 Medicaid program integrity professionals, including state and federal decision-makers, investigators, and industry leaders. Sponsoring NAMPI puts your organization directly in front of a highly targeted audience working to protect Medicaid and reducing Fraud, waste and abuse in the program. A sponsorship at NAMPI offers unmatched opportunities for brand visibility, thought leadership, and meaningful relationship building with the people who matter most to your business.
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.
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
Audit Manager, OMIG
Heather Laudico
Medicaid Integrity Specialist 2 (Financial Analysis), New York State Office of the Medicaid Inspector General
Medicaid Integrity Specialist 2 (Financial Analysis), New York State Office of the Medicaid Inspector General
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
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.
VERA POE
Senior Assistant Attorney General, Department of Justice, State of Oregon
Senior Assistant Attorney General, Department of Justice, State of Oregon
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
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.
*All Attendees Welcome*
*All Attendees Welcome*
Tamara McNatt
Program Integrity Audit Unit Manager, Oregon Health Authority
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
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.
Lori Stiles
Manager, Medicaid Program Integrity Unit, Idaho Department of Health & Welfare
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.
Vanessa Templeman
Inspector General, AHCCCS OIG
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).
Frank Walsh, Jr.
Acting Medicaid Inspector General, New York State Office of the Medicaid Inspector General
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.
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
Interim Director, Oregon Health Authority
Starting with the portrayal of the dialysis industry in his recent book, How to Make a Killing: Blood, Death and Dollars in American Medicine, investigative reporter Tom Muller will explore the patterns of wrongdoing and deception that underlie individual fraud schemes.
Thank You to Our Keynote Sponsor!

Tom Mueller, PhD
Investigative Journalist, Author
Investigative Journalist, Author
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.
Discover a unified intelligent AI approach to program integrity. The use of integrated data science ecosystems plus advanced AI-driven analytics platforms can dramatically improve results. Learn how Ethical AI automation plus human-in-the-loop decision making builds a stronger program integrity enterprise.
Bart Armstrong
Senior Director, Program Management., HMS/Gainwell Technologies
Senior Director, Program Management., HMS/Gainwell Technologies
Will Mapp, III
Chief Technology Officer, Qlarant
Chief Technology Officer, Qlarant
Holly Pu
Vice President Product Development, Qlarant
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.
Arizona’s Medicaid agency, AHCCCS, is advancing a prevention-first approach to program integrity by bringing earlier fraud detection, stronger workflows, and human oversight into the review process. Following the NAMPI webinar Insight into Action: Arizona’s Program Integrity Journey, this session explores how Arizona’s model moved from concept to production, including pre-adjudication fraud detection, integrated pre-pay and post-pay activities, AI-driven prioritization, real-time fraud edits, and connected case management. AHCCCS and Alivia Analytics will share implementation lessons, collaboration considerations, and practical guidance for Medicaid agencies evaluating more proactive, technology-enabled approaches to addressing fraud, waste, and abuse.
Lynne Emmons
Assistant Deputy Director of FFS Programs, AHCCCS
Assistant Deputy Director of FFS Programs, AHCCCS
Matt Perryman
Chief Technology Officer, Alivia Analytics
Chief Technology Officer, Alivia Analytics
Vanessa Templeman
Inspector General, AHCCCS OIG
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).
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.
Johnny Brooks
Director Program Integrity, Georgia Department of Community Health
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.
Derik Ciccarelli
Director of Operations, Fraud Scope, Codoxo
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.
Sara Rodriguez
Healthcare Fraud Analyst, Codoxo
Healthcare Fraud Analyst, Codoxo
With CMS tightening spending oversight, many Medicaid programs are moving FWA upstream, shifting from “pay and chase” to prevention‑focused controls. States are reassessing how prepayment review can strengthen program integrity and ease downstream burdens. This session examines prepayment review within Medicaid claims and ripple effects across program integrity. Presenters will explore how prepayment controls influence post‑payment audits, appeals, recovery, and more, helping agencies reduce rework and improve accuracy. The discussion will focus on lessons from implementing prepayment review within existing structures and address common challenges, such as balancing timely access to care with payment safeguards.
Cindy Beane
Owner/ CEO, Beane Medicaid & Health Solutions
Owner/ CEO, Beane Medicaid & Health Solutions
Gary Call
Chief Medical Officer, Health Management Systems, Inc. (HMS)
Chief Medical Officer, Health Management Systems, Inc. (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.
Greg Fischer
Senior Vice President of FWA Markets, Health Management Systems, Inc. (HMS)
Senior Vice President of FWA Markets, Health Management Systems, Inc. (HMS)
William O'Neill
VP, Product, FWA & Analytics, HMS
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.
