Scott Mcwilliams, Cfe Email & Phone Number

Manage a team of Investigators on the CMS No Surprises Act contract. Responsible for training, evaluating and reviewing all aspects of investigations & processes. Review complaint summaries and findings reports for proper identification of statute violations, investigative assessments & proper statutory & regulatory reasoning. Review all reports and communications with consumers & CMS. Manage all aspects of the contract with the prime contractor, to include staffing, interviews of Investigator… Show more Manage a team of Investigators on the CMS No Surprises Act contract. Responsible for training, evaluating and reviewing all aspects of investigations & processes. Review complaint summaries and findings reports for proper identification of statute violations, investigative assessments & proper statutory & regulatory reasoning. Review all reports and communications with consumers & CMS. Manage all aspects of the contract with the prime contractor, to include staffing, interviews of Investigator candidates, employee timesheets, PTO requests, periodic and yearly employee reviews. Show less

Remote

- Coordinate proactive, Centers for Medicare & Medicaid Services (CMS), General Dynamics Information Technology, Inc. (GDIT) & Program Integrity Modeling & Analytic Support Contract (PIMASC) leads/complaints into projects; policy research; provide guidance to data analysts and investigators; function as auditor/investigator creating an initial plan of action; assist investigators and medical review nurses with policy research and provide investigative guidance- Develop and run data projects… Show more - Coordinate proactive, Centers for Medicare & Medicaid Services (CMS), General Dynamics Information Technology, Inc. (GDIT) & Program Integrity Modeling & Analytic Support Contract (PIMASC) leads/complaints into projects; policy research; provide guidance to data analysts and investigators; function as auditor/investigator creating an initial plan of action; assist investigators and medical review nurses with policy research and provide investigative guidance- Develop and run data projects & reports utilizing SAS, Business Objects, and One P.I.- Utilize multiple open-source intelligence gathering tools to assist in the identification of subjects and associates to include background, link analysis, business connections, social media and networking, and others Show less

Remote

- Coordinated proactive, CMS, GDIT PIMASC leads/complaints into projects; policy research; provided guidance to data analysts and investigators; functioned as auditor/investigator to create initial plan of action; assisted investigators and medical review nurses with policy research and provided investigative guidance. Developed and ran data projects & reports utilizing SAS, Business Objects and One PI- Utilized multiple open source intelligence gathering tools to assist in the… Show more - Coordinated proactive, CMS, GDIT PIMASC leads/complaints into projects; policy research; provided guidance to data analysts and investigators; functioned as auditor/investigator to create initial plan of action; assisted investigators and medical review nurses with policy research and provided investigative guidance. Developed and ran data projects & reports utilizing SAS, Business Objects and One PI- Utilized multiple open source intelligence gathering tools to assist in the identification of subjects and associates to include background, link analysis, business connections, social media and networking and others- Developed and delivered training to SE UPIC, NE UPIC investigators- Investigated FWA for the Unified Program Integrity Contractor, Southeast (SE UPIC)- Developed, analyzed and manipulated data queries and ad hoc reports for each investigation- Identified billing aberrancies through data analysis, clinical research & medical coding- Conducted healthcare provider and beneficiary interviews to substantiate identified billing aberrancies- Maintained case load of up to 21 cases and used SGS Workload Management Module and Unified Case Management System to input, monitor and close investigations- Attended Major Case Coordination meetings with CMS Stakeholders Show less

Nashville, Tennessee

- Documented all aspects of investigation in clear and concise reports to management, the supervisor, and the customer- Member of State of Tennessee TennCare liaison group for Medicaid Fraud- Performed fraud investigations from lead generation through closing of cases- Participated in monthly stakeholder engagement meetings with CMS- Responsible for up to 20 open workload cases at a time- Liaison to TN State Medicaid, TennCare, weekly to investigate Medicaid fraud, waste… Show more - Documented all aspects of investigation in clear and concise reports to management, the supervisor, and the customer- Member of State of Tennessee TennCare liaison group for Medicaid Fraud- Performed fraud investigations from lead generation through closing of cases- Participated in monthly stakeholder engagement meetings with CMS- Responsible for up to 20 open workload cases at a time- Liaison to TN State Medicaid, TennCare, weekly to investigate Medicaid fraud, waste, and abuse - Used AdvanceTrack, Fraud Investigation Database (FID), Fraud Prevention System (FPS), case management systems to track leads, audits and investigations across all CMS contractor lines- Selected by Supervisor as team lead to conduct onsite investigations for other team members as well as train new team members in the conduct of onsite investigations Show less

416Th Theater Engineer Command, Darien, Il

- Performed investigative duties, trial preparation, and report review in support of all legal actions within the Division- Selected as the Company First Sergeant (senior manager of all personnel and actions) to oversee the Theater Engineer Headquarters operations in Iraq (2008-2009, 1 year 3 months)- Managed all aspects of life support on two compounds comprising over 1,500 personnel in a combat environment to include operations, personnel issues, discipline, housing, security, food… Show more - Performed investigative duties, trial preparation, and report review in support of all legal actions within the Division- Selected as the Company First Sergeant (senior manager of all personnel and actions) to oversee the Theater Engineer Headquarters operations in Iraq (2008-2009, 1 year 3 months)- Managed all aspects of life support on two compounds comprising over 1,500 personnel in a combat environment to include operations, personnel issues, discipline, housing, security, food, medical/psychological services, and supplies- Demonstrated strong communication skills to win the confidence and trust of stakeholders ranging from officers and enlisted soldiers to national and local Iraqi public officials- Planned and executed projects that had complex schedules, strict deadlines, and confidential information- Utilized large scale intelligence information to develop focused and actionable reports- Awarded the Legion of Merit for leadership and actions, U.S. Army Show less

416Th Theater Engineer Command, Darien, Il

Chicago, Il

- Conducted short & long term investigations of highly centralized enterprises set up for the purpose of engaging in illegal activities. Identified organizational actors and associates, criminal activity, businesses utilized to launder proceeds, weapons purchases and safe houses- Conducted Intelligence gathering through surveillance and wire taps- Selected as an investigator for the Chicago Police Department Organized Crime Division- Selected as 1 of only 8 investigators of the… Show more - Conducted short & long term investigations of highly centralized enterprises set up for the purpose of engaging in illegal activities. Identified organizational actors and associates, criminal activity, businesses utilized to launder proceeds, weapons purchases and safe houses- Conducted Intelligence gathering through surveillance and wire taps- Selected as an investigator for the Chicago Police Department Organized Crime Division- Selected as 1 of only 8 investigators of the Chicago Anti-Gun Enforcement Team (CAGE) to conduct investigations into the nexus, ownership and path to crime of every firearm recovered in the city of Chicago- Worked in conjunction with the Chicago field offices of the Bureau of Alcohol, Tobacco, Firearms and Explosives (BATF), Federal Bureau of Investigations (FBI), & Drug Enforcement Agency (DEA)- Planned and led complex, short and long term investigations of criminal enterprises requiring strong organizational skills and the ability to multi-task - Conducted financial analyses of subjects to identify, trace and secure assets obtained through illegal activities Show less