Fraud, waste, and abuse has been closely scrutinized by Federal legislatures and the judiciary in recent years because of the rapid increase in healthcare costs and the cost of fraudulent, wasteful and abusive practices. Jackson, Dunham, Sato & Associates have assembled a unique combination of individuals that have experience in virtually all areas of the administration and oversight of Federal healthcare programs. Our staff has worked with State agencies and Medicare contractors on integrity issues; developed cases for prosecution by the Department of Justice; assisted in the development of regulations and guidelines designed to control wasteful spending; and assisted in the recovery of program funds misspent as the result of abusive practices through application of various civil penalty laws and regulations.
In January 2007, Ben founded Ben Jackson Consulting, LLC to provide professional consulting services for program integrity oversight and compliance with Federal and State healthcare programs. Effective August 2009, Ben formed Jackson, Dunham, Sato and Associates, LLC to provide broader coverage in the unique areas of program integrity oversight. Currently the staff consists of two senior partners and 23 senior staff consultants with years of experience in managing and directing audits and investigations in both Medicare and Medicaid. Our high level management team provide many years of healthcare experience in all health care provider types.
Ben retired in January 2004 from the Office of Inspector General (OIG), U.S. Department of Health and Human Services (HHS) as the Director of Field Operations for Medicare and Medicaid Audits, Centers for Medicare and Medicaid Audits Division (CMS). In that position, Ben was responsible for the technical direction and management of nationwide audits of the Medicaid Drug Rebate Program that included audits of pharmaceutical companies, Medicaid State agencies and the Centers for Medicare and Medicaid Services. These audits included reviewing methodologies of pharmaceutical company's average manufacturer prices; pricing issues involving the use of average wholesale prices in State Medicaid reimbursement; internal control reviews in State pharmacy programs for the billing, collection and resolution of disputes for Medicaid rebates, and oversight of program implementation by CMS. Ben also played the lead role in briefing congressional staffers on Medicaid Rebate program vulnerabilities and made recommendations to Congressional committees for program legislative changes.
Ben's other duties included directing national audits of the Medicaid program that included disproportionate share hospital cost reviews, upper payment limits, institutions for mental diseases, credit balances, school based health services and reviews of Medicaid nursing facilities. Under Medicare, Ben was responsible for the audit oversight of home heath agency reviews, hospice, partial hospitalization programs including community mental health centers and Medicare related drug issues.
Ben served four years of active duty in the U.S. Coast Guard prior to receiving his B.S. degree from Virginia Commonwealth University in Richmond, Virginia. He was a Certified Government Financial Manager, a member of the Association of Government Accountants (AGA) and the Maryland Chapter of AGA. He also was a Certified Fraud Examiner. He has received numerous OIG awards, including two Exceptional Achievement Awards for his work on developing, directing and analyzing the Health Care Financing Administration's implementation of the Prescription Drug Program. In May 1993, he received the Baltimore AGA Chapter Achievement of the Year Award in recognition of his leadership and outstanding achievement in developing, implementing and improving the Medicaid Drug Rebate Program.
In 1994, Ben received one of the Office of Inspector General's highest awards, "AUDIT MANAGER OF THE YEAR", for outstanding accomplishments in auditing the Medicaid drug rebate program and organizing joint Federal and State auditor reviews of the Medicaid program. Ben also received three Secretarial Distinguished Service Awards for national audits of the Medicare partial hospital program, Medicaid drug rebates and Medicaid upper payment limits. These audits identified savings and recoveries of nearly $100 billion.
Gerald Dunham retired in 1998 from the Office of Inspector General, (OIG), U. S. Department of Health and Human Services (HHS), as a Medicare audit manager of the Atlanta Region, Region IV, which is comprised of the states of Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Florida, Alabama, and Mississippi. Gerald was responsible for supervising from 10 to 15 auditors involving audits of the Medicare and state Medicaid programs. He also developed ideas for the OIG work plan, plans to conduct nationwide and regional audits of healthcare providers, and managed the audits as they were conducted. Gerald has managed audits of compliance with the Medicare and Medicaid program regulations for nursing homes, durable medical equipment, home health, hospital, and physician groups industries.