Karen Shields
Strategic Advisor, Gainwell Technologies
Strategic Advisor, Gainwell Technologies
Receiving a subpoena to testify can be a stressful experience for staff. This session provides a practical, real-world overview of what it means to serve as a witness in a fraud case and how to effectively prepare. Presented from dual perspectives of a Medicaid program integrity professional and a MFCU prosecutor, the session will walk attendees through the lifecycle of a case, investigation to courtroom testimony, highlighting expectations, common pitfalls, and best practices. Attendees will leave with a clearer understanding of their role, increased confidence in navigating the legal process, and actionable strategies to support successful outcomes.
Ann Kaperak
Assistant Chief, Florida Agency for Health Care Administration
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
Assistant Attorney General, FL Office of the Attorney General - Medicaid Fraud Control Unit
Care Management services were implemented over a decade ago, but significant increases in billing occurred in 2025 and 2026 due to the addition of new codes. The presentation will include a coding/billing overview and complaint examples from the SMP. The session will focus on the highest billed service of Chronic Care Management including data analysis of codes, diagnosis, and place of service trends. The emerging trend of duplicate billing with Remote Patient Monitoring, clinical concerns, the use of AI, third party service providers, and combination services to justify a broad scope of care management billing will also be discussed.
Mike Cohen
Operations Officer, HHS Office of Inspector General
Operations Officer, HHS Office of Inspector General
Jennifer Trussell
Fraud Prevention Consultant, SMP Resource Center
Fraud Prevention Consultant, SMP Resource Center
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 case 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
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.
Anthony Florio
Deputy Inspector General, Illinois Department of Healthcare and Family Services - Office of Inspector General
Deputy Inspector General, Illinois Department of Healthcare and Family Services - Office of Inspector General
Walking through Washington State Medicaid Fraud and Abuse Division's (MFAD) data driven approach to investigating dental fraud. Managing Assistant Attorney General Naomi Smith and Data Scientist April Minton will explain which codes lend themselves to a data driven approach (as opposed to chart-by-chart or sample group expert review), and characteristics of those codes. Presenters will go through de-identified real case examples and application. Finally, they will discuss how MFAD and Health Care Authority (Washington's Medicaid Agency) communicate and collaborate to address dental fraud.
April Minton
Data Scientist, Washington State Medicaid Fraud Control
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
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.
The panel will feature representatives from State Medicaid, CMS, HHS-OIG, and
FinCEN to discuss how states are using prepay strategies today to prevent improper payments before they occur, and how federal partners are using financial intelligence in their own strategies to strengthen oversight, investigations, and administrative action. The discussion will highlight how policy alignment, provider enrollment controls, claims analytics, prepayment edits, enrollment verification, and revalidation can help states identify risk earlier and act before payment
Rosalind Abankwah
Health Insurance Specialist, Centers for Medicare & Medicaid Services
Health Insurance Specialist, Centers for Medicare & Medicaid Services
Gary Cantrell
Program Integrity Lead, Deloitte
Program Integrity Lead, Deloitte
Ricardo Carcas
Assistant Special Agent in Charge, HHS-OIG
Assistant Special Agent in Charge, HHS-OIG
Ashley Dirienzo
Fraud, Waste & Abuse Director, Colorado Medicaid
Fraud, Waste & Abuse Director, Colorado Medicaid
Adam Thurston
Section Chief, Financial Crimes Enforcement Network
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.
Mary Vanatta
Senior Advisor for Program Integrity, Centers for Medicare and Medicaid Services
Senior Advisor for Program Integrity, Centers for Medicare and Medicaid Services
State Medicaid agencies are challenged to achieve strong program integrity outcomes while managing growing audit volume, limited resources, and administrative burden. This session shares practical audit best practices that improve efficiency, consistency, and compliance without sacrificing rigor. Attendees will learn strategies for risk-informed audit planning, policy-centric and system-driven reviews, streamlined documentation and communication, and effective corrective action management. Drawing on real-world experience supporting state Program Integrity Units, the session highlights how collaboration, prevention-focused approaches, and modernized workflows can reduce operational friction, strengthen audit outcomes, and create more resilient and effective Medicaid program integrity programs.
Davilyn Ariail
Deputy Director - Program Integrity and Medical Review, Alliant Health Solutions
Deputy Director - Program Integrity and Medical Review, Alliant Health Solutions
Katie Pass
Director, Stakeholder Engagement, Alliant Health Solutions
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.
Medicaid program integrity conversations often center on eligibility, funding, and compliance — and not necessarily on the data itself. This session brings together payment integrity and claims data experts for a candid look at what happens when states actually dig into their data — and what happens when they don't. What states can act on today without waiting on legislation sits at the center of the conversation — along with how a comprehensive, AI-enabled payment integrity program can quickly identify and rein in the spend drivers compared to periodic audits or building internal capacity from scratch.
