Develop and execute strategies to detect and address non-compliance, Fraud, Waste, and Abuse (FWA) within UCLA Health's Medicare Advantage and Prescription Drug programs. Leading a team of managers, I oversee internal audits, FWA detection through data mining, and ensure compliance with CMS and DMHC regulations.Key Responsibilities IncludeOversee aspects of the Medicare Advantage Prescription Drug Anti-Fraud, Special Investigations Unit (SIU), and Audit Programs through subordinate managers.Develop and implement strategies to detect non-compliance and FWA using data mining and internal audits.Ensure compliance with regulatory requirements related to non-compliance, FWA, and SIU.Guide strategic goals to manage health plan resources effectively and align with broader system initiatives.File necessary documentation with CMS and DMHC to demonstrate compliance or identify risk areas.

Founded Knight Vision Global Solutions, LLC (KVGS) (www.kvgs.us) which is a strategic consultancy spanning a wide spectrum of services from financial crimes and investigations to information security and payment operations. • Currently working for the US Department of Justice/US Attorney’s Office as an Investigative Expert Consultant and within the first month uncovered nearly $8M in hidden assets from perpetrators of healthcare fraud.• Advised a Fortune 100 company, enhancing fraud prevention with 8 actionable strategies and identifying tech upgrades, slashing manual review alerts by up to 97% and reducing fraud losses within 3 months. • Created and launched 3 online courses on ethics, fraud program development, and more. Presented 4 speeches to professional groups, engaging 250 attendees. Authored 3 documents on fraud fundamentals, program assessments, and safeguarding E-commerce.

*Current contract position with Knight Vision Global Solutions LLC to provide services to the US Attorney's Office related to criminal and civil investigations within Health Care Fraud. 1-3 year engagement*Assist in the planning and execution of investigations related to health care fraud and opioid-related matters and, when appropriate, in conjunction with federal agencies such as the FBI, HHS, and DEA.-Plan, schedule, and conduct investigations and identify any resources required to advance investigative objectives.-Provide investigative techniques for evidence collection of both physical and digital items to build case for successful litigation.-Conduct interviews, including admission seeking interviews, both in-person and telephonic.-Identify need for warrants and subpoenas and secure participation of appropriate law enforcement agents.-OSINT-Complete investigative reports as well as compile documents and evidence for use by AUSAs in motions and trials.-Conduct expert testimony at trial when required.

Recruited to join this insure-tech startup to design, implement, and lead the inaugural fraud and loss prevention program and manage a domestic staff. Reporting to CEO and C-Suite Executives.• Initiated and conducted the company's inaugural Fraud Risk Assessment, leveraging comprehensive data sources encompassing known fraud trends, forthcoming regulatory audit priorities, historical fraud incidents, and internal fraud data. The assessment identified urgent vulnerabilities in 2 business units while also pinpointing 31 specific fraud risks to the company as a whole. Among these risks, 2 significant threats were identified, while an additional 20 required immediate attention due to emerging threats. This proactive approach provided actionable insights for targeted risk mitigation strategies, contributing to enhanced fraud prevention and safeguarding the company's financial integrity.• Designed and implemented a comprehensive suite of 30 fraud prevention, detection, and correction alerts, resulting in a nearly 200% increase in the identification of actual fraudulent activity within the first six months of deployment. Additionally, successfully integrated and configured a companywide case management system for all business units, streamlining incident management processes and reducing resolution times by several months.• Generated an 867% increase in fraud case velocity referrals, leading to the identification and successful resolution of the company's largest fraud collusion case.

Tapped by Amazon to design, implement, and lead a new loss prevention investigative department specializing in workers’ compensation fraud, identity theft, COVID-19 fraud, and bereavement fraud.• Successfully reclaimed and mitigated over $4.5 million in losses within the first year, resulting in a remarkable 2,306% increase in realized savings and accountability returned to the business. This exponential trend in fraud loss savings continued, reaching $25 million by the fourth year.• Attained a team success rate of 98%, as evidenced by the successful execution of advanced program development initiatives. This accomplishment was recognized with an award from Amazon for outstanding contributions in program development.