Since retiring, Gerald has advised healthcare providers on the implementation of compliance controls that ensure that providers will comply with applicable Federal regulations related to Tricare, Medicare and Medicaid. These clients included medical diagnostic laboratories, hospitals, rehabilitation facilities, independent diagnostic testing facilities, hospice, home health agencies, and community mental health centers. Gerald has also reviewed the internal control structure for the Medicare contractors in South Carolina, Texas, and Ohio to ensure that the contractors were administering the Medicare program in accordance with applicable Medicare regulations. For the past 4 years, he has worked with the Medic on Part D compliance audits and over the last 2 years, he has worked closely with the implementation of a Medicaid Integrity Contractor (MIC) on the Audit MIC contract.
Gerald served four years of active duty in the U.S. Air Force where he was a rescue medic serving with the 33rd air rescue squadron. During his tour of duty he received the Air Force Expeditionary Medal for service in Southeast Asia and a Good Conduct Medal. He was given an honorable discharge in May 1965.
Gerald is a 1969 graduate of Campbellsville College in Campbellsville, Kentucky, with B.S. in Business Administration & Accounting.
Gerald received numerous OIG awards including: Outstanding OIG Employee of the year for 1995 for outstanding performance and dedication to furthering the mission of the OIG; "AUDIT MANAGER OF THE YEAR" for 1996 for outstanding accomplishments in the presidential initiative Operation Restore Trust, which focused on abusive practices in the Federal healthcare programs; and in 1998, post-retirement, the Secretary's Award for Distinguished Service for Outstanding Leadership in working with the Health Care Financing Administration (now Centers for Medicare and Medicaid Services) to develop multi-agency and multidisciplinary teams to reform home health care.
In August 2009, Gordon retired after 35 years from the Office of Inspector General (OIG), U. S. Department of Health and Human Services (HHS), as the Regional Inspector General for Audit Services for the Dallas Region, Region VI. He directed a staff of approximately 83 people located in five field offices throughout the five states (Texas, New Mexico, Oklahoma, Arkansas and Louisiana) that are part of Region VI.
Gordon was responsible for providing comprehensive audit services over HHS programs in the five state Region and leadership over nationwide audits. His audits covered a wide range of healthcare areas such as prospective payment systems transfers, Medicaid drugs, drug manufacturers, Medicare Part D drugs, Chief Financial Officer Reviews, Medicaid payment error rate oversight, Medicaid partnership audits with State Auditors, and disproportionate share hospital payments. He has provided support to investigative agencies in both criminal and civil matters. Gordon has been involved in developing relationships with Congressional staff including personally briefing staffers on issues that affected pending legislation.
Since joining JDS & Associates, Gordon has worked on various ZPIC initiatives and projects. He served as a Co-Director of Health Integrity’s Home Health Outlier project. Gordon has also participated in and provided input on projects involving hospice, zero and one day hospital stays, ambulance transports, Durable Medical Equipment, and Community Mental Health Center issues.
Gordon graduated from the University of Texas at Austin with a BBA and a MBA. He is a Certified Public Accountant (CPA) in the State of Texas and a Certified Government Financial Manager, Association of Government Accountants (AGA). Gordon is a member of the AGA, Dallas Chapter and a member of the American Institute of Certified Public Accountants (AICPA).
Gordon has received numerous awards for contributions to the improvement of government financial management, including the 2007 and 2006 President's Council on Integrity and Efficiency Awards for Excellence, the 1998 IG's Cooperative Achievement Award, the 1996 Secretary's Award for Distinguished Service, HHS and the 1998 IG's "OUTSTANDING AUDIT MANAGER" Award. Gordon also received the 2000-2001 Local AGA Chapter Award for Government Financial Manager of the Year.