Marilyn Bartlett
Consultant, MJBartlett LLC Consulting
Consultant, MJBartlett LLC Consulting
Dave Gemmill
Director of Account Management, SmartLight Analytics
Director of Account Management, SmartLight Analytics
This session guides Medicaid constituents in adopting proactive strategies to strengthen program integrity and prevent or detect fraud, waste, and abuse. Highlighting the connection between provider behavior, policies, and controls, the discussion emphasizes evaluating policy gaps in programs like Applied Behavior Analysis therapy, Personal Care Services, and Non-Emergency Medicaid Transportation. Participants will explore data-driven approaches, including encounter data analysis and claims testing, to anticipate vulnerabilities and enhance compliance. Leveraging Myers & Stauffer’s expertise, this session offers practical strategies for shifting focus to preventive measures and fostering sustainable improvements, reducing reliance on reactive audits while strengthening Medicaid programs.
Kimberly Forrest
Director, Myers & Stauffer
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
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.
John Lott
Senior Manager, Myers & Stauffer
Senior Manager, Myers & 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.
Travis Melton
Senior Manager, Myers & Stauffer
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.
Medicaid programs face increasing pressure to identify and respond to risk earlier, particularly within service areas that have historically attracted heightened program integrity, audit, and oversight attention. Risk indicators often emerge across multiple Medicaid functions, including member eligibility, managed care oversight, provider monitoring, audits, investigations, and other program integrity activities. Each function provides a unique perspective on emerging risk. This session will explore how states can identify, interpret, and act upon risk signals across the Medicaid enterprise to strengthen accountability and support more effective risk-based decision making. Through a practical framework and discussion-based case study, presenters will demonstrate proactive risk-management.
Jay Derby
Senior Consultant, Public Consulting Group
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.
Sarah Kolar
Program Manager, Public Consulting Group
Program Manager, Public Consulting Group
Hannah Trate
Senior Consultant, Public Consulting Grouo
Senior Consultant, Public Consulting Grouo
This session highlights OMIG’s multi-engagement audit approach: a coordinated, simultaneous review of one provider’s Medicaid Fee for Service claims and Managed Care Organization encounters. While Fee for Service and managed care audits were traditionally conducted separately, this model streamlines the process while maintaining separate audit universes, samples, and findings for each payor source. Attendees will learn about provider notification, plan-specific engagement, sampling, and record review, as well as benefits including stronger oversight, efficient workflows, and reduced provider burden. This session will offer attendees an 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
Audit Manager, Office of the Medicaid Inspector General
Shavasya Jacob, MPA
Audit Supervisor, New York Office of the Medicaid Inspector General
Audit Supervisor, New York 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.
Join the Oregon and Nebraska teams as they discuss Electronic Visit Verification (EVV) and their efforts to address issues with personal care services. The session will cover a brief history of EVV in both states, corrective actions taken, what has proven successful, and what new holes have appeared in the fence guarding the Medicaid program.
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
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.
Caleb Richards
FWA Detection and Prevention Manager, Oregon Health Authority
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.
Vernalisa Taylor
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
Aaron Ziska
Provider Fraud Investigator, NE DHHS MLTC
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.
This session will show how financial forensics helps investigators “follow the money” in complex Medicaid provider fraud cases. We will walk through the process of tracing Medicaid funds from initial payment streams into personal and business accounts, related entities, and assets such as real estate, vehicles, investments, and luxury purchases. The session will also demonstrate how bank records, wire transfers, corporate filings, and open-source information can be combined to identify hidden ownership, shell companies, nominee owners, and circular payment schemes that may indicate kickbacks or self-dealing.
Donna Knapp
Manager, Major Case Unit, Texas HHSC Office of the Inspector General
Manager, Major Case Unit, Texas HHSC Office of the Inspector General
CMS will outline Medicaid/CHIP program integrity efforts pursued through PERM eligibility reviews and CPI targeted eligibility audits, focusing on oversight of states' unwinding from flexibilities associated with the COVID-19 PHE and other high-risk eligibility categories/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/CHIP program integrity.
Nicholas Bonomo
Supervisory Health Insurance Specialist, CMS
Supervisory Health Insurance Specialist, CMS
Chrissy Fowler
Director of Payment Accuracy & Reporting Group, Centers for Medicare and Medicaid Services/ Office of Financial Management
Director of Payment Accuracy & Reporting Group, Centers for Medicare and Medicaid Services/ Office of Financial Management
Shirin Hormozi
Director Division of State Program Integrity, CMS
Director Division of State Program Integrity, CMS
Camiel Rowe
Division Director, Center for Medicare and Medicaid Services
Division Director, Center for Medicare and Medicaid Services
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.
Tasha Gardner
Special Deputy Attorney General, NC Department of Justice - Medicaid Investigations Division
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.
Eddie Kirby, Jr.
Director, North Carolina Department of Justice, Medicaid Investigations Division
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
Financial Investigations Supervisor, NCDOJ - Medicaid Investigations Division
Kevin Lownds
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
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.
This session will walk through the communication and collaboration between the Medicaid agency and the Medicaid Fraud Control Unit (MFCU) from the time the Medicaid agency receives a potential fraud allegation through the formal referral process. It will also cover the ongoing coordination, information sharing and cooperation between the agencies as the case progresses until it is resolved.
