Don Schmadel

Don Schmadel Email and Phone Number

Retired @ XXXXX
Don Schmadel's Location
Blythewood, South Carolina, United States, United States
Don Schmadel's Contact Details

Don Schmadel personal email

n/a
About Don Schmadel

Compliance, Medicare, Medicaid, Regulatory Affairs, Managed Care and Advantage Plans, Health Plan Operations, Payment Safeguards, Security-Operational/Physical/IT, Contract Procurement/Management, Investigations/Audit, Law Enforcement, Corporate Leadership30+ years operations leadership & management -15 years corporate executive level (strategic planning, finance, profit/loss, compliance, security, IT, contracting, ISO, project management) Management of large/small offices, remote field staff & multi-locations35+ years payment safeguards, criminal/civil investigations, information systems, fraud prevention/detection, data analysis, audit, security management, regulatory compliance15 years law enforcement: management & investigationsUSAF officer (Major) assigned to AF Office of Special Investigations as federal investigator, Security Police Shift Commander; 7 years active duty & 8 years Reserves. Top Secret clearance City police officer 5 years; patrol, corporal and training officerProject/Contract management - multi-agency criminal & fraud investigations (federal, state, local agencies) task forces, training of federal and state officials/agenciesExperienced in corporate and regulatory compliance (contracts, internal audit, conflict of interest, reporting) 25+ years of healthplan experience, specialized training in Medicare, Medicaid, Managed Care, Durable Medical Equipment, Home Health. Experienced in Federal Acquisition Regs and government contracting Cost Accounting Standards.Operational experience in an ISO (Quality Management System) registered environment.Detailed knowledge of privacy act standards, HIPAA, NIST, HITRUST.Experience creating and managing Anti-Fraud & Special Investigations Units (SIU); developing budgets, compliance programs, risk assessments, Standard Operating Procedures & training programs Expert Witness testifying at criminal & civil proceedingsCertified Fraud Examiner (CFE) 1996, member of Nat'l HealthCare Anti-Fraud Association (NHCAA)

Don Schmadel's Current Company Details
XXXXX

Xxxxx

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Retired
Don Schmadel Work Experience Details
  • Xxxxx
    Retired
    Xxxxx Jun 2024 - Present
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  • Absolute Total Care
    Vice President, Compliance
    Absolute Total Care Aug 2021 - Jun 2024
    Columbia, South Carolina, United States
  • Wellcare Health Plans
    Director, Market Compliance Officer
    Wellcare Health Plans Feb 2018 - Aug 2021
    Columbia, South Carolina Area
    Responsible for all Program Integrity activities (investigations, audits, reporting) with the South Carolina Managed Care market. Direct contact for South Carolina Department of Health and Human Services Program Integrity staff. Serve as the contact for the Corporate Compliance Officer for compliance and ethics activities in South Carolina. Function as the local contact for the Corporate Compliance Department’s functional units (policy development, delegation oversight, training, HIPAA/Privacy, security) and serve as a Market resource for identifying, tracking, mitigating and reporting on operational compliance risks.
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  • Tricenturion
    Vice President Operations/Program Director
    Tricenturion Oct 2002 - Mar 2017
    Columbia, South Carolina
    Responsible for participating in all corporate management decisions to include benefit plan selection, compliance, financial direction, business strategic planning, development of a company wide compensation and communications plans, and implementation of process improvements. As Program Director, directly managed Medicare Contract Task Orders: DME Region A Task Order for the northeast and previously a second Region, the Midwest US; (prior to March 1, 2008; led a contract with all Medical Review (MR) functions) for the northeast and SC A/B/RHHI regional task order (southeast, southwest US). Among the responsibilities were all payment safeguard and customer service activities, Medical Review, claims processing, IT and operational Security, Provider Education and Training, medical policy development, data analysis, contract financial management, and HIPAA/PHI and Privacy Act Compliance.
  • Palmetto Gba
    Director Anti-Fraud Unit
    Palmetto Gba May 1993 - Oct 2002
    Columbia, Sc
    Responsible for directing and supervising fraud and abuse control activities of operations, data analysis and provider enrollment background investigations to detect, prevent, identify, develop and refer for prosecution instances of fraud and abuse. Established the fraud unit during a regional implementation in 1993; developed policies and procedures, hired and trained staff and directed the incoming transition of over 1000 fraud cases. Managed over 100 staff with a budget of $8 million and a case workload involving over 500 subjects.
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  • Usaf Office Of Special Investigations/Security Police
    Special Agent (Major)
    Usaf Office Of Special Investigations/Security Police May 1985 - Dec 1999
    Mcguire Afb, Nj
    Supervised and managed investigative detachment operations of ten Special Agents. Was a member of the US Air Force Security Police from 04/1985 - 12/1988 managing, supervising and training 80 Air Force Security Policemen. Managed the Detachment multi-level anti-fraud program; conducted base wide risk assessments to identify high risk fraud targets and developed the annual strategic fraud plan. Conducted over 120 fraud and criminal investigations and participated in protective service operations. Directed joint multiple federal and military agency efforts in multi-million dollar contractor false claim investigations and coordinated the recovery of lost monies directly with the Department of Justice. As USAF Reserve Special Agent from 1993 - 1999, served in a reserve capacity supplementing the USAF OSI Detachment Commander at a SC AFB supervising Special Agents. Directed security operations for multi-billion dollar USAF assets, facilities, civilians, dependents and military personnel. Held Top Security Clearance. Became inactive reserve with a rank of Major in 1999

Don Schmadel Skills

Fraud Private Investigations Investigation Medicare Enforcement Hipaa Policy Certified Fraud Examiner Criminal Law Government Contracting Insurance Training Data Analysis Process Improvement Criminal Justice Health Insurance Police Background Checks Medicaid Leadership Law Enforcement Claim Healthcare Management Strategic Planning Law Enforcement Operations Government Risk Assessment Evidence Criminal Investigations Fraud Investigations Management Auditing Quality Assurance Project Management Analysis Managed Care Security Management Statistics Change Management Proposal Writing Organizational Leadership Operations Management Access Team Management Corporate Compliance Fraud Prevention Corporate Management Healthcare Analytics Security Operations

Don Schmadel Education Details

Frequently Asked Questions about Don Schmadel

What company does Don Schmadel work for?

Don Schmadel works for Xxxxx

What is Don Schmadel's role at the current company?

Don Schmadel's current role is Retired.

What is Don Schmadel's email address?

Don Schmadel's email address is do****@****are.com

What is Don Schmadel's direct phone number?

Don Schmadel's direct phone number is +180392*****

What schools did Don Schmadel attend?

Don Schmadel attended Indiana University Of Pennsylvania, Bishop Mccort Hs.

What skills is Don Schmadel known for?

Don Schmadel has skills like Fraud, Private Investigations, Investigation, Medicare, Enforcement, Hipaa, Policy, Certified Fraud Examiner, Criminal Law, Government Contracting, Insurance, Training.

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