Eileen Bechkes retired in December 2011 from the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), Office of Audit Services after 32 years of service. As an audit manager with the Centers for Medicare and Medicaid Audits Division, Eileen was responsible for planning, developing, coordinating, and implementing nationwide policy and compliance audits of Medicaid and Medicare Part B issues. Eileen was responsible for nationwide Medicaid audits, including those related to personal care services, school-based services, hospice services, home health services, inpatient services, nursing facility services, family planning services, and waivers services. For Medicare Part B, Eileen was responsible for nationwide audits of physician services, clinical laboratory services, ambulance services, and durable medical equipment and supplies. Eileen also worked closely with the Department of Justice on several investigative audits which resulted in multi-million dollar civil settlements with the Federal government.
Eileen received numerous awards while at OIG, including, in 2010 and 2011 the Inspector General’s Award for Excellence in Financial Management; in 2009 the Council of Inspector General on Integrity and Efficiency award for Excellence; in 2000 and 2001, OIG’s Cooperative Achievement Award; in 2000, OIG’s Award for Excellence; in 1999, the Secretary’s Award for Distinguished Service; and in many years, the OIG’s Award for Exceptional Achievement.
Eileen graduated from the Pennsylvania State University with a Bachelor of Science degree in accounting.
Gene Berti retired from the U. S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), Office of Audit Services, in October 2008 as an audit manager after 40 years of service. Gene has extensive experience in health care auditing, fraud and abuse and compliance issues. Gene worked on issues related to Medicare reimbursement for hospitals, physician services, the prescription drug program, Medicaid fee for services, school based health services and the Medicaid Drug Rebate program. At the OIG, Gene was responsible for identifying nationwide healthcare audit issues, developing national audit sampling plans, supervising both nationwide and regional audits, and assisting the OIG's Counsel in reviewing the results of Independent Review Organizations audits of Corporate Integrity Agreements.
Gene was a national project leader on the OIG's Physicians at Teaching Hospitals national initiative. This initiative was undertaken as a result of an audit he supervised which suggested that some physicians practicing in teaching hospitals were not in compliance with Medicare reimbursement requirements.
As a national project leader he has made numerous presentations to OIG staff, Assistant United States Attorneys, the FBI and Medicare and Medicaid personnel nationwide. He also served as a Regional Audit manager responsible for coordinating audits with the OIG Office of Investigation and the U.S. Attorney's office leading to numerous Medicare and Medicaid settlements with healthcare providers.
Gene received numerous awards including the President's Council on Integrity and Efficiency Award for Excellence, the Council of Inspectors General on Integrity and Efficiency Award for Excellence, the Secretary's Award for Distinguished Service, and the Excellence in Financial Management Award. Gene graduated from the University of Scranton with a BS in Accounting.
Upon joining JDS, Gene was assigned to Health Integrity’s Medicaid Integrity Contract as the Task Order 1R Lead Auditor. His duties include providing subject matter expertise on the Medicaid program and technical guidance on audit related issues. He also is responsible for ensuring the quality of issued audit reports.
Ron Bryan retired from the Centers for Medicare and Medicaid Services (CMS) after 29 years of professional, technical, and managerial experience. He has:
Ron served in various first and second level management positions related to Medicare Fee for Service contracting in the Midwest and Northeast.
He performed financial reviews of Medicare Fee for Service contractor budgets to identify reasonable, allocable, and allowable costs. Ron represented regional leadership in the development of performance review protocols for Medicare fee for service contractors.
Ron conducted reviews of Medicare fee for service contractors for compliance with contract provisions. He represented regional leadership in the development of performance review protocols for Medicare managed care organizations. Ron conducted interviews with and reviews of hospitals and physicians contracting with Medicare managed care organizations. He served as technical lead for regional demonstration projects involving Medicare managed care organizations, hospitals, and physicians. Ron also served as technical lead for professional coordination and education of hospital and physicians and their professional associations.