Kevin Lownds
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
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
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.
This session will present examples of successful program recommendations that resulted in positive changes. Then, the audience will engage in discussions about best practices and tips for effectively preparing and promoting program recommendations.
Lane Olson
Chief Investigator, Utah MFCU
Chief Investigator, Utah MFCU
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
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.
Kaye Lynn Wootton
Director, Medicaid Fraud Control Unit, Utah Attorney General's Office
Director, Medicaid Fraud Control Unit, 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.
Aaron Ziska
Provider Fraud Investigator, NE DHHS MLTC
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.
Come chat with Ohio and Arizona as we discuss key investigation considerations as part of the joint NAMFCU and NAMPI skills block training session.
Justin Gates
Chief Special Agent, Ohio Medicaid Fraud Control Unit
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.
Ben Karrasch
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
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.
Vanessa Templeman
Inspector General, AHCCCS OIG
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).
This presentation outlines how fraud occurs in non-emergency medical transportation (NEMT) by explaining provider structures, their relationships with Managed Care Organizations, and gaps that allow misuse. It highlights key evidence-gathering methods—including provider records, MCO data, and recipient verification—and tools like Part II Orders. It also addresses challenges such as inconsistent documentation, subcontracted drivers, and vulnerable or hard-to-locate recipients. Attendees will learn how to structure investigations, identify critical evidence, and build strong fraud cases.
Pamela Graham, AHFI, CPC
Investigator III, Oregon Department of Justice
Investigator III, Oregon Department of Justice
Alex Hargrove
Senior Assistant Attorney General, Oregon Department of Justice
Senior Assistant Attorney General, Oregon Department of Justice
Fritz Jenkins
Administrator for Program Integrity, Oregon Health Authority
Administrator for Program Integrity, Oregon Health Authority
Back by popular demand! In this engaging panel, Medicaid PI leaders will share real-world stories about emerging schemes, provider outliers, utilization spikes, and lessons learned from CMS and HHS OIG audits, all while eating hot wings! Hear from burning mouths how Program Integrity teams try to stay ahead of “hot” schemes and use data more proactively to identify risk before improper payments fly out the door.
Jason Helmandollar
VP Healthcare Solutions, Pulselight
VP Healthcare Solutions, Pulselight
Ann Kaperak
Assistant Chief, Florida Agency for Health Care Administration
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.
Ben Karrasch
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
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
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.
David Ward
Sr. Director, LTSS, Oklahoma Health Care Authority
Sr. Director, LTSS, Oklahoma Health Care Authority
What if investigators spent their days investigating — not chasing documents? Peraton's Operational Excellence Initiative reimagined how AI, LLMs, and RPA ease friction in program integrity work — powered by Rapid FI's scalable fraud intelligence, no rip-and-replace required. Key Takeaways • A Repeatable Method for Finding Opportunity: A structured approach to surface high-value automation candidates.
• LLM and RPA Fundamentals for Program Integrity: What each does well, how they complement, where human expertise leads • Platform-Enabled Scale with Rapid FI: Incremental adoption — no disruptive re-platforming.
Mikhial Jerzak
Technical Architect, Peraton
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
Chief Operating Officer, Safeguard Services, LLC a Peraton company
In the evolving Medicaid FWA landscape, static claims data alone can leave critical blind spots. To detect sophisticated schemes such as phantom providers and behavioral health anomalies, SIUs must expand beyond traditional data sources. This session will show how external data enrichment and public records can convert raw information into actionable intelligence, revealing hidden provider networks, corporate relationships, and geographic anomalies. We will also demonstrate how enriched data strengthens medical record review by delivering pre-vetted, contextual insights directly to auditors. This approach helps teams identify vulnerabilities faster, reduce manual file fatigue, improve review accuracy, and support stronger payment integrity outcomes.
Karen Weintraub
Executive Vice President, Healthcare Fraud Shield
Executive Vice President, Healthcare Fraud Shield
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
Senior Managing Consultant, IBM Consulting
Jillian Scalvini, MPH
Associate Manager, IBM
Associate Manager, IBM
Kyle Dale Walters
Managing Consultant, IBM
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.
Sponsored by Public Consulting Group
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
Acting Deputy Inspector General for Investigations, U.S. Health and Human Services, Office of Inspector General
Large language models (LLM) are creating new opportunities to analyze information more efficiently, strengthen investigative workflows, and make better use of existing FWA detection assets. Join this session to learn how technology can support fraud detection, lead reviews, summarize results, draft correspondence, and develop case files. We’ll focus on applied techniques, implementation considerations, and responsible use of AI in program integrity operations. • How LLMs can assist with fraud analytics across complex data environments • Techniques for summarizing investigative results, surfacing patterns, and prioritizing leads • Demonstrate how AI-assisted tools, including Copilot capabilities, can help develop and execute fraud studies.
