Ray Acuña Email & Phone Number

Grove City, Ohio, United States

Contributor to meeting CoventBridge Group’s objective: To provide services to our clients that exceedtheir expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. The Medicaid Fraud SME is responsible for activities related to fraud investigation development. Identify proactive data analysis study ideas, working closely with the Data Analysis, Medical Review and Program Integrity teams to ensure actionable leads with ROI that meets CMS requirement. Develop and coordinate investigative approaches and plans for fraud leads in order to expedite the investigative progress. Help establish and maintain relationships with State Medicaid Agencies and CMS. Monitor security of evidence gathered during the development of fraudinvestigations. Support the team in meeting quality and production standards. Ensure departmentalcompliance with Quality Management System and ISO requirements.

Austin, Texas Area

National Association of Inspectors GeneralTexas Chapter Board of DirectorsPresident of Texas Chapter

Austin, Texas, United States

Coordinate all aspects of the OIG's Quarterly Fraud Detection Operations concentrating on Dental, EEG, Telecommunications, Pharmacy, Day Activity Health Services, DME and Genetic Testing Healthcare Providers,

Austin, Texas Area

The MPI Manager oversees, reviews and evaluates fraud, waste and abuse investigations within the Texas Medicaid Program. Analyze, report and monitor the Texas Medicaid FWA efforts and providing recommendations to executive team on matters related to FWA compliance. Demonstrate strong analytical acumen needed to analyze complex data, conduct risk assessment and identify areas vulnerable to fraud, waste, and abuse. Track and report unit activities to ensure compliance with state and federal FWA requirements.

Austin, Texas Area

Investigation of Healthcare Provider Fraud, Waste and Abuse. Civil and Administrative investigations specializing in the areas of dental, durable medical equipment and orthotics/prosthetics.