Ron has worked as an Auditor for Jackson, Dunham, Sato and Associates, LLC on the Medicaid Integrity Contract held by Health Integrity, LLC, since January, 2010. He performs audits of medical and financial records of selected providers to assure compliance with Federal and State Medicaid billing and reimbursement regulations, identifies potential fraudulent practices, and writes audit reports.
Paul Chesser retired with 28 years of service with the U.S. Department of Health and Human Services, Office of Inspector General (OIG), Office of Audit Services. Paul served the OIG as an audit manager in the Little Rock, Arkansas field office for 14 years. Prior to joining the OIG, Paul worked for the Arkansas Division of Legislative Audit for 5 years as a field auditor.
As an Audit Manager for the OIG, Paul was responsible for developing, planning and supervising many complex audits of the Medicaid and Medicare programs. Much of Paul's audit efforts were focused on reimbursement issues for Medicaid prescription drugs. Additionally, Paul played a key role in the OIG’s oversight of all aspects of the Medicaid drug rebate program.
Paul received numerous awards during his career with the OIG, highlighted by the Bronze Medal for Audit Manager of the Year in 2007. Paul graduated from the University of Arkansas at Little Rock with a BS in accounting. He is a Certified Public Accountant in the State of Arkansas.
Michael Cummins retired with 29 years of Federal service including over 21 years as a special agent with the U.S. Food and Drug Administration’s (FDA) Office of Criminal Investigations (OCI). Michael retired as the Deputy Special Agent in Charge of Headquarters’ Operations.
As Deputy Special Agent in Charge of Headquarters (HQ), Michael was responsible for providing management, oversight, and leadership to the daily operations of OCI HQ. He helped lead OCI’s HQ unit comprised of 30 personnel including four Assistant Special Agents in Charge. He provided troubleshooting support, intervention, and consultation to OCI and FDA personnel. Additionally, he coordinated with field, agency and industry personnel on policy, case initiation, development, and criminal investigations. Michael was also OCI’s subject matter expert on pharmaceutical crime and advised both agency and industry representatives on regulatory (civil) matters and potential criminal investigations to include issues pertaining to the Drug Quality and Security Act (DQSA).
While working as an OCI field agent, Michael independently planned, coordinated, and conducted criminal investigations of alleged violations of criminal law pertaining to the FDA. He conducted investigations into the illegal importation of unapproved, misbranded, and counterfeit pharmaceuticals, falsely labeled seafood, illegal distribution of pharmaceuticals through the Internet, adulterated and misbranded medical devices, and the off-label promotion of pharmaceuticals.
Prior to becoming a special agent, Michael worked as an auditor and senior auditor with the U.S. Department of Health and Human Services’ Office of the Inspector General, the U.S. Army Audit Agency and for the U.S. Nuclear Regulatory Commission’s Office of the Inspector General. Michael graduated from the University of Georgia with a Bachelor of Business Administration in accounting. Michael is an inactive Certified Public Accountant in Maryland.
In October 2005, Don Czyzewski retired with 30 years auditing experience with the Department of Health and Human Services (HHS), Office of Inspector General (OIG), Office of Audit Services. Don was the Public Health Services Audit Manager in the Boston field office for 12 years and the Medicare Audit Manager in the Miami field office for five years. His assignments included, but were not limited to, reviews of: (1) Medicare claims submitted by Independent Diagnostic Testing Facilities, Home Health Agencies, Community Mental Health Centers and Comprehensive Outpatient Rehabilitative Facilities, (2) Medicaid hospital outpatient laboratory services, (3) Adjusted Community Rate Proposals developed by Managed Care Organizations (4) home office costs under Medicare's End Stage Renal Dialysis program, (5) duplicate fee for service claims under the Medicare Part B program for beneficiaries enrolled in risk based health maintenance organizations, (6) Medicaid outpatient claims duplicating all inclusive in patient hospital claims, (7) Institutions for Mental Disease under the Medicaid program, (8) contract proposals for special demonstration projects under the Medicare and Medicaid programs, (9) security of dangerous biological agents at college and university laboratories, and (10) PHS systems for assuring programs are necessary, productive and non-duplicative.