Kevin Hutchinson
VP, Business Development, State Government Solutions, Optum
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.
James Lukenbill
Analytics Strategic Product Manager, State Government Solutions, Optum
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.
Ulyana Peychev
Senior Manager Data Analytics, State Government Solutions, Optum
Senior Manager Data Analytics, State Government Solutions, Optum
Join us as InComm Healthcare explores how rewards and digital delivery can strengthen Medicaid member engagement. Dave Etling, SVP and GM of InComm Payments will dive into: -How rewards motivate members to complete healthy actions and address care gap -Why digital delivery drives greater engagement through immediate access to incentives while eliminating the cost and complexity of physical fulfillment -Real-world results and key considerations for designing and implementing effective rewards programs.
Dave Etling
SVP & GM, InComm Payments
SVP & 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.
Federal expectations for state program integrity have never been higher. CRUSH, provider revalidation, payment deferrals, and MFCU reviews demand action on compressed timelines, yet terminations without due diligence can devastate access in rural and shortage communities. This session makes the case for running program integrity as one connected system — enrollment, claims, analytics, investigations, and managed-care oversight working from the same playbook, not in silos. Drawing from leading practices across industries, it offers a practical path for calibrating enforcement, a six-component diagnostic for where your program stands, a phased roadmap, and concrete moves you can make immediately.
Anne Harvey
Program Integrity Administrator, Nebraska Medicaid
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.
Bharath Mamathambika
Principal, PwC
Principal, PwC
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
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.
Between 2024 and 2026, HHS-OIG audited Medicaid-funded Applied Behavior Analysis services in Indiana, Wisconsin, Maine, and Colorado. In every state, 100% of sampled claims contained improper payments, totaling nearly $200 million in recommended federal refunds. This panel explores the regulatory blind spots revealed by these audits, including documentation deficiencies, credentialing gaps, and billing for non-therapeutic activities. Panelists will analyze the audit process, state-specific responses, and concerns regarding extrapolation methodology. Attendees will gain actionable strategies to design robust state-level audit frameworks and proactively identify high-risk billing vulnerabilities within their own Medicaid programs.
Ashley Dirienzo
Fraud, Waste & Abuse Director, Colorado Medicaid
Fraud, Waste & Abuse Director, Colorado Medicaid
Sarah Geduldig
Provider Integrity Section Manager, Colorado Department of Health Care Policy and Financing
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.
Casey Klippel
Director of Program Integrity, Indiana Medicaid
Director of Program Integrity, Indiana Medicaid
Tabitha Ramminger
Deputy Inspector General, Wisconsin Department of Health Services
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.
The session will present a visual “ecosystem map” illustrating how SCDHHS, MCOs, MFCU, and other stakeholders interact throughout PI processes. It will explain how MCO compliance plans and annual PI reviews support contract oversight. Attendees will also learn how SCDHHS’s secure PI SharePoint environment is used to share live data sets, manage contract deliverables with version control, support referral coordination, and track federal and state information requests.
Duane Kimball
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
The Office of Inspector General for the Illinois Department of Healthcare and Family Services (HFS OIG) conducted a study to determine whether Illinois’ State Medicaid Agency was effectively identifying managed care capitation payments made for members post-mortem and ensuring recovery of those payments. This analysis involved contractual and regulatory review, gaining access to new datasets, coordination with various stakeholders, and significant data analysis, resulting in the identification of $100M in overpayments available for recoupment. In this presentation, HFS OIG will discuss this project’s objectives, challenges, and outcomes in an effort to support similar projects in other states.
Brian Dunn
Inspector General, IL HFS OIG
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.
Kelly Waldhoff
Chief Operating Officer, Office of Inspector General for the Illinois Department of Healthcare and Family Services
Chief Operating Officer, Office of Inspector General for the Illinois Department of Healthcare and Family Services
This session will review Nebraska's recent implementation of the Legally Responsible Individual (LRI) provider category for personal care services from screening and enrollment to post-payment review. We'll discuss some of the risks that we have identified, and potential steps to limit these risks.
Melinda Abbott
Provider Relations Administrator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Provider Relations Administrator, 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
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.
Betsie Steenson
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
The Healthcare Fraud Prevention Partnership conducted an innovative analysis across high-risk program areas to detect anomalous billing behaviors.
The analysis encompassed ten diverse home and community-based services:
• Adult Companion Services
• Adult Day Care
• Assertive Community Treatment
• Behavioral Services for Youth with Autism or Related Conditions
• Home and Personal Support Services
• Long-Term Residential Behavioral Health
• Non-Emergency Medical Transportation
• Peer Services
• Psychosocial Rehabilitative Services
• Residential and Community Support Services
This session will provide insights into methodologies employed, key analytics findings, and broader implications for improving program integrity within home and community-based care.
