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Senior Fraud Investigator

Location:
Potomac, MD
Posted:
April 08, 2021

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Resume:

CHRISTOPHER A. WILSON

301-***-**** adljbl@r.postjobfree.com Potomac, MD

SENIOR FRAUD INVESTIGATOR & PROGRAM DIRECTOR

Award-winning Senior Special Agent, results-oriented Investigative Program Director and Project Manager, skilled Data Analyst, respected Executive Advisor, and experienced Training Facilitator and Lead Instructor with a comprehensive investigative, healthcare, financial, management, legal, regulatory, and information technology background and an exemplary record of achievement throughout 19 years of service to the federal government and eight years of private-sector employment. Elite Senior Fraud Investigator and manager with an unrivaled record of mining big data to identify fraudulent activity and trends, and investigating complex violations of healthcare and financial laws and regulations through the use of data science, forensic accounting, and advanced fraud detection techniques. Strong expertise in the development, implementation, and management of public health fraud programs, resulting in unparalleled increases in agency performance and financial recoveries. Widely recognized as a highly effective leader, relationship-builder, and communicator who takes initiative to solve difficult problems and investigate high-impact crimes through the use of informatics and exceptional analytical skills. [ SA TS ACFE ] AREAS OF EXPERTISE

§ Complex Data-Driven Fraud Investigations § Complex and Major Fraud Schemes § Integrity and Leadership by Example

§ Data Mining, Analysis, and Presentation § Fraud Detection and Prevention § Delivering Quality and Timely Results

§ Interviews, Persuasion, and Negotiation § Technical Writing and Editing § Investigative Reports and Presentations

§ Training, Facilitation, and Instruction § Maximizing Operational Efficiency § Analyzing Data to Solve Problems

§ Sensitive and High-Profile Investigations § Logical Problem-Solving Skills § Developing and Improving Policy

§ Leading Programs, Projects, and People § Legal and Regulatory Compliance § Informatics and Information Systems SELECTED CAREER HIGHLIGHTS

Ø Formulated, directed, and managed a nationwide fraud program as the agency’s first Healthcare Fraud Program Director.

§ Oversaw a $42 million budget and created forecasts to geographically allocate personnel to maximize return on investment.

§ Increased investigative financial impact from $299 million the previous year to $4.1 billion during the assignment.

§ Designed and taught a series of multi-course training programs that educated all agents on public health laws and procedures, known fraud schemes, agency nexus, and the use of proven investigative techniques and established resources.

§ Represented the agency in quarterly meetings with senior government executives, briefed senior leaders on progress, and organized nationwide symposia to provide instruction, disseminate information, and discuss regulatory and policy changes.

§ Established and continuously improved fraud models to assist agents in identifying high-risk claims for potential investigation.

§ Received awards for “Outstanding Accomplishments,” “Overall Contributions to Headquarters Operations,” and the

“Certificate of Appreciation and Official Commendation and Recognition of Superior Performance.” Ø Designed, developed, and led case management projects as an Office of Investigations Headquarters Project Manager.

§ Managed the development of healthcare fraud detection and case management reporting tools.

§ Developed and justified project budgets. Audited, analyzed, and reported financial progress to agency leadership.

§ Provided expert-level advice to senior executives regarding strategic, operational, and technical matters.

§ Received numerous awards, including the annual Assistant Inspector General for Investigations Excellence Award. Ø Coordinated and executed Quality Assurance Reviews (QAR) of Office of Investigations divisions and field offices.

§ Led teams of Senior Special Agents in verifying and enforcing legal, policy, and regulatory compliance per CIGIE guidelines.

§ Presented QAR findings and recommendations to senior executives via reports and presentations.

§ Formally recognized with multiple awards and accommodations for stellar performance. Ø Spearheaded investigations of three Fortune 100 companies and one Fortune 500 company engaging in false claims, fraud against the government, and related crimes with international co-conspirators, in an effort to target $3 billion in government payments.

§ Led and directed a team of data analysts and investigative personnel in the re-creation of big data contained in complex databases required to identify co-conspirators, detect fraud schemes, and calculate financial losses to the government.

§ Analyzed the data for evidence required for negotiation and produced reports and presentations tailored to a variety of audiences.