In 2003, Don received the Secretary’s Award for Distinguished Service for contributions to the IG’s Innovative Anti-Bioterrorism team and also an award for Audit Excellence from the President’s Council on Integrity & Efficiency. In addition, he received numerous meritorious service awards including the Inspector General’s Exceptional Achievement Award for recognition of major contributions toward the Office of Inspector General’s goals and objectives. Further, he was recognized by the Boston Chapter of AGA in 1993 with Special Achievement Award for major contribution in managing a nationwide HHS audit of indirect costs claimed by colleges and universities.
After retiring Don continued his auditing career with Catapult Consultants, LLC where he helped develop the audit protocols for the Medicaid Integrity Program, managed the CMS Medicaid Integrity Program “test” audits project and provided Subject Matter expertise on numerous other CMS contracts.
Don graduated Magna Cum Laude from the University of Massachusetts in Amherst, Massachusetts in 1975 with a B.S. in Accounting and elected to Beta Gamma Sigma (National Honor Society for Business Students). He is a Certified Public Accountant in the state of Florida.
Sandra Hall retired from the Centers for Medicare & Medicaid Services (CMS) after 33 years of Federal service. At the time of her retirement, she held the position of Technical Director of the Division of Medicaid and Children's Health in the Dallas Regional Office. Sandra has extensive experience in all aspects of the Medicaid program. During her career with CMS, she:
Sandra successfully developed and led teams throughout her career and was also selected to serve on several national workgroups dealing with complex Medicaid issues of national importance.
Sandra graduated from the University of Connecticut with a degree in Elementary Education and has completed 24 semester hours of post graduate studies in Accounting and Public Policy Administration. She has received numerous awards including the CMS Administrator's Citation in 1991 and 2005, the CMS Administrator's Achievement Award in 1995 and 2002, and HHS Regional Director's Leadership Award in 2006.
In January 2010, Sandra joined Jackson, Dunham, Sato and Associates, LLC, and currently performs a wide array of investigative and analytical duties related to detecting fraud, waste and abuse in the Medicare and Medicaid programs.
Beth Ann Irvine retired from the federal government after more than 31 years of service, during which time she worked for the Department of Health and Human Service, Office of Inspector General, Office of Investigations (HHS-OI), as a Special Agent for nine years before being promoted in 2014 to Assistant Special Agent in Charge in HHS-OI’s Boston Regional Office. Prior to HHS-OI, Beth Ann spent an additional twelve years in federal law enforcement with the United States Postal Service, Office of Inspector General and the United States Postal Inspection Service.
As a Special Agent and as Assistant Special Agent in Charge, Beth Ann conducted investigations and managed a squad of Special Agents who conducted investigations involving the pharmaceutical industry, the medical device industry, durable medical equipment, home health, personal care services, drug diversion, treatment and testing, genetic testing as well as a variety of other health care fraud schemes impacting Medicare, Medicaid and other insurance programs. During her career, she worked on many national, multi-year investigations. Most notably, the Pfizer/Pharmacia/Upjohn investigation that resulted in a guilty plea and a $2.3 billion settlement and Orthofix, Inc. which led to ten felony convictions of executives, employees and contractors in addition to a $35 million settlement.
Throughout her career Beth Ann has collaborated with various federal, state and local entities, including the National Association of Medicaid Fraud Control Units (NAMFCU), various State Medicaid Fraud Control Units, State Program Integrity entities, and health care insurers and has received numerous awards from HHS-OI, the Department of Justice, and the Counsel of Inspector’s General on Integrity and Efficiency.
Beth Ann received her Bachelors in Accounting from Goldey Beacom College, her MBA from the University of Delaware and is a Certified Public Accountant in Massachusetts.
