Health Care Management

Location:

Jackson, MS, 39206

Posted:

January 05, 2011

Contact this candidate

Resume:

Robert D. Church, Jr.

** ********** . *******, ** ***** . 601-***-**** . abhyni@r.postjobfree.com

Certified Public Accountant

HEALTH CARE FRAUD AND ABUSE ( Whistleblower case development and analysis (

ECONOMIC Damage DETERMINATION ( FINANCIAL FRAUD ( FORENSIC INVESTIGATIONS (

ECONOMIC CRIME (

Certifications:

Certified Public Accountant / Certified Valuation Analyst / Certified Fraud

Examiner / Certified Forensic Consultant / Certified in Financial Forensics

/ Certified Forensic Accountant / Diplomate American Board of Forensic

Examiners International / Fellow American Board of Forensic Examiners

International / Certified Divorce Planner / Certified Divorce Financial

Practitioner / Certified Financial Planner / Personal Financial Specialist

/ Certified Healthcare Business Consultant / Certified Healthcare

Consultant / Fellow Institute of Financial Consultants / Chartered Trust

and Estate Planner / Chartered Financial Management Analyst / Chartered

Financial Consultant

Specific areas of expertise include:

Medicaid/Medicare Rules/Regulations . Medicaid Financing . Health Care

Fraud and Abuse . Economic Crime Management . Damage Determination .

Strategic Planning and Operational Improvement . Fraud & Forensic

Investigations . Internal Control Analysis and Implementation . Accounting

Issues . Business Planning . Health Care Management and Financing of

Governmental Health Care Programs . Public Policy

Professional Experience

ALABAMA MEDICAID AGENCY, Montgomery, AL 2009-

Present

Commissioner of Alabama Medicaid &

Chief Financial Officer

Chief Financial Officer for $6.4B Medicaid agency for the State of Alabama.

Duties have included reorganization of entire finance unit,

implementation of internal controls, management of employees, determination

of DSH and UPL payment limits, negotiation of $600M liability to CMS,

implementation of new payment methodologies for inpatient and outpatient

services, comprehensive program and administrative budgeting for entire

agency, daily interaction with CMS at both Regional and Central Offices,

implementation of managed care alternatives, management of agency finances,

coordination with Governor's office, Comptroller's office and others to

ensure smooth operations. Was able to negotiate liability of $600M to CMS

to a zero balance and implement new methodologies for program financing for

the future. Responsible for Third Party Liability, Program Integrity,

Statistical Support, administrative services and fiscal intermediary

relations. Responsible for rate setting, policy, cost reporting reviews,

and related work. Possesses in-depth knowledge of health care policy,

strategy and long-term planning. Strong health care fraud and abuse and

related investigations background, including work with DOJ via US Attorney

Offices, FBI, OIG, State Medicaid Agencies and others key to the

identification of health care fraud and abuse activities.

MISSISSIPPI DIVISION OF MEDICAID, Jackson, MS

2008-2009 (24 mos.)

Acting Assistant Deputy Administrator for Audit and Recovery (Consulting

Capacity)

Responsible for oversight of Program Integrity functions relating to all

provider types, review investigations, institute policies and procedures to

enable more efficient program operations, review provider issues and

opportunities to improve pay and chase functions, coordination with

Medicaid RAC, CMS officials, legislature and Governor's office related to

Medicaid financing issues, recoveries, recoupments, settlements, hearings

and associated functions. Was involved in DSH and UPL issues, CMS 64 and

37, budgeting, PERM, and related programs. Was responsible for

identifying multi-million dollars of overpayments and addressing recoveries

from fraudulent and abusive providers. Also was involved in financial

decisions related to Medicaid operations and financing.

Church, devoe & associates, pllc, Jackson, MS

1990 - Present

Accountant/Consultant

Partner in certified public accounting firm with two locations in

Mississippi. Provide expansive accounting, tax and financial services,

including business valuation, economic damage determination for litigation

matters, financial divorce consulting, economic crime management, fraud and

forensic services, development of and implementation of internal controls,

strategic planning, business development, operational improvement,

financial modeling, health care financing and fraud and abuse consulting

services to businesses and governmental agencies. Develop client

relationships, recruit, train and manage staff. Serve as expert in

federal and state courts providing deposition testimony, determination of

damages, evaluation of opposing expert reports and valuations, and fraud

and forensic investigations. Testified in federal and state courts on

variety of issues and involved with broad range of industries and issues.

Expertise in evaluating opposing party reports, analyses and related data

as well as innovation in damage determination and evaluation. Extensive

experience in investigations, health care fraud and abuse cases, and

related matters.

Healthcare Economics, P.A., Jackson, MS

1990 - 2001

Founder/Owner

Founded in 1990 with goal of providing leading-edge consulting services to

health care clients throughout United States. Developed management

company, which was engaged directly by 8 of top hospital companies in U.S.

Provided, comprehensive facility and practice management, including varied

consulting, merger, acquisition, strategy development, financing, managed

care development and negotiation, fee schedule and charge master evaluation

and management and related services throughout United States.. Managed

multitude of provider organizations in 22 states. Represented nursing

facilities, individual providers, hospitals, DME companies, hospice, and

other health care companies. Experienced in Medicare, Medicaid, commercial

insurance, DSH, UPL payments, quality of care, health care fraud, abuse and

waste knowledge and have worked with DOJ, OIG and State agencies.

. Built health care business with $750 investment into $5M in revenue

within 10 years and 249 employees.

. Assisted federal government in revealing health care schemes and

recovering multi-million dollars in fraudulent and abusive schemes.

Robert D. Church, Jr.

PAGE 2 OF 3

Ernst & Young, Houston, TX/jackson, MS

1982 - 1990

Manager/Senior Manager

Specialized in providing tax and consulting services to businesses and

individuals within United States. Served both domestic and international

companies, high net worth executives and expansive list of health care

clients. Planned, developed, and reviewed other

team members' work. Accountable for participating in business development

and maintaining client relationships. Transferred to Jackson, Mississippi

to build practice which began with self-developed health care base

extending to large and diverse litigation, bankruptcy, valuation, and tax

planning matters. Involved extensively in forensic and fraud

investigations. Assisted in development of firm products for measuring

profitability among mid-level companies and operation improvement.

. One of youngest team members to be promoted to executive position.

. Expanded firm to Jackson, Mississippi area starting from zero and

totaling over $1M in revenues within four years.

. Developed business software product which analyzed business practices

and improved profits for clients.

Price waterhouse/coopers, Houston, TX

1980 - 1982

Senior Staff

Chosen as senior staff member within international tax division for

international certified public accounting and consulting firm providing

accounting and financial services to clients across world. Major global

clients included Exxon, Esso Eastern, Shell, Brown & Root, and Halliburton,

among others. Primary role involved compliance related work between

companies and individuals. Corresponded with corporation employees and

officers daily.

. Administered international tax practice consisting of both corporate and

individual work with annual revenues in excess of $2M annually.

Education, Certifications, and Designations

M.S. in Economic Crime Management, Utica College/SYRACUSE UNIVERSITY,

Syracuse, New York - Completion Spring, 2011

B.B.A. in Accounting, UNIVERSITY OF MISSISSIPPI, University, Mississippi