Maricruz Bonfante
Deputy Director, Division of Vulnerability Strategy, Audits and Vulnerabilities Group, Center for Program Integrity, Centers for Medicare & Medicaid Services
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.
Amanda Burrows
Subject Matter Expert Supervisor, HFPP-GDIT
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.
Richard Haines
Sr. Investigative Analyst, Healthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
Sr. Investigative Analyst, Healthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
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 in their states. 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.
Lee Grossman
Medicaid Director, Iowa Health and Human Services
Medicaid Director, Iowa Health and Human Services
Neda Jasemi
Senior Policy Analyst, The National Association of Medicaid Directors (NAMD)
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
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.
Kaye Lynn Wootton
Director, Medicaid Fraud Control Unit, Utah Attorney General's Office
Director, Medicaid Fraud Control Unit, 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.
To combat Medicaid fraud, it is essential that managed care organizations (MCOs) refer any potential provider fraud that they identify to State Medicaid agencies (States) and MFCUs. Recent OIG work indicated that some MCOs made few referrals of potential provider fraud. Through evaluations of MCOs, States, and MFCUs, OIG has identified promising strategies for increasing the volume and/or quality of MCOs’ fraud referrals. In this session, we will describe OIG’s recent work on this topic and some of these promising strategies. Strategies include States and MFCUs offering fraud referrals training to MCOs and enhancing communication between States, MFCUs, and MCOs.
Craig Diena
Team Leader & Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General
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.
Michael Henry
Director of the Medicaid Fraud Control Unit Oversight Division, HHS/OIG
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
Team Leader and Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General, Office of Evaluation and Inspections
The presentation will walk attendees through a multi-million-dollar fraudulent behavioral health provider case. It will provide details regarding the data analytics performed to identify the provider, how the fieldwork and investigation were conducted, as well as the case outcome and a follow-up on the individuals involved.
Cori Ellis
Assistant Special Agent in Charge, Investigations, Louisiana Department of Justice/Medicaid Fraud Control Unit
Assistant Special Agent in Charge, Investigations, Louisiana Department of Justice/Medicaid Fraud Control Unit
Erin McAlister
Assistant Special Agent in Charge, Louisiana Department of Justice/MFCU
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.
This session will explore the complexities associated with providing care for these individuals, specifically the implications on payments to hospice providers when pediatric patients can continue receiving concurrent palliative and curative care. Additionally, we'll review how to determine care coordination between hospice providers, attending physicians, and managed care organizations.
Anton Dutchover
Deputy Inspector General of Audit and Inspections, Texas HHSC OIG
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.
Patrick Smith
Audit Director, Texas Office of Inspector General
Audit Director, Texas Office of Inspector General
An overview of CMS's core priority areas with a closer look at our newer analytic platforms; key updates and changes on the oversight and enforcement side; working with law enforcement partners to combat fraud; and an update on resources and educational technical assistance available to support state partners.
Jeneen Iwugo
Acting Director, Center for Program Integrity (CPI), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
Acting Director, Center for Program Integrity (CPI), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
NAMFCU President Kaye Lynn Wootton and V.P. Eddie Kirby will provide a brief summary of the year's events and NAMFCU projects.
Eddie Kirby, Jr.
Director, North Carolina Department of Justice, Medicaid Investigations Division
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).
Kaye Lynn Wootton
Director, Medicaid Fraud Control Unit, Utah Attorney General's Office
Director, Medicaid Fraud Control Unit, 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.
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
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.
Vanessa Templeman
Inspector General, AHCCCS OIG
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).
Health Insurance Specialist, Centers for Medicare & Medicaid Services
READ BIOCenters for Medicare & Medicaid Services
Provider Relations Administrator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
READ BIONebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Deputy Director - Program Integrity and Medical Review, Alliant Health Solutions
READ BIOAlliant Health Solutions
Senior Director, Program Management., HMS/Gainwell Technologies
READ BIOHMS/Gainwell Technologies
Consultant, MJBartlett LLC Consulting
READ BIOMJBartlett LLC Consulting
Owner/ CEO, Beane Medicaid & Health Solutions
READ BIOBeane Medicaid & Health Solutions
Acting Deputy Inspector General for Investigations, U.S. Health and Human Services, Office of Inspector General
READ BIOU.S. Health and Human Services, Office of Inspector General
Deputy Director, Division of Vulnerability Strategy, Audits and Vulnerabilities Group, Center for Program Integrity, Centers for Medicare & Medicaid Services
READ BIOCenters 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.
Supervisory Health Insurance Specialist, CMS
READ BIOCMS
Director Program Integrity, Georgia Department of Community Health
READ BIOGeorgia 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.
Subject Matter Expert Supervisor, HFPP-GDIT
READ BIOHFPP-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.
Chief Medical Officer, Health Management Systems, Inc. (HMS)
READ BIOHealth Management Systems, Inc. (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.
Program Integrity Lead, Deloitte
READ BIODeloitte
Assistant Special Agent in Charge, HHS-OIG
READ BIOHHS-OIG
Director of Operations, Fraud Scope, Codoxo
READ BIOCodoxo
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.