Ron Kerr retired after over twenty-two years of service with the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations (HHS-OI). Ron worked as a Special Agent for twelve + years with HHS-OI’s Philadelphia Office before being promoted in 2010 to Assistant Special Agent in Charge in HHS-OI’s Philadelphia Regional Office. Prior to HHS-OIG, Ron spent over twelve years with the Defense Contract Audit Agency as a Senior Auditor and with the Internal Revenue Service as a Revenue Agent.
As Assistant Special Agent in Charge, Ron managed a squad of Special Agents who conducted investigations involving hospice, home health, physicians, rehabilitation, drug treatment, diagnostic testing, genetic testing, DME, SNF/RUGs, personal care services, pill mill/Opiod diversion, Medicaid Waiver programs, adult day care, child day care, pharmacy/pill shortage and a variety of other health care fraud schemes impacting Medicare, Medicaid and other insurance programs. During his career, Ron managed Special Agents assigned to the Drug Enforcement Administration’s Tactical Diversion squads in VA, PA, MD and DE who focused on the nation’s Opiod epidemic and related healthcare fraud. Recently, Ron assisted with the planning and implementation of the Philadelphia Health Care Fraud Strike Force and the Appalachian Regional Prescription Opiod Task Force in Western Virginia which resulted in dramatic increases in successful healthcare fraud and diversion convictions. As a Special Agent, Ron brought a variety of complex healthcare fraud cases to successful conclusions and worked as a full time task force officer on the FBI’s Organized Crime Squad for four years.
Ron collaborated with CMS at CPI Missions involving ambulance, hospice and home health fraud, sharing case experiences which helped identify various program vulnerabilities/risks. Ron appeared in an ABC News story focusing on Ambulance Fraud in Philadelphia and was interviewed by ABC News reporter David Kerley. Ron received numerous awards during his federal career from HHS-OI, the Department of Justice, Drug Enforcement Administration, DCAA and the Counsel of Inspector’s General on Integrity and Efficiency.
Ron received his MBA and Bachelors in Accounting from Temple University and is a Certified Public Accountant in Pennsylvania. Ron also served 28 years in the Navy Reserve, retiring in 2016.
Ann Lowe retired with 30 years of service with the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG). Ann served the OIG as an Auditor, Senior Auditor, and Audit Manager in the Office of Audit Services (OAS) for 28 years and as a Program Analyst in the Office of Management and Policy (OMP) for 2 years.
During her years with OAS, Ann was responsible for developing, planning, and supervising many complex audits of the Medicaid and Medicare programs. Most of Ann’s audits were performed in the Medicaid area. Examples of program areas audited included:
During her years with OMP, Ann provided critical analysis of HHS programs and activities. The analysis included analytic expertise, drawing on her knowledge and understanding of the substantive nature of interrelationships of data, programs, planning, and processes to assist OIG components in conducting oversight work. Ann also worked with the Transformed Medicaid Statistical Information System (T-MSIS) data serving as the main contact for the ingestion of the data to the OIG data warehouse, quality control, and training.
Ann received numerous awards during her career with the OIG, highlighted by the Bronze Medal for Outstanding Employee of the Year in 2012. Ann graduated from the University of Missouri with a Bachelor of Science degree in accounting.
Patrick Petty retired after 21 years of service with the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG). Pat was a criminal investigator working out of the Nashville, TN field office. Prior to working for HHS OIG, Pat worked seven years with the U.S. Department of Education as an auditor and a criminal investigator.
Pat was responsible for conducting criminal, civil, and administrative investigations regarding allegations of fraud, waste, and abuse against programs administered by HHS. Pat led, planned, coordinated and conducted investigations of a complex and highly-sensitive nature. These investigations uncovered health care fraud, bribery, conflict of interest, false statements, grant fraud, embezzlement/theft, kickbacks, wire fraud, mail fraud, child support enforcement, and other offenses committed against the United States.
