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.
Peter “Pete” Blackburn retired from the U.S. Department of Health and Human Services Office of the Inspector General Office of Investigations (OIG) after 21 years as a Special Agent. Pete was based in the Kansas City Regional Office. Following retirement Pete has been an Investigations Consultant for the Optum Avoidance Investigations Unit.
During his career with the OIG and subsequent consultant work Pete has conducted numerous complex investigations into health care fraud related matters. Pete’s investigations spanned multiple U.S. Districts and a wide variety of provider types and Health and Human Services programs. These investigations had a direct impact on the health, safety and welfare of federal program and private insurance beneficiaries. His investigations have resulted in recovery in excess of $100 million and the conviction of those responsible for crimes. Pete has been involved in numerous national impact investigative projects.
In addition to investigative work with the OIG Pete provided training and support to fellow agents and the public serving as a Firearms Instructor, Certified Control Tactics Instructor, Disaster Relief Response Team Member, Peer Support Counselor and a member of the HHS OIG Tactical Rifle Team. Pete was also involved extensively with Protection Operations for the OIG.
Prior to the OIG Pete served as a Missouri State Trooper, he also served in the U.S. Army and then United States Marine Corps from 1987 through 2008. Pete is a veteran of Operation Enduring Freedom and Iraqi Freedom.
In 1997, Pete received a Bachelor of Science Degree from Park University in Management.
In August 2021, John retired after 15 years of service from the Department of Health and Human Services (DHHS), Office of Inspector General (OIG), Office of Audit (OAS), as a Senior Auditor in the Boston regional office. John began his career with the Internal Revenue Service as a revenue agent audit manager.
During his OIG career, John performed a review of claims in the DME CERT error rate testing program and served as team leader for many Region 1 hospital compliance audits. John also developed and initiated audits that concerned Medicare costs associated with prematurely failed or defective medical devices. One of these audits estimated that Medicare services related to seven recalled and prematurely-failed medical devices resulted in Medicare costs of approximately $1.5 billion and an estimated $140 million in beneficiary copayment and deductible liabilities.
In recognition of his performance, John received multiple Exceptional Achievement awards throughout his federal career. John graduated from Merrimack College with a Bachelor of Science Degree in accounting and Bentley College with a Masters Degree in Taxation.
Jason Boyd started his career as a Texas Peace Officer in 2002. In 2009, he transferred to an investigative unit. During his time as a police detective, Jason worked on both the North Texas Identity Theft Task Force and the North Texas Drug Task Force. During this time, Jason expanded his fraud expertise into white collar crime.
Jason joined the Texas Attorney General’s Office Medicaid Fraud Control Unit (MFCU) in 2014. While at MFCU, Jason worked both state and federal cases, including multiple Strike Force cases involving Community Mental Health Clinics and PHP, Partial Hospitalization Programs.
In 2021, Jason left the public sector to work as a Senior Investigator at Optum’s Avoidance Investigative Unit, where he now holds the position of Manager. Jason oversees a team that investigates out of network providers for potential fraud.
Jason served in the United State’s Coast Guard from 1995 to 1999, and is Certified Fraud Examiner (CFE). Jason holds a Bachelor of Science degree in Criminal Justice from Texas A&M-Commerce.
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.
Gerald "Gerry" Dunham started his federal career in 1999 as a Program Analyst with the U.S. Department of Health and Human Services, Office of Inspector General, Office of Audit Services and transferred to the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations (OI) as an Investigations Analyst that same year. In June 2000, Gerry became a Special Agent with OI where he conducted complex criminal, civil and administrative investigations pertaining to HHS programs, primarily Medicare Part A, B, and D and Medicaid. He completed several investigations concerning health care and grant fraud, child support enforcement and employee misconduct in which a criminal conviction and/or civil settlement was achieved resulting in over thirty million dollars in judgements and recoveries to the Medicare Trust Fund. While at OI, he started the nursing home quality of care task force and a task force in West Georgia combatting the Oxycontin and opioid crisis. In 2013, Gerry received the United States Attorney’s Award for an OI investigation involving a nursing home in North Georgia. Gerry was also a member of the Atlanta Healthcare Fraud Task Force in Atlanta, Georgia until departure in 2008. Additionally, Gerry became a Firearms Instructor and Coordinator in 2003 where he planned and coordinated quarterly firearms training for Region IV in Atlanta, Georgia.