Operations Officer, HHS Office of Inspector General
READ BIOHHS Office of Inspector General
Senior Consultant, Public Consulting Group
READ BIOPublic 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.
Team Leader & Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General
READ BIOU.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.
Fraud, Waste & Abuse Director, Colorado Medicaid
READ BIOColorado Medicaid
Inspector General, IL HFS OIG
READ BIOIL 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.
Deputy Inspector General of Audit and Inspections, Texas HHSC OIG
READ BIOTexas 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.
Assistant Special Agent in Charge, Investigations, Louisiana Department of Justice/Medicaid Fraud Control Unit
READ BIOLouisiana Department of Justice/Medicaid Fraud Control Unit
Assistant Deputy Director of FFS Programs, AHCCCS
READ BIOAHCCCS
SVP & GM, InComm Payments
READ BIOInComm 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.
Senior Vice President of FWA Markets, Health Management Systems, Inc. (HMS)
Deputy Inspector General, Illinois Department of Healthcare and Family Services - Office of Inspector General
READ BIOIllinois Department of Healthcare and Family Services - Office of Inspector General
Audit Manager, OMIG
READ BIOOMIG
Director, Myers & Stauffer
READ BIOMyers & 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.
Director of Payment Accuracy & Reporting Group, Centers for Medicare and Medicaid Services/ Office of Financial Management
READ BIOCenters for Medicare and Medicaid Services/ Office of Financial Management
Special Deputy Attorney General, NC Department of Justice - Medicaid Investigations Division
READ BIONC 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.
Chief Special Agent, Ohio Medicaid Fraud Control Unit
READ BIOOhio 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.
Provider Integrity Section Manager, Colorado Department of Health Care Policy and Financing
READ BIOColorado 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.
Director of Account Management, SmartLight Analytics
READ BIOSmartLight Analytics
Senior Manager, Myers & Stauffer
READ BIOMyers & 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.
Investigator III, Oregon Department of Justice
READ BIOOregon Department of Justice
Audit Manager, Office of the Medicaid Inspector General
READ BIOOffice of the Medicaid Inspector General
Medicaid Director, Iowa Health and Human Services
READ BIOIowa Health and Human Services
Sr. Investigative Analyst, Healthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
READ BIOHealthcare Fraud Prevention Partnership (HFPP) - General Dynamics Information Technology
Senior Assistant Attorney General, Oregon Department of Justice
READ BIOOregon Department of Justice
Program Integrity Administrator, Nebraska Medicaid
READ BIONebraska 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.
VP Healthcare Solutions, Pulselight
READ BIOPulselight
Director of the Medicaid Fraud Control Unit Oversight Division, HHS/OIG
READ BIOHHS/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.
Director Division of State Program Integrity, CMS
READ BIOCMS
VP, Business Development, State Government Solutions, Optum
READ BIOOptum
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.
Acting Director, Center for Program Integrity (CPI), Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
READ BIOCenters for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI)
Audit Supervisor, New York Office of the Medicaid Inspector General
READ BIONew York 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.
Senior Policy Analyst, The National Association of Medicaid Directors (NAMD)
READ BIOThe 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.
Administrator for Program Integrity, Oregon Health Authority
READ BIOOregon Health Authority
Technical Architect, Peraton
READ BIOPeraton
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.
Assistant Chief, Florida Agency for Health Care Administration
READ BIOFlorida 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.
Director-Medicaid Fraud Control Unit, Ohio Attorney General's Office
READ BIOOhio 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.
Operation and Managed Care Oversight Manager, South Carolina Department of Health and Human Services (SCDHHS)
READ BIOSouth Carolina Department of Health and Human Services (SCDHHS)
Director, North Carolina Department of Justice, Medicaid Investigations Division
READ BIONorth 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).
Director of Program Integrity, Indiana Medicaid
READ BIOIndiana Medicaid
Manager, Major Case Unit, Texas HHSC Office of the Inspector General
READ BIOTexas HHSC Office of the Inspector General
Program Manager, Public Consulting Group
READ BIOPublic Consulting Group
Medicaid Integrity Specialist 2 (Financial Analysis), New York State Office of the Medicaid Inspector General
READ BIONew York State Office of the Medicaid Inspector General
Financial Investigations Supervisor, NCDOJ - Medicaid Investigations Division
READ BIONCDOJ - Medicaid Investigations Division
Senior Manager, Myers & Stauffer
READ BIOMyers & 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.
Division Chief, Office of the Massachusetts Attorney General, Medicaid Fraud Division
READ BIOOffice 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.
Analytics Strategic Product Manager, State Government Solutions, Optum
READ BIOOptum
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.