§ Planned, organized, and led a 36-hour operation of over 50 federal, state, and local law enforcement officers in the simultaneous execution of high-risk search warrants at multiple locations in furtherance of the agency’s most high-profile investigation.

§ Received multiple awards for “Outstanding work above and beyond,” “Leadership,” and “Resourcefulness.” Ø Stellar record of personal investigative achievement resulting in over $100 million in healthcare fraud savings and recoveries. Ø Received the 2010 Law Enforcement Public Service Award from United States Attorney Neil H. MacBride, Department of Justice, Eastern District of Virginia, for successfully investigating complex public health fraud violations that resulted in convictions. Ø Emergency responded to the U.S. Capitol to investigate a U.S. Postal Service (USPS) employee who piloted a gyrocopter into the Air Defense Identification Zone (ADIZ) surrounding Washington, D.C., in a potential terrorist act. Coordinated with the U.S. Capitol Police to interview the subject and obtained a full confession. Assisted the U. S. Attorney’s Office (USAO) for the District of Columbia in the successful negotiation of a plea deal which included incarceration. Ø Analyzed data and provided expert-level advice to senior executives on strategic, operational, financial, and technical matters as a founding member of 10 separate investigative councils and programs. Ø Assisted in recovery efforts in the wake of Hurricane Katrina. Responded to emergency communications requiring immediate action. Researched, located, acquired, and managed distribution logistics in response to equipment and supply requests. Ø Pioneered and streamlined the USPS Office of Inspector General’s (USPS OIG) Continuation of Operations Plan (COOP) and policies to ensure the continuation of Primary Mission Essential Functions (PMEF) in emergency situations. Responsible for the personal protection of the Inspector General during emergencies. Ø Formally recognized for “superior sustained performance” for additional collateral duties, including service as a Facilitative Instructor, Healthcare Fraud Instructor, Surveillance Techniques and Technology Instructor, Undercover Operations Instructor, Financial Fraud Instructor, Certified Training Agent, Leadership Development Program Member, Certified Mentor, Area Threat Management and Training Coordinator, Certified Firearms Instructor, Certified Master Shotgun Instructor, Officer Tactics Instructor, Use-of-Force Instructor, Certified Armorer, and multiple successful personal security details. PUBLIC SECTOR EXPERIENCE

Principal Investigator (40 hrs.) 2020 to Present

Northrop Grumman, Defense Systems (Supporting a U.S. government national security contract) Remote/Woodlawn, MD

§ Reviews and investigates benefit claims and individual transactions to identify fraudulent acts and nationwide fraud trends.

§ Evaluates system alerts for fraudulent activity via data mining and the analysis of multiple proprietary benefit claim systems.

§ Develops advanced fraud detection techniques and improves existing fraud models to identify fraudulent benefit payments.

§ Works with technical staff to test fraud models, while implementing proper cybersecurity and information security concepts.

§ Prepares management reports and presents findings to Northrop Grumman and agency executives.

§ Represents Northrop Grumman and U.S. government agencies in investigative meetings and events. Senior Special Agent (Specialist) (GS-14, 50 hrs.) 2015 to 2020 USPS OIG, Major Fraud and Contract Fraud Investigations Division Remote/Bethesda, MD

§ Planned, organized, and directed complex and sensitive investigations identified as “Major Fraud” cases due to singular or systematic high-profile financial, public health, contract, and bank fraud violations, including false claims, embezzlement, loan fraud, procurement fraud, non-compliance, product substitution, misuse of funds, conflicts of interest, public corruption, bribery, kickbacks, conspiracy, false statements, and additional criminal, civil, regulatory, and administrative violations.

§ Mined big data sets for indicators of fraud, abuse, and trends. Investigated and identified employees and companies involved in a complex multi-company conspiracy to submit knowingly false claims to the government and military for approximately 10 years.

§ Utilized proprietary software tools to research subjects, identify fraud schemes, and gather evidence for criminal and civil action.

§ Communicated investigative findings, results, and regular case status updates to management, executive leadership, partner agencies, prosecutors, and opposing counsel via detailed written reports, formal meetings, and oral presentations.

§ Met and traveled regularly with the DOJ, Criminal Division, Healthcare Fraud Unit Assistant Chief for all investigative proffers.