Pat’s significant accomplishments include:
Pat received the Attorney General’s Award for Exceptional Service (Columbia/HCA Investigative Team), multiple Exceptional Ratings and Special Act Awards and multiple OIG Cooperative Achievement Awards,
Pat received a Bachelor of Science degree in Accounting from Middle Tennessee State University. He is also a Certified Public Accountant.
Dalavone Phothisen joins us after 18 years of service from the U. S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), Office of Audit Services (OAS). Dalavone was a Senior Auditor in Dallas, Texas.
While with the OIG, Dalavone led many IT security audits of State Medicaid Management Information Systems in the southwestern US (5 states) and assisted other nationwide auditors with Medicaid requirements and waivers. Some other audits included: CMS’s Federal market place for health care (Healthcare.gov), audits of the Medicaid School-Based Administrative Claiming Program, audits dealing with the Payment Error Rate Measurement (PERM) program and compliance with CMS data processing. Dalavone also performed some sensitive work at the National Institutes of Health that included consulting with the FBI, CIA, and DOD, to identify weaknesses and impact of NIH's controls over sensitive data.
Dalavone received multiple Exceptional Achievement Awards while with the OIG.
Dalavone graduated from the Southwestern University with a BA in Accounting.
Carmen Ryan has over 8 years of audit experience with the U. S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), Office of Audit Services (OAS). She served as a Senior Auditor and planned, coordinated, and supervised complex audits of government programs, including Medicare, Medicaid, and Social Security. Carmen conducted research; developed audit ideas; performed survey work; participated and conducted meetings with program officials; developed audit guides; planned, coordinated, conducted and supervised complex audits; used computer audit techniques and advanced sampling methodologies, when appropriate, to accomplish audit objectives; and communicated audit results in oral presentations and written reports.
Carmen received the Inspector General's Exceptional Achievement Award in 1997 and the Inspector General's Special Citation Award in 1992. She graduated from Oklahoma State University, Stillwater, Oklahoma, and received a Bachelor of Science in Finance with a minor in Accounting. Carmen was on the Dean's List of Distinguished Students.
Carmen currently works as an investigator for Jackson, Dunham, Sato and Associates, LLC, on Health Integrity's Medicare Zone Program Integrity for Zone 4. Her efforts include conducting investigations based on complaints and proactive data analysis, identifying potential provider fraud/abuse, developing the cases for law enforcement referral, and acting as liaison with law enforcement after the referral is accepted.
In January 2016, Steve retired after 38 years of service from the Office of Inspector General (OIG), U.S. Department of Health and Human Services (HHS), as the Regional Inspector General for Audit Services (RIGA) for the Philadelphia Region, Region III. During his 13 years as RIGA, Steve managed regional resources (budget and about 60 professional staff) to contribute to the successful accomplishment of the audit mission of the OIG. He directed audits of HHS programs in Pennsylvania, Maryland, Delaware, Virginia, West Virginia, and the District of Columbia.
During his OIG audit career, Steve performed, managed, and directed audits of a wide variety of HHS programs with an emphasis on health care. Examples of program areas audited include: Medicare and Medicaid fee-for-service, Medicare error rate, State Medicaid financing schemes, school-based health services, disproportionate share payments, managed care, and most recently the Affordable Care Act. Steve also provided audit assistance to the Department of Justice and the OIG’s Office of Investigations for investigations of health care providers resulting in numerous civil settlements.
Steve received many awards throughout his Federal career including two Secretary’s Award for Distinguished Service (1997 and 2001). Steve graduated from the Pennsylvania State University with a Bachelor of Science degree in accounting. He is a Certified Public Accountant in Pennsylvania.
Robert Vito retired after 36 years of service with the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG). Rob served the OIG both in the Office of Audit Services where he served as the Acting Assistant Inspector General for the Centers for Medicare and Medicaid Services (CMS) Audits and the Office of Evaluation and Inspections where he served as the Regional Inspector General for Region III for 25 years.
