Senior Manager, Special Investigations Unit
Resume:
DAVID G. BRUCE, SR
**** ********* ****, *********, ******** 21208
*********@*****.***
QUALIFICATIONS PROFILE
Results-driven, detail-oriented, and highly committed professional, offering solid investigative experience in all aspects of fraud investigation and fraud detection, as well as corporate ethics and compliance.
Equipped with proven multidisciplinary expertise in high-profile criminal investigations, including bank fraud, drug diversion, internal employee investigative issues, healthcare fraud, counter intelligence, and undercover operations. Highly effective leader, with strong reputation for delivering high-quality work on-time, managing a broad range of responsibilities, and striving under pressure. Proficient with Microsoft Office Suite (Word and Excel), Access, and various fraud detection software systems. Retired U.S. Assistant Special Agent.
AREAS OF EXPERTISE
Criminal/Civil Law Enforcement Principles
Security and Surveillance Operations
Budget Administration
Case Management
Tactical Planning and Investigative Research
Liaison and Intelligence Sources
Information Risk Assessment
Conflict Management and Resolution
PROFESSIONAL EXPERIENCE
UNIVERSITY OF MARYLAND MEDICAL SYSTEM TIMONIUM, MD
Special Investigation Unit /Senior Manager Medicare–Medicaid 2017–Present
Oversee investigations of FWA of the Medicare and Medicaid programs as well as budget process of the unit's operation
Work closely with federal, state, and local law enforcement agencies, including the Centers for Medicare and Medicaid Services and the Maryland Medicaid Fraud Control Unit in combating FWA
Observe strict compliance with all requirements related to SIU and fraud, waste, and abuse (FWA) investigations
Direct and coordinate all efforts of Investigation Team on highest evidence development and investigative actions
Devise a FWA/SIU long and tracking system, while arranging files and documentation to support intake and investigation of reported FWA
Design and execute FWA program description, P&Ps, and standard operating procedures (SOP) in collaboration with compliance officer
Perform comprehensive interviews with providers, members, and witnesses to gather information that will be considered admissible under generally accepted criminal and civil rules of evidence
Take charge of verifying and submitting investigative reports covering all phases of the investigation, while discussing highly technical information to others
Serve as liaison with public officials, law enforcement, and others to confer assistance in conducting investigations
CAREFIRST BLUE CROSS BLUE SHIELD OWINGS MILLS, MD
Special Investigation Unit Manager 2014–2017
Special Investigation Unit Supervisor 2013–2014
Expertly handled all investigations, audits, and projects in progress for the Maryland and District of Columbia plans
Administered and maintained suitable records, reports, and files with documented investigative work and reporting for all audits performed in accordance with departmental policies and procedures to support company objectives
Keenly assessed investigative and audit findings and projects in progress to create monthly status reports to the director of special investigation (SI)
Collaborated with director SI in developing and implementing departmental strategic and operating plan with goals, objectives, and quality measures
Maximized departmental resources and aligned scopes with the strategic and operating plans through development of financial, quality, and time measures
COVENTRY HEALTH CARE ROCKVILLE, MD
Special Investigation Unit/Senior Investigator 2008–2013
Set strategic direction to a team of investigators and an analyst in the SIU in identifying and addressing fraud, waste and abuse under the Federal Employee Health Benefit Plan (FEHBP), as directed by U.S. Office of Personnel Management, Office of the Inspector General (OPM-OIG)
Successfully accomplished case assignments, including case development, case review, overpayment recoveries, prepay, as well as post-pay investigations in conjunction with the OPM-OIG and the U.S. Department of Justice (DOJ) in the pursuit of prosecution and civil recoveries of violators of federal healthcare criminal and civil law
EARLIER CAREER
UNITED STATES GOVERNMENT BALTIMORE, MD 1982–2007
Criminal Investigator, SSA/Office of the Inspector General
Criminal Investigator, Federal Deposit Insurance Corporation/OIG
Criminal Investigator, HHS/Office of the Inspector General
Criminal Investigator, Drug Enforcement Administration
Claims Investigator, Social Security Administration
EDUCATION
Bachelor of Science in in Political Science
Bowie State University, Bowie, MD
PROFESSIONAL DEVELOPMENT
Graduate, Federal Law Enforcement Training Academy, Glynco, GA
Graduate, Federal Bureau of Investigation (FBI) Academy, Quantico, VA
Investigative Management Certification
AFFILIATIONS
National Law Enforcement Officers Association
Federal Law Enforcement Association
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