In 2008, Gerry joined the U.S. Department of Health and Human Services, Food and Drug Administration, Office of Criminal Investigations (OCI) as a Senior Special Agent, where he conducted major fraud investigations throughout the United States, India and Europe affecting the U.S. Public Health, and U.S. Pharmaceutical and Tobacco companies related to foreign unapproved drugs and devices, counterfeit tobacco, and adulterated food products. The investigations included fraud related to pharmaceutical drug studies, counterfeit drugs, misbranded drugs, unapproved drugs, and drug diversion
In 2018, Gerry was promoted to Senior Operations Manager (SOM) for Training and the National Firearms Coordinator assigned to FLETC in Charleston, SC until January 2021. He was responsible for all firearms and defensive tactics training across the entire agency as well as conducting yearly new agent training courses and in-service training. He was responsible for reviewing and developing operational policies and developing statements of work for contracts involving firearms and service equipment.
In 2021, Gerry returned to the OCI Resident Office in Atlanta, Georgia and retired from federal service December 31, 2021.
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.
In September 2022, Dave retired after 34 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 Boston regional office. During his 8 years as RIGA, Dave was responsible for overseeing a staff of 50 audit professionals. He directed financial and performance audits of HHS programs and operations at Federal agencies, insurance companies, health care providers, and state agencies.
During his OIG career, Dave developed, performed, and directed a number of major and complex audits covering many of the Department’s programs, with a focus on Medicare. These audits resulted in billions of dollars in cost savings and cost recoveries, and procedural recommendations that led to improved financial management systems and internal controls. For instance, Dave worked on the initial CFO financial statement audits of Medicare expenditures. These audits established for the first time a nationwide Medicare fee-for-service annual payment error rate. Dave recently directed an audit of early discharges from hospitals to hospice care for which the report recommendation led CMS to initiate a change in its regulations that resulted in billions of dollars in Medicare trust fund cost savings. Also, in recent years, his leadership on the hospital compliance audits led to hundreds of these audits being conducted across the country.
In recognition of his leadership in audit activities, Dave received numerous awards throughout his federal career, including the Secretary’s Award for Distinguished Service, the Inspector General’s Bronze Medal for Outstanding Employee of the Year twice, and multiple Council of the Inspectors’ General on Integrity and Efficiency awards. Dave graduated from Northeastern University with a Bachelor of Science Degree in accounting. He was a Certified Public Accountant in Massachusetts.
R.D. Lashar retired after over 19 years of service with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). R.D. was a Special Agent working out of the Oklahoma City Field Office. Prior to working for HHS-OIG, R.D. worked over 5 years as a Special Agent with the United States Secret Service.
While at HHS-OIG, R.D. conducted large scale, highly complex health care investigations involving physicians, hospitals and other various health care industry entities. These investigations included Durable Medical Equipment Companies, Hospitals, Optometrists, Nursing Homes, Chiropractors, Cardiologists, Pain Management Specialist and Pharmaceutical Companies. Additionally, R.D. conducted investigations into grant fraud, child support and was a member of a Prescription Drug Task Force. R.D. was also a Certified Control Tactics Instructor, Disaster Relief Response Team Member and a member of the HHS-OIG Tactical Rifle Team.
As a Special Agent with the United States Secret Service (USSS), R.D. conducted Criminal investigation involving bank fraud, credit card fraud and threats against the President of the United States. R.D. also conducted Protective Operations for the President, Vice President and more than twenty-four Heads of State. These Protective Operations were conducted in forty-two different states and seven different countries around the world. During part of his tenure at the USSS, R.D. was assigned to the FBI Joint Terrorism Task Force where he conducted investigations into both Domestic and Foreign Terrorism groups and their associates.
In addition to working as a Criminal Investigator, R.D. is also a Professional MMA Fighter.
In 1991, R.D. received a Bachelor of Science degree in Criminal Justice from the University of Oklahoma.
Spencer Melton retired after 22 years of service with the U.S. Department of Health & Human Services (HHS), Office of Inspector General (OIG). Spencer was a Special Agent working out of the Miami, Florida, Lexington and Louisville, Kentucky offices. Prior to working for HHS-OIG, Spencer worked for the Immigration and Naturalization Service (INS) as a District Adjudications Officer.
During his time with HHS-OIG, Spencer was responsible for working criminal and civil cases involving fraud, waste and abuse of the Medicare and Medicaid programs. Over the course of 22 years, Spencer worked a variety of complex cases involving Medicare Parts A, B, C and D. The last 5 years of his tenure was dedicated to the prescription drug epidemic plaguing Kentucky and surrounding states. Spencer was a lead investigator in many high-profile cases with the Appalachian Region Prescription Opioid (ARPO) Strikeforce. As a result of his hard work, Spencer ended his career with 98 prosecutive actions resulting in over $75 million back to the Medicare Trust Fund.
