Manager Office Staff

Name

James Wright

Position Title

Auditor

Professional Summary

Mr. Wright is team player with 20+ years of professional experience with proven strengths in auditing. His skills include conducting audits, leadership and report writing.

Education

B.S. in Accounting, University of Delaware

Certifications, Training and Awards

None

Categories of Experience

Auditing

Investigation

Report writing

Case file documentations

Research

Evidence Collection

Accounting

Relevant Professional Experience and Qualifications

AUDITOR 2018-Present

Integrity Management Services, Inc.

Develop and document reports of investigative findings, compile case file documentation, improper payments, and issue findings, recommendations, and corrective actions in accordance with applicable regulations, policies and procedures.

Communicate with federal/state agencies and providers regarding issues such as general regulatory compliance, audit findings, and the recovery process.

Work on the Northeast Unified Program Integrity Contractor for CMS.

Assigned 65 audits in a nine month period. Sixty of the audits were completed with findings. The other five are in process and will result in over $1,000,000 in findings.

Worked with the data analysis on a weekly basis to develop more productive audits with higher ROI.

AUDIT LEAD 2010 - 2018

Health Integrity, LLC.

Responsible for leading and managing the Medicaid audits associated with Health Integrity's Medicaid Integrity Contract (MIC) Task Order IR. Audit requirements cover 14 states and the District of Columbia.

Typical workload involves coordinating over 115 concurrent active Medicaid audits in this geographical area. Audits can include any medical services or provider of medical services covered by the Medicaid Programs. Audit work entails understanding the variability of these states' Medicaid Programs and governing statutes and regulations and possible association of the Medicaid beneficiary's activities to other state programs.

Included is analysis of the completeness and accuracy of data available for review (particularly when related to managed care organizations operated by private insurance firms) and performing statistical data analysis to target the Medicaid program claims features that may lead to a variety of conclusions. These final outcomes of the audits can include identification of improper payments for collection from the medical providers to identification of possible fraudulent provider or beneficiary behavior that needs to be referred to the Health and Human Services, Office of Inspector General and/or the Medicaid Fraud Control Unit in a specific state. To Date audits that I have been assigned have found over $30 million in Medicaid overpayments.

Present work entails managing the work schedules of a staff of three senior auditors and six auditors that include Health Integrity employees and sub-contractor staff. Schedule and oversee all field and desk audits, and review audit findings with the auditors and medical personnel. Work with Centers for Medicare and Medicaid Services staff, state officials and provider representatives to ensure they understand the audit findings. For potential fraud cases, work with CMS and the OIG staff to discuss the details of the fraud referral and provide subsequent assistance when needed as the case is fully developed.

CHIEF FINANCIAL OFFICER 2007 - 2010

Caroline Nursing and Rehab

Responsible for oversight of a $6M operating budget.

Worked with private firms to negotiate insurance purchases and ensured the implementation of those policies for health, liability and workers compensation.

Supervised five staff working on accounts payable, receivables and human resource issues. During my employment period, company operating cash grew from less than $IM to $2.3M.

ASSISTANT CONTROLLER 2006 – 2007

Chester River Hospital

Supervised the Business Office staff responsible for accounts payable, payroll, and cash management.

Designed, developed, and implemented cash controls. Discovered a fraud operation in the Hospital Dietary Department which amounted to over $250K in lost revenue to the hospital.

Worked with fraud investigations to assist in the closure of this case and improve the conditions that allowed this to occur.

ACCOUNT MANAGER/DIETRARY FINANCE MANAGER 1995 - 2006

Washington College

Supervised the Accounting Department's six staff members in the areas of accounts payable and receivables and payroll.

Helped to create and oversee a $35M budget. Responsible for all cash accounts, fixed assets, and the reconciliation of the College's many endowments.

Reduced the accounts receivable balance through development and implementation of improved collection procedures.

Discovered a large workers compensation calculation error that saved the College over $100K.

Implemented weekly food inventories to determine the average cost per student meal which greatly decreased the College's overall meal cost. These weekly inventories cut down on employee food thief as well.

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