Vernell Johnson Email and Phone Number

• Conduct reviews and investigations received from North Carolina residents, Legislators, OIG, and PHP plans on allegations of fraud, waste, and abuse. Conduct compliance monitoring of County DSS Fraud Plans by conducting site visits monthly.• Conduct reviews and audits of DSS program integrity processes and procedures to ensure compliance, efficiency, and accountability with identifying and addressing allegations of member fraud/waste, abuse to identify federal requirements and state status implement by the Center for Medicare and Medicaid (CMS) Fraud/Waste/Abuse initiatives.• Study records to substantiate claims, analyzes policy in relationship to the allegation, documents findings and if warrant, refer the case to the originating county to conduct a full investigation'.• Follow State policy and CMS regulations for quality control reviews, systematically review and evaluate samples of cases and document review findings in a review workbook for each case.• Verify eligibility factors for beneficiaries through contacts with businesses, federal and state agencies, and individuals with knowledge specific to the beneficiary'.• Review county performance reports and conduct follow up with appropriate county personnel.• Assist with developing & implementing training for local county DSS PI Investigator staff & development. • Keep abreast of Center of Medicaid Services (CMS) federal agency policy changes, statues, rules, regulations, and accuracy standards.