As a Special Agent, Spencer earned numerous awards for his investigative work, including but not limited to the following: The Department of Justice Leadership Award (ARPO); Inspector General’s Exceptional Achievement Award; Inspector General Honor Award for Quality and Value; and the Secretary’s Award for Service to America.
Spencer graduated from Eastern Kentucky University where he earned a Bachelor of Science degree in Criminal Justice and Psychology. Spencer is a husband and father of three.
Debbie has over 35 years audit and compliance experience in the Health Care and Hospital Industry sectors. With over 12 years audit experience with the U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), Office of Audit Services (OAS). Debbie worked in the Boston Field Office and planned, coordinated, and supervised a number of major and complex audits of government programs mainly in the Medicare and Medicaid areas. These audits resulted in billions of dollars in cost savings and cost recoveries, procedural recommendations that led to improved financial management systems and internal controls. In recognition of her outstanding work in audit activities, Debbie received numerous awards throughout her career including the Inspector General’s Bronze Medal for Outstanding Employee of the Year.
After leaving the OIG, Debbie continued her career in health care auditing and corporate compliance programs in the Northeast as Associate Vice President and Chief Compliance Officer. Debbie conducted risk assessments, research, planned, coordinated, conducted and supervised complex audits, used computer audit techniques, data analytics and statistical sampling methodologies, as appropriate, to accomplish various needs of the compliance auditing and monitoring programs. Debbie has a diverse audit/investigative experience in hospital and physician billing, Medicare, Medicaid, third-party payer, managed care, home health, hospice, behavioral health, ambulatory surgical center, drug diversion, and research reviews.
Debbie graduated from Le Moyne College with a Bachelor of Science Degree in Accounting and a member of the Dean’s List.
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.
Mike Stapleton retired from the federal government after more than 24 years of service, during which time he worked for the Department of Health and Human Service, Office of Inspector General, Office of Investigations (HHS-OI), as a Special Agent for ten years before being promoted in 2020 to Assistant Special Agent in Charge in HHS-OI’s Dallas Regional Office. Prior to HHS-OI, Mike spent an additional ten years in federal law enforcement with the United States Postal Service, Office of Inspector General (USPS-OIG). Mike began his federal career with one year spent working as an Auditor with USPS-OIG.
As a Special Agent and as Assistant Special Agent in Charge, Mike managed a squad of Special Agents who conducted investigations involving home health, hospice, durable medical equipment, drug diversion, treatment and testing, laboratory testing, COVID-related fraud, and the pharmaceutical industry, as well as a variety of other health care fraud schemes impacting Medicare, Medicaid and other insurance programs. During his time with HHS-OI, Mike’s casework resulted in more than $426 million in judgements and settlements, with 35 criminal convictions and 12 civil actions.
Throughout his career Mike has collaborated with various federal, state and local entities, including the Federal Bureau of Investigations, the Centers for Medicare and Medicaid Services, the Department of Labor, the Veterans Administration, various State Medicaid Fraud Control Units, and health care insurers and has received numerous awards from HHS-OI, the Department of Justice, the Executive Council on Integrity and Efficiency, Texas Mutual Insurance Company, and the Dallas/Fort Worth Federal Executive Board.
Mike earned a Bachelor of Science in Agricultural Economics from Texas A&M University – College Station, Texas.
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.
David Westall is a retired U.S. Homeland Security Investigations (HSI) supervisory special agent with 26 years of law enforcement experience. David served as the Deputy Special Agent in Charge of the Special Operations Division, as well as the Assistance Special Agent in Charge of the State of Oklahoma.
Prior to serving with HSI, David was a special agent with HHS-OIG and FDA-OCI where he conducted complex criminal, civil and administrative investigations pertaining to HHS programs; primarily Medicare Part A, B, and D and Medicaid. At HSI, David was the senior HSI executive responsible for directly combatting transnational criminal organizations with a combined multi-agency staff of special agents, intelligence analysts, and multiple subordinate supervisors.
David is a Purple Heart recipient, received the Inspector General’s Achievement Award for healthcare investigations, and was recognized as the Undercover Agent of the Year for infiltrating a transnational criminal organization exploiting children around the world.
David holds a Masters degree in Criminal Justice from the University of Alabama and served on active duty with the United States Marine Corps.
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.