§ Participated in the DOJ’s Procurement Collusion Strike Force (PCSF). Recent successes are extensive and ongoing, including a

$195 million criminal penalty against a manufacturer of generic drugs; the largest antitrust penalty imposed against a domestic entity. In addition, the USPS OIG and the PCSF investigated a pharmaceutical company for falsely marketing a new opioid product as, “less-susceptible to accidental pediatric exposure,” in an illicit nationwide scheme to expand use under CMS- administered programs. The resulting plea deal totaled over $2 billion; DOJ’s largest financial resolution in an opioid case.

§ Testified at trials, before judges in pre-trial and administrative hearings, and before federal and local grand juries.

§ Drafted affidavits for search and arrest warrants and drafted and served OIG and grand jury subpoenas.

§ Planned, organized, and executed numerous high-risk federal search warrants and arrest warrants as an Operation Team Lead.

§ Reviewed medical, personal, and corporate records, financial statements, and tax, loan, and payroll records for fraud indicators.

§ Forensically analyzed incoming fraud allegations, reviewed claims, and determined whether further investigation was warranted. Senior Special Agent, Assistant Special Agent in Charge (GS-14, 50 hrs.) 2014 to 2015 USPS OIG, Capital Metro Area Field Office, Healthcare Fraud Team Remote/Bethesda, MD

§ Planned, conducted, directed, and supervised complex and sensitive healthcare fraud investigations.

§ Supervised and mentored agents. Developed investigative plans and provided ongoing guidance to junior agents.

§ Advised outside law enforcement agencies regarding developing fraud schemes and the improvement of investigative programs.

§ Utilized professional and personal contacts from outside federal, state, and local agencies and entities, the NICB, and FinCEN to investigate fraudulent health insurance claims, trace financial transactions, and identify and locate individuals and assets.

§ Summarized investigative findings and activities in accurate and concise Reports of Investigation and memoranda.

§ Negotiated settlements, charges, sentences, fines, and restitution with subject counsel for presentation to the Court.

§ Performed Training Agent duties, mentored, and instructed numerous incoming transfers, junior agents, and fraud analysts.

§ Instructed agents and analysts in investigative techniques and strategies, fraud schemes and indicators, and internal controls. Healthcare Fraud Program Director, Lead Subject Matter Expert (GS-14, 50 hrs.) 2012 to 2014 USPS OIG, Headquarters Operations Remote/Arlington, VA

§ Developed an overarching vision, strategy, and a comprehensive training program for a nationwide healthcare fraud program.

§ Established and oversaw the agency’s fraud program, managed budgets, and standardized investigative procedures.

§ Managed a team of eight Program Managers, who each managed 30 to 50 Special Agents located across the country.

§ Advised the Assistant Inspector General of Investigations, proposed and executed strategies to increase return on investment, and recommended and implemented proactive initiatives and projects to increase program impact.

§ Analyzed current and historical data to improve processes and procedures, and authored and updated applicable policy.

§ Expanded program from an administrative focus toward complex and high-impact investigations involving conspiracies with medical providers, kickbacks, price-fixing, and false claims to public health government programs like Medicare and Medicaid.

§ Developed proactive initiatives to identify fraudulent activity and improper or ineffective management practices and controls.

§ Compiled data from multiple sources and used predictive analytics and geographic information system (GIS) mapping to establish fraud indicators and tripwires, develop and improve fraud models, and design and generate management reports.

§ Disseminated important procedural, legal, regulatory, and policy changes to internal and external entities. Special Agent, Assistant Special Agent in Charge, Project Manager (GS-13, 50 hrs.) 2004 to 2012 USPS OIG, Washington Field Office Remote/Arlington, VA

§ Planned, conducted, and supervised complex and sensitive investigations of healthcare fraud, contract fraud, bank fraud, financial and economic crimes, public corruption, embezzlement, and employee misconduct violations.

§ Summarized investigative findings and activities in accurate and concise Reports of Investigation and memoranda.

§ Drafted, reviewed, and approved operational plans for high-risk search warrants and arrest warrants.

§ Developed informants, conducted undercover operations, and provided formal training classes in these investigative techniques.

§ Created multiple automated investigative processes and subsequently managed their nationwide implementation.

