Robert Ortegon, Mba, Cfe Email & Phone Number

Mckinney, Tx, Us

Mckinney, Tx, Us

Chicago, Il, Us

*Investigate medium to highly complex cases of fraud, waste and abuse.*Detect fraudulent activity by members, providers, employees and other parties against the Company.*Develop and deploy the most effective and efficient investigative strategy for each investigation.*Maintain accurate, current and thorough case information in the Special Investigations Unit’s (SIU’s) case tracking system.*Collect and secure documentation or evidence and prepare summaries of the findings.*Participate in settlement negotiations and/or produce investigative materials in support of the latter.*Collect, collate, analyze and interpret data relating to fraud, waste and abuse referrals.*Ensure compliance of applicable federal/state regulations or contractual obligations.*Report suspected fraud, waste and abuse to appropriate federal or state government regulators.*Comply with goals, policies, procedures and strategic plans as delegated by SIU leadership.*Collaborate with state/federal partners, at the discretion of SIU leadership, to include attendance at work-groups or regulatory meetings.

Garland, Texas, Us

Responsible for the complex analysis of policies, procedures, financial documents and contracts to ensure accuracy of expenditures, maximization of revenues, efficiency and effectiveness of operations, and compliance with federal, state and local regulations and laws. The Sr. Auditor may also train and lead auditors in the field.• Conduct complex operational and performance audits of procedures to direct and control City assets, resources, services, and products in conformity with Generally Accepted Government Auditing Standards.• Investigate fraud, waste, and abuse (FWA) allegations reported directly or via the anonymous hotline.• Assist with training lower-level auditors in appropriate business procedures and internal controls. Promote cohesion among team members.• Verify City's compliance with federal and state rules, regulations, and internal policies and guidelines.• Conduct comprehensive risk assessments and develop an audit program and process to determine timeline and resources.• Perform comprehensive reviews of controls related to the City's acquisition processes.• Evaluate the effectiveness of the City's internal controls system and operations efficiency.• Review cost control procedures used for operating expenditures.• Review the system of management controls in place to ensure that vendors and customers comply with contracts.• Provide a report of findings and recommendations for corrective measures in areas needing improvement.• May supervise staff auditors in the absence of the Audit Manager.

Austin, Texas, Us

• Discussed, planned, and organized the audit/investigation plan with state/federal investigative partners.• Investigated Medicaid provider fraud and patient abuse or neglect in health care facilities and board and care facilities.• Queried, examined, and analyzed Medicaid claims data to contribute to an efficient, team-oriented investigation.• Performed advanced audit techniques and examinations of alleged Medicaid provider fraud, including developing audit/investigation objectives and plans.• Applied statistical sampling techniques to claim data as necessary.• Obtained information and data from various systems to contribute to investigations.• Collected and analyzed case evidence, including business, financial, banking, and medical records.• Identified violations of Federal and State law(s), including Medicaid rules and regulations for the provider and its employees.• Obtained evidence to support violations, including via witness and subject interviews.• Summarized the corresponding Medicaid overpayments associated with the identified violations.• Maintained knowledge of Health Insurance Portability and Accountability Act (HIPAA) requirements in the workplace.

• Collected, analyzed, and evaluated relevant information per Generally Accepted Government Auditing Standard.• Conducted risk assessments and developed audit programs and processes to determine timelines and resources.• Reviewed the system of management controls in place to ensure that the county agencies complied with regulations.• Documented information and conclusions in an organized and helpful manner. • Formed an objective opinion on the appropriateness of accountability, economy, efficiency, effectiveness, and compliance within the department under review. • Executed follow-up audits to determine the degree to which previous recommendations have been implemented by management.• Presented findings and workable recommendations clearly to the County Auditor. • Assisted with department administrative duties.

Us

• Audited independently or as a team member all pertinent books of original and closing entries of large multi-state or multi-national corporations electronically and physically at a taxpayer’s location. • Analyzed and reconciled, for audit purposes, inter-company transactions, financial relationships, and business practices. • Reviewed tax returns and records to determine compliance with various Florida Tax Statutes, which included sales tax, use tax, communications sales tax, etc. Determine tax liability as it may apply to sales, purchases, job costs, and leases.• Prepared detailed reports of audit results, offered professional comments and recommendations on the soundness of taxpayers’ accounting methods and procedures, and prepared internal reports for management as necessary.• Performed pre-audit analysis and developed audit plans and procedures to establish audit trails in determining the most effective manner to conduct audits within established guidelines.• Reviewed and scheduled case workload to ensure efficient use of time.• Conducted closing conferences with taxpayers or taxpayers’ representatives; explained applicable laws and facts supporting changes in tax liabilities and attempted to secure agreement to findings in audit reports.• Researched and reviewed various issues and problems peculiar to particular audit clients.

Sacramento, California, Us

• Planned, organized, and directed work staff of (7) special investigators in Southern California for claims made against the State's Uninsured Employers Benefits Trust Fund and Subsequent Injuries Fund under the general direction of the Chief Counsel and Assistant Chief Counsel. • Recruited and trained investigative staff in technical knowledge and methods for performing their duties.• Audited projects conducted by Public Works were subject to California prevailing wage laws or the Federal Davis-Bacon Act and if employees were due prevailing wages for past or future work performed.

Sacramento, California, Us

• Performed audits on Beverage Manufacturers/Distributors; gathered data and reviewed prior audit reports and records. • Reviewed and analyzed participants’ records per audit policies, procedures, and programs to comply with the requirements of Title 14, California Code of Regulations. • Conducted examinations and investigations, wrote and compiled reports based on observations and conversations, followed by making recommendations based on audit findings of participants committing fraud against the Fund or in non-compliance with the requirements of Title 14, California Code of Regulations. • Assisted and testified with administrative, criminal, and grand jury hearings in preparation, examination, securing, and compiling legal basis for enforcement cases and issues related to program enforcement. • Received and secured documents and physical evidence, logged into inventory, and maintained records regarding evidence transfers.• Returned evidence to appropriate parties per established procedures. • Protected the integrity of a billion-dollar fund against fraud by the program participants. • Trained new auditors assigned to the section and performed peer reviews.

Master, Business Administration

Bachelor Of Science, Business Administration