Investigator, Analyst, Compliance, Security

BLAKE M. ROGERS

Chicago, IL 815-***-**** *****.************@*****.***

SUMMARY OF QUALIFICATIONS

Experienced in leading complex investigations to substantiate allegations of fraud and abuse to ensure the subject is in compliance with the ever-changing regulations administered by federal and private insurance programs.

Effectively ceased and collected monetary payments in amounts of over $1M after validating misrepresentation, overutilization, services not rendered, and non-compliant

Successfully influenced federal law enforcement officials to accept investigations for further actions and/or prosecution

Conducted unannounced and announced onsite audits to validate that the subject is in accordance with their practicing contract

Highly skilled in interviewing subjects and witnesses, analyzing data to identify trends and aberrant billing, extensive internet research, and writing detailed reports, while exhibiting an objective attitude

PROFESSIONAL EXPERIENCE

HEWLETT-PACKARD, SafeGuard Services, LLC, Miami, FL February 2015 – July 2015

Healthcare Fraud Investigator III

Developed investigations in a timely manner to substantiate allegations of potential fraud and abuse within compliance of the Centers for Medicare and Medicaid Services (CMS)

Implemented payment suspensions, revocations, overpayments, edits, and other administrative actions to protect the Medicare Trust Fund

Conducted in-person interviews with beneficiaries, physicians, complainants, and other key witnesses to validate Medicare funded services

Executed onsite audits on suspected subjects to confirm the healthcare provider is operating in conjunction within the policies of the Program Integrity Manual (PIM) regulated by CMS

Referred investigations where fraud or abuse has been discovered to the Department of Health and Human Services Office of Inspector General (OIG) and the Federal Bureau of Investigation (FBI) for further criminal and/or civil prosecution

Attended Healthcare Fraud Task Force Meetings to discuss predictive and current billing trends relating to Federal Law Enforcement Investigations and/or cases

Analyzed claims and financial data to identify any trends and/or aberrant billing patterns

Collaborated with Data Analysis and Medical Review Department to further assist in validating allegations of Medicare fraud

Attended over 60 hours of training, which included ‘New Investigator Training’ and ‘Handling US Government Confidential Documents’

BLUE CROSS BLUE SHIELD OF ALABAMA, CSA, LLC Chicago, IL June 2014-February 2015

Healthcare Fraud Investigator II

Conducted investigations for allegations of potential fraud and abuse within the Centers for Medicare and Medicaid Services’ (CMS) guidelines in a concise, efficient manner

Performed interviews with complaints, beneficiaries, and other key parties to obtain valuable information relating to potential fraud

Liaised with the Department of Health and Human Services Office of Inspector General (OIG) and the Federal Bureau of Investigation (FBI) to implement payment suspensions on Medicare providers and submit referrals for further criminal and/or civil investigations

Participated in Strike Force Meetings with Federal Law Enforcement Officers to discuss current and predictive billing trends involving suspected insurance fraud

BLAKE M. ROGERS C: 815-***-**** *****.************@*****.*** Page 2/2

THE ROBISON GROUP, Chicago, IL August 2013-September 2014

Special Investigations Unit (SIU) Field Investigator

Executed suspected insurance fraud investigations within client compliance policies related to multi-line P&C claims throughout Illinois, Indiana, and Wisconsin

Conducted recorded statements of claimants, the insured, witnesses, and others identified parties, neighborhood canvasses, criminal/civil background checks, process serving, surveillance and other investigative tasks

Provided timely, detailed investigative reports and recommendations for insurance companies regarding such investigations

Participated in training presentations involving interviewing skills and detecting deception

Consistently managed a workload comprised up to 20 investigations

CUNA MUTUAL GROUP, Madison, WI June 2013-August 2013

Special Investigations Unit (SIU) Claims Intern

Investigated suspected cases of insurance fraud for all lines of business, in particular Life & Disability and Property & Casualty claims, while remaining compliant in state regulations

Reported suspected cases of insurance fraud to proper law enforcement, such as the National Insurance Crime Bureau (NICB), and the Department of Insurance

Promoted anti-fraud awareness amongst claims professionals and underwriters by contributing in presentations relating to fraud indicators or red flags

Attended several seminars which include “Interviewing Skills & Deception Training” presented by Jack Morgan CFE, CFI, FCLS, CIFI and “Catastrophic Fraud Indicators” presented by Special Agents with the National Insurance Crime Bureau (NICB)

BETHEL WORK RELEASE CENTER, Duluth, MN May 2012-May 2013

Corrections Officer

Supervised up to 40 federal, state, and huber residents in a minimum security facility

Resolved resident conflict through de-escalation techniques, while promoting safe environment

Initiated discipline procedures and expectations in compliance with the Department of Corrections

Operated multiple security CCTV’s systems

Transcribed detailed and accurate daily activity reports and incident reports in conjunction to specific inmate action

Collected and processed both residential and non-residential urinalysis samples

TRILLIUM SERVICES, Duluth, MN March 2012-August 2012

Program Counselor

Developed rapport and reciprocal relationships with adults with developmental disabilities

Assisted consumers with daily living skills, community involvement, and by promoting the opportunity for consumer choice and independence

Monitored the behaviors of 4-6 consumers

EDUCATION

Bachelor of Arts-Criminology/Coaching, University of Minnesota May 2013

Athlete, Football Team Participant, Deans List Spring 2013

COMMUNITY INVOLVEMENT

East Aurora Elementary Mentorship Program, October 2014-February 2015

Assistant Baseball Coach, Fond Du Lac Tribal Community College, January 2013-May 2013

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