§ Directed case management development projects using appropriate software development life cycle methodologies.

§ Utilized investigative software, government and public databases, and financial records to identify fraudulent activity.

§ Mined and analyzed investigative data and created customized monthly performance reports for senior management review.

§ Reviewed claimant medical files for appropriate medical coding and proper justification for prior and ongoing benefits.

§ Supervised employees, prepared annual appraisals, reviewed applications, and interviewed, rated, and selected applicants.

§ Investigated the agency’s first healthcare fraud “paper case,” based on inconsistencies between medical documentation, CPT, ICD, NDC, and additional medical codes, and related fraudulent pharmaceutical claims, which led to the prosecution and incarceration of the subject.

§ Provided advice and guidance on investigative strategies and techniques to managers and subordinates.

§ Received the “Strong Service Award for Professional Dedication and Excellence in Performance” for drastically exceeding individual performance goals during each year of service within the division. Special Agent, Information Systems Investigator and Auditor (GS-12, 40-50 hrs.) 2002 to 2004 USPS OIG, Computer Crimes Unit Arlington, VA

§ Planned and conducted computer forensic, computer intrusion, and cybersecurity investigations.

§ Memorialized activities in memoranda and reports to management, external entities, and stakeholders.

§ Investigated cybercrimes as a member of the Federal Bureau of Investigations (FBI) Cyber Division task forces.

§ Audited information systems and processes to assess security risks and ensure regulatory and policy compliance. PRIVATE SECTOR EXPERIENCE

Director of Compliance, Investigations, and Government Affairs 2020 to 2021 Digital Studios Remote/Bethesda, MD

§ Conducted financial, operational, and contract reviews and audits involving complex laws and regulations.

§ Conducted risk assessments, identified and investigated questionable transactions, and analyzed and improved internal controls.

§ Ensured corporate compliance with applicable government regulations and federal contract requirements.

§ Developed and fostered strategic relationships with government personnel. Site Marshall (Officer), COVID-19 Task Force (upon request, during emergencies) 2020 to Present Industrial Medical Support, Inc. Falls Church, VA

§ Implement COVID-19 Jobsite Requirements, control measures, and PPE utilization at local construction project locations.

§ Conduct screenings and ensure compliance with comprehensive COVID-19 exposure control, mitigation, and response plans, and CDC reporting requirements necessary for SARS-CoV-2 and COVID-19 surveillance efforts. Journalist, Editor, Podcast Host and Producer 2017 to Present Minute Media/Freelance Remote/Los Angeles, CA

§ Write and edit written sports news content.

§ Host and produce weekly sports news podcasts.

§ Awards include NFL Writer of the Year, 2019.

Systems Security Specialist 2001 to 2002

Johns Hopkins Medicine Baltimore, MD

§ Maintained the internal computer network for the Johns Hopkins Radiology Department, Neuroradiology Division.

§ Built and maintained servers and workstations for the Johns Hopkins Radiology Department.

§ Established security policies and performed standardized testing of servers, systems, and network hardware. Technical Lead 2000 to 2001

The Media Shoppe, Inc. Towson, MD

§ Managed and oversaw the Technology Department for the U.S. subsidiary of an international corporation.

§ Developed and managed a corporate data center and multiple server farms, and designed, implemented, and maintained computer networks, including security policies for all server and network equipment.

§ Performed penetration testing and security audits of corporate computer networks, firewalls, and security systems.

§ Managed the development of custom software application projects with software developers located worldwide.

§ Worked full time while pursuing and completing an undergraduate academic degree. Lead Systems Engineer, Network Security Specialist 1996 to 2000

US Net, Inc. Laurel, MD

§ Designed and maintained computer networks and server farms for an Internet Service Provider.

§ Developed software applications to automate administrative tasks, and implemented security policies for public users.

§ Assisted customers with web application and database issues.

§ Worked full time while pursuing an undergraduate academic degree. EDUCATION

Ø Bachelor of Science, Computer Information Systems. Towson University, Towson, MD; Graduated with Honors: summa cum laude (GPA 3.8/4.0). Ø Criminal Investigator Training Program. Federal Law Enforcement Training Center, Glynco, GA; Graduated with Academic Honors: (Grade 97.73).



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