Drove the development of loss prevention investigators specializing in internal fraud and theft conducted by employees and vendors while also managing global teams and staff. This included managing payment processors and fraud rules, overseeing fraud prevention and detection tech implementation, and working with retail banking partners to ensure AML and corporate card compliance. • Led the investigation and resolution of Amazon's largest recorded case of internal embezzlement, resulting in the recovery of $400,00 in misappropriated funds. Managed all investigation aspects, including building a compelling case for law enforcement referral, delegating investigation tasks, conducting over 20 employee and external interviews, personally interviewing the suspect and obtaining admission, gathering and analyzing nearly 500 pieces of intelligence and data, and authoring multiple detailed investigative reports.• Implemented new technology and systems that significantly improved fraud prevention, detection, and reimbursement efficiency. The new system immediately detected and prevented a $250,000 false invoice fraud attempt.

Led and overhauled the fraud department which investigated all types of fraudulent activity related to transactions while managing a global staff. This included managing payment processors and certain vendors, project management of tech implementations, conducting internal and external investigations, risk assessments, loss prevention, AML compliance, and other regulatory requirements. Reporting to CFO and C-Suite Executives.• Developed, authored, and implemented GSN Games’ inaugural "Policy on Anti-Money Laundering," establishing comprehensive guidelines and protocols to combat financial crime.• Implemented a comprehensive overhaul of the company's fraud prevention program, resulting in a 49% reduction in financial losses attributed to fraud. Additionally, found innovative ways such a technology implementation, procedure updating, and fraud team education that yielded substantial program savings of $500,000 per year, demonstrating significant improvement in the company's financial security and efficiency.

Subject matter expert covering, but not limited to, know your customer (CIP/KYC), enhanced due diligence (EDD), Bank Secrecy ACT (BSA), US PATRIOT Act, Suspicious Activity Reports (SARs), emerging trends, product risk, and risk assessments. Main engagements with Boston Private Bank & Trust, Santander Bank, and Citizens Bank.• Conducted expert analysis of a financial institution merger, identifying high-risk customers and outlining necessary compliance remediation measures. This analysis facilitated the mitigation of potential regulatory risks and ensured seamless integration, safeguarding the institution's reputation and financial stability.• Received commendation from the US Office of the Comptroller of the Currency for outstanding performance, specifically cited for successfully identifying an on-shore organization that appeared to be involved in trade-based money laundering with high-risk countries that previously went undetected by internal staff.

Part of a specialized investigative unit conducting the company’s most complex and high-risk cross-border financial crimes investigations related to AML and credit/debit card fraud. The special unit team consisted of 5 investigators for the entire company engaged in full cycle of Know Your Customer (KYC+), AML/EDD Investigations, Customer Identification Program (CIP), Reg E, risk management programs, and filing of Suspicious Activity Reports (SAR) and Suspicious Transaction Reports (STR) for US and Canada, respectively.• Identified, investigated, and reported on a suspected international terrorist organization, leading to the identification of approximately $1 million in proceeds of crime and funds believed to be linked to terrorism financing. The report was submitted to both US and Canadian task forces, contributing to ongoing efforts in combating terrorism financing and criminal activities across borders.• Achieved recognition as the top performer in credit card fraud cases (Reg E) and AML investigations, with a nearly twofold increase in case resolutions compared to peers. This accomplishment resulted in a 50% reduction in average case resolution time.

Sworn police officer for the city of Oxford, Maine & Emergency 9-1-1 Dispatcher and Operator for Oxford County, Maine. Upheld Maine Criminal and Civil statutes through detective work, physical security, reactive and proactive investigations, and more. Included routine patrol, alarm responses, community engagement, and other law enforcement activities.• Volunteered during personal time to spearhead the local Maine Child Identification Program (CHIP), facilitating the collection and distribution of vital information to the public and law enforcement agencies in the event of a missing child situation. Through this initiative, around 100 children were registered, providing essential identification resources to their families and law enforcement partners, enhancing community safety and responsiveness to emergencies.• Discovered and dismantled a multi-state drug trafficking ring through strategic investigative techniques, comprehensive interviews, and analytical methodologies. This collaboration with the Maine Drug Enforcement Agency (MDEA) led to the arrest and prosecution of multiple individuals on felony charges, resulting in the seizure of kilograms of illicit substances and the disruption of criminal operations across state lines. The successful outcome underscores the effectiveness of partnership efforts in combating organized crime and ensuring public safety.