Nicholas J. Messuri, J.D. Email & Phone Number

Charlestown, Massachusetts

• Leads a national anti-fraud and abuse program for a Medicaid, Commercial, and Medicare Advantage dental insurance business that has more than 30 million members in 32 states.
• Built effective 23-person investigations unit to improve fraud detection, reduce losses, and cut operational costs.
• Dramatically improved information sharing and collaboration on FWA, and significantly enhanced relations with managed care and state agency clients.
• Drove 300% increase in savings from FWA prevention and detection, and substantially increased return on investment.
• Won recognition for expertise in multi-agency collaboration and building investigations resulting in effective enforcement actions; drove creation of NHCAA national committee to develop best public/private partnership.
• Led successful fraud prosecutions in Illinois, NY, and TN in collaboration with DentaQuest investigations team.

Boston, MA

• Recruited to create first special investigations unit devoted to fraud, waste, and abuse. Developed private plan anti-FWA strategies modeled after government enforcement, and audit plans to protect/recover monies for.
• Exceeded internal savings targets for 8 consecutive years with sustained 9:1 ROI, and substantially increased FWA cost savings.
• Implemented inter-departmental collaboration and workflows so that the correct cost control lever and monitoring could be activated. Also increased FWA detection by 40%, and established closer partnerships with New.
• Selected by Americas Health Insurance Plans (AHIP) to represent their 1300 Plan membership as the model Private Plan Special Investigation Unit anti-FWA initiatives at first national healthcare fraud summit at National.
• Appointed because of success of 2010 AHIP Anti-Fraud Summit presentation to be co-chair of National Health Care Fraud Prevention Partnership by Centers for Medicare and Medicaid Services in 2011.
• Invited by National Healthcare Anti-Fraud Association to join board in 2010; appointed board chair in 2015.Associate General Counsel directs all anti-fraud and abuse cost-containment strategies and investigations to.

Boston, Massachusetts, United States

• Bureau Chief, Business and Labor Protection 2004-2006Division Chief, Medicaid Fraud Division 1996-2006Trial Division Litigator 1992-1995Promoted to head new anti-fraud program and increase number of prosecutions by.
• Prosecuted or favorably settled 165 criminal fraud allegations, and achieving record number of wins in Massachusetts criminal law history.
• Drafted legislation signed into law that increased penalties for healthcare fraud and elder abuse.
• Testified before US Senate Finance Committee in 2006 on methods to improve Medicaid fraud control.
• Successfully prosecuted 13 pharmaceutical manufacturers under state False Claims Act for generic pricing fraud.
• Brought first state criminal malpractice case against physicians for medically unnecessary prescriptions; secured convictions, with state supreme court affirming ruling, and through separate prosecution; established.

Cambridge, Massachusetts, United States

• Recruited as Assistant District Attorney, promoted to District Court Supervisor in charge of 8 other ADAs. Managed jury trials and felony trials in superior courts. Named Superior Court Prosecutor in 1990 to oversee.
• Recognized as ADA with largest caseload and highest number of resolved cases out of 125 ADAs; youngest-ever District Court Supervisor at appointment in 1987.

Juris Doctorate, Law

Leadership Program

Bachelor Of Science, Highest Honors,, Biology/Criminal Justice

Activities and Societies: National Honor Society of Criminal Justice, Co-Op experience-Pathology/Autopsy Assistant