Desarae Robinson
Fraud Investigator/ Regulatory Specialist at Office of the State Inspector General- Claim this Profile
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Bio
Experience
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Office of the State Inspector General
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Security and Investigations
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1 - 100 Employee
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Fraud Investigator/ Regulatory Specialist
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Sep 2012 - Present
Receive and analyze referrals and complaints from various sources alleging fraud on the part of a FoodShare, BadgerCare Plus or Wisconsin Medicaid recipient. Schedule and conduct the interviews with recipient and/ or sources found to be relevant to investigation. Conduct Surveillance Collect and review all evidence to determine what violations of program policy, Federal guidelines and/or Wisconsin State Statues have been committed. Prepare detailed reports documenting investigations to support filing of complaint and other appropriate reports, forms and correspondence Collect, protect and preserve physical evidence to ensure the integrity of the chain of custody and the admissibility of that evidence in court hearings and trials. Represent and testify in administrative hearings and other relevant legal proceedings. Effectively recommend termination, suspension, or other discretionary sanction for fraudulent or abusive recipients based on investigative activities. Provides technical assistance to county counterparts in strengthening Fraud Prevention and Program Integrity Show less
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Hewlett Packard Enterprise
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United States
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IT Services and IT Consulting
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700 & Above Employee
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Internal Consultant/ Quality Assurance
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Jul 2010 - Sep 2012
Responsible for facilitating meetings and workgroups to solve complex Inappropriate and Potential Inappropriate Payment Issues surrounding Wisconsin Medicaid programs Works with contract compliance management team to assist with identifying, development and monitoring corrective action and creating Corrective Action Plans. Conducts internal audits of operational and system teams supporting Wisconsin’s ForwardHealth Portal, interChange and other Medicaid Management Information Systems (MMIS) Lead analyst for Department of Justice and Open Records request submitted through PRISM. Responsible for preparation of internal audit schedules Responsible for preparation of final audit reports including observations, recommendation and process improvements Monitor and investigate Fraud and Abuse complaints submitted by Forward Health Member Service Call Center Performs weekly internal reviews for Claim Adjudication, and Prior Authorization Documents and maintains the Team Workgroup Procedures and participates in the development of the common procedures as required. Provides training on Common and Team Workgroup procedures Ensures the Wisconsin Healthcare Account QMS is implemented and maintained within the organization, including the documentation and maintenance of the departments’ procedures Assist operational and systems teams in monitoring the implementation of solutions to any non-conformances and verify the effectiveness of those solutions Responsible to initiate action to prevent non-conformances in the quality system, process and deliverables. Show less
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Education
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Alverno College