Principal, PwC
READ BIOPwC
Chief Technology Officer, Qlarant
READ BIOQlarant
Senior Managing Consultant, IBM Consulting
READ BIOIBM Consulting
Assistant Attorney General, FL Office of the Attorney General - Medicaid Fraud Control Unit
READ BIOFL Office of the Attorney General - Medicaid Fraud Control Unit
Assistant Special Agent in Charge, Louisiana Department of Justice/MFCU
READ BIOLouisiana 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.
Program Integrity Audit Unit Manager, Oregon Health Authority
READ BIOOregon 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.
Senior Manager, Myers & Stauffer
READ BIOMyers & 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.
Assistant Chief Special Agent, Arizona Attorney General's Office
READ BIOArizona 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.
Data Scientist, Washington State Medicaid Fraud Control
READ BIOWashington 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.
Investigative Journalist, Author
READ BIOAuthor
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.
Director: Division of Program Integrity, Department of Health Care Finance
READ BIODepartment 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.
VP, Product, FWA & Analytics, HMS
READ BIOHMS
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.
Chief Investigator, Utah MFCU
READ BIOUtah MFCU
Interim Director, Oregon Health Authority
READ BIOOregon Health Authority
Director, Stakeholder Engagement, Alliant Health Solutions
READ BIOAlliant 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.
Chief Technology Officer, Alivia Analytics
READ BIOAlivia Analytics
Senior Manager Data Analytics, State Government Solutions, Optum
READ BIOOptum
Senior Assistant Attorney General, Department of Justice, State of Oregon
READ BIODepartment of Justice, State of Oregon
Health Bureau Chief, Nevada Health Authority
READ BIONevada 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.
Vice President Product Development, Qlarant
READ BIOQlarant
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.
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
READ BIONebraska 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.
Deputy Inspector General, Wisconsin Department of Health Services
READ BIOWisconsin 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.
FWA Detection and Prevention Manager, Oregon Health Authority
READ BIOOregon 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.
Healthcare Fraud Analyst, Codoxo
READ BIOCodoxo
Division Director, Center for Medicare and Medicaid Services
READ BIOCenter for Medicare and Medicaid Services
Associate Manager, IBM
Director and Counsel, Fraud Enforcement and Audit Response, Commonwealth of Massachusetts
READ BIOCommonwealth 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.
Strategic Advisor, Gainwell Technologies
READ BIOGainwell Technologies
Managing Assistant Attorney General, Washington Attorney General's Office
READ BIOWashington 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.
Audit Director, Texas Office of Inspector General
READ BIOTexas Office of Inspector General
Chief Operating Officer, Safeguard Services, LLC a Peraton company
READ BIOSafeguard Services, LLC a Peraton company
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
READ BIONebraska Department of Health & Human Services Division of Medicaid & Long-Term Care
Manager, Medicaid Program Integrity Unit, Idaho Department of Health & Welfare
READ BIOIdaho 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.
Medicaid Provider Fraud & Abuse Investigator, Nebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
READ BIONebraska Department of Health and Human Services, Division of Medicaid and Long-Term Care
Inspector General, AHCCCS OIG
READ BIOAHCCCS 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).
Team Leader and Social Science Analyst, U.S. Department of Health and Human Services Office of Inspector General, Office of Evaluation and Inspections
READ BIOU.S. Department of Health and Human Services Office of Inspector General, Office of Evaluation and Inspections
Section Chief, Financial Crimes Enforcement Network
READ BIOFinancial 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.
Senior Consultant, Public Consulting Grouo
READ BIOPublic Consulting Grouo
Fraud Prevention Consultant, SMP Resource Center
READ BIOSMP Resource Center
Senior Advisor for Program Integrity, Centers for Medicare and Medicaid Services
READ BIOCenters for Medicare and Medicaid Services
Chief Operating Officer, Office of Inspector General for the Illinois Department of Healthcare and Family Services
READ BIOOffice of Inspector General for the Illinois Department of Healthcare and Family Services
Acting Medicaid Inspector General, New York State Office of the Medicaid Inspector General
READ BIONew 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.
Managing Consultant, IBM
READ BIOIBM
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.
Sr. Director, LTSS, Oklahoma Health Care Authority
READ BIOOklahoma Health Care Authority
Executive Vice President, Healthcare Fraud Shield
READ BIOHealthcare Fraud Shield
Director, Medicaid Fraud Control Unit, Utah Attorney General's Office
READ BIOUtah 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.
Provider Fraud Investigator, NE DHHS MLTC
READ BIONE 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.
Hilton Portland Downtown | 921 SW 6th Ave
Located in the heart of downtown Portland, this year's conference hotel is steps from restaurants, shopping, and iconic landmarks. NAMPI has reserved a limited block of rooms — availability is limited, so we encourage attendees to book early.
Room Rate: $159/night + taxes and fees
Cut-Off Date: July 31, 2026
Important Notice: Only book through the hotel link above or in official NAMPI communications. If you receive an unsolicited offer, do not click links or share payment information. We cannot assist with reservations made through other links or third-party sources.
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.