As the Regional Inspector General for Region III, Rob was responsible for planning, directing, and coordinating all program activities, comprehensive studies and analyses, and project research, analysis, and development. Under Rob’s leadership Region III issued hundreds of reports that resulted in billions of dollars in savings to both the Medicare and Medicaid programs and the taxpayers. As the Acting Assistant Inspector General for CMS Audits, Rob led the audit work for hundreds of Auditors in eight regional offices through a leadership team of 18-20 staff. His work included many national health care issues such as the Federal Marketplace at Healthcare.gov, coding for physician services, Medicare payment for Durable Medical Equipment and National Institute of Health Conflict of Interest. Rob built a reputation as a content expert in fraud, waste, and abuse detection and prevention, as well as Medicare and Medicaid prescription Drug program pricing, rebates, and compliance. Rob testified 10 times before the House and Senate Congressional Committees. The hearings focused on Medicare fraud, waste, and abuse, as well as Medicare and Medicaid Prescription Drug pricing and rebates.
Rob received numerous awards while at the OIG including: Inspector General’s Bronze Medal for Outstanding Employee of the Year; Inspector General’s Ethics in Government Award; Secretary’s Award for Distinguished service; and the Council of Inspector General on Integrity & Efficiency Award for Excellence. He is the only two-time award winner of the HHS OIG most prestigious award, Thomas D. Morris Leadership Award, in OIG history.
Tony Wilkinson retired from the HHS Office of Inspector General, Office of Audit Services (OAS), after 34 years of service as Director of Information Technology (IT) Audit Systems. He was responsible for oversight of all Information Technology audits issued by OAS. This included all IT reports related to audits conducted of HHS’ operations, including its contractors. His responsibilities also included audits conducted and reports issued on State Medicaid systems, hospitals and other covered entities. During this time, Tony directly supervised up to 11 staff in headquarters and responsible for coordination of audits, workplan items and reports of 24 other IT audit staff members located in OAS locations across the country. He provided direction and recommendations regarding long term goals of the IT audit division as new systems are being developed by HHS and state agencies due to recent legislative changes. This new growth has placed a huge demand on the OAS to conduct more IT audits in an environment of reduced resources. As such, this required a detailed risk analysis based on potential program vulnerabilities that may exist with these new and existing systems. It was Tony's responsibility to ensure that IT audits were still being conducted in the high risk areas, although staff was reduced as a result of budget cuts.
During his tenure, he was also responsible for developing a specialized group with the IT audit division to conduct penetration testing of auditee’s security systems. This required selected individuals whom he deemed to be qualified and experienced enough based on work on previous audits and their technical findings. The OAS initiated its first penetration audit under Tony’s direction which was later determined to be a success as the staff members were able to penetrate the auditee’s security systems and expose critical vulnerabilities that were eventually remediated.
Prior to his most recent position, Tony served as an audit manager during which time he supervised and managed over 90 various audits related to Medicare contractors, state agencies, covered entities and HHS departmental operating divisions. As manager, he lead his team through the audit process including planning coordinating, field work and the report process to provide a final written audit report. These reports cover audits that include a mixture of both discretionary and statutory/mandatory audits. Due to the ever-changing environment of HHS programs and IT industry, use of the current and applicable criteria is critical for all audits. All assignments are properly staffed in order to meet agreed upon deadlines that may be also mandated by Congress. Many of Tony’s audits were self-initiated as well as mandated.
His duties also include management of the Advanced Audit Techniques Staff (AATS) and statistical sampling members who were responsible for providing auditors and managers with critical data needed to perform most audits conducted by OAS. He also participated as a member on several workgroups and committees within both the OAS and OIG that involved policy related to IT security, work planning, procurement and training.
Tony was also involved with the development, design and operation of the information related to the OIG Data Warehouse. The Data Warehouse is the database of Medicare and Medicaid claim information and is used as the source for OIG audits and investigations.
Tony graduated from the University of Texas at San Antonio with a Bachelor’s Degree. He received many awards during his career including the HHS OIG’s Bronze Medal for Auditor of the Year.