Fraud, Waste and Abuse in Healthcare IT

Moderator

Charles Gabrial,

Digital Standards Lead at Federal Electronic Health Record Modernization (FEHRM)

Charles Gabrial serves as the Digital Standards Lead for the Federal Electronic Health Record Modernization (FEHRM) program office. In his role, he leads digital health standards to enhance interoperability and advance data sharing. Mr. Gabrial collaborates and coordinates with multiple large agencies, including the Department of Veterans Affairs, Department of Defense, and Office of the National Coordinator for Health Information Technology, on policy, standards, and technology. He successfully led multiple impactful endeavors at the Defense Health Agency that involved patient safety, quality improvements, and the determinants of health for predicting community health and wellness levels.

Prior to assuming his federal role, Mr. Gabrial gained more than 25 years of experience in data sciences, analytics, and digital and IT transformation. His experience spans various industries, including health care, health planning, finance, banking, and media, and he has a strong track record as an expert in implementing mission-critical IT modernization, including migration, predictive analytics, machine learning, and robotic processes automation. Mr. Gabrial led multiple major initiatives during his tenure at Deloitte and IBM, advising and transforming client systems in large organizations such as Freddie Mac, Discovery Communications, the World Bank, the Centers for Medicare and Medicaid Services, Humana, Walgreens, and the Blue Cross Blue Shield Association.

Speakers

Jennifer K. Dietz, MS, AHFI, CFE 

Director, Program Integrity at DHA

Jennifer has served with the Defense Health Agency in a variety of roles including Contracting Officer’s Representative for the TRICARE West region contract, Technical Representative for Claims, and Health Care Fraud Specialist.  She has extensive experience in the TRICARE program to include oversight, implementation of changes, contract proposal review and negotiation, and leading transition activities for the T2017 TRICARE West contract.  Prior to coming to the Defense Health Agency in 2007, she worked for the Department of Labor developing, investigating and adjudicating worker compensation claims and at the Veterans Administration processing domestic and foreign claims.  She has a variety of leadership experience, including the civilian co-chair of the Making Health Plans Great workgroup, establishing a mentoring program within DHA, and various leadership positions in local school and university boards.  Ms. Dietz holds a Master of Science Degree in Criminology from Regis University, a Master of Science in Government Information Leadership from the National Defense University, and a Master of Science in Leadership with Brookings Executive Education in partnership with Washington University in St. Louis.  Ms. Dietz is an Accredited Healthcare Fraud Investigator, Certified in Healthcare Compliance, and Certified Fraud Examiner.

James Ross

Deputy Assistant Inspector General for Investigations at VA Office of Inspector General

James Ross was appointed Deputy Assistant Inspector General, Office of Investigations (OI), in VA’s Office of Inspector General (OIG) in August 2020. In this capacity, he is responsible for directing the investigative efforts of OI’s seven field divisions, as well as its two proactive components: the Investigative Development Division and the Healthcare Fraud Division.

Previously, DAIG Ross was the Special Agent in Charge of OI’s South Central Field Office from August 2018 to August 2020. In this role, he was responsible for leading a field division comprised of criminal investigators and administrative staff who conducted investigations into allegations of crimes and other violations of law impacting VA’s programs and operations.  Before this position, DAIG Ross was a special agent in and later the Resident Agent in Charge of OI’s Houston Resident Agency.

Before his work at VA OIG, DAIG Ross was a special agent with the U.S. Secret Service and was responsible for leading complex financial crimes and threat investigations, as well as protective operations, in the agency’s New Orleans and San Francisco Field Offices.  DAIG Ross began his law enforcement career with the Orlando, Florida, Police Department. DAIG Ross holds a bachelor’s degree in Criminology from Florida State University and is currently completing a Master of Science Degree in Data Analytics and Policy at Johns Hopkins University.

Aaron Testoff

Product Owner at Centers for Medicare and Medicaid Services

Aaron has been with the Center for Program Integrity at the Centers for Medicare and Medicaid Services for five years. With CPI, he currently serves as the Product Owner for the Fraud Prevention System and provides program oversight of the Program Integrity Modeling and Analytic Support Contract. In this role, he leverages product management principles and a user-centric approach to ensure that the FPS is a robust and intuitive analytic suite that creates value beyond the generation of fraud leads. A key area of emphasis for Aaron in supporting this vision is ‘explainability’ of the advanced analytics used by investigators seeking administrative actions against fraudulent providers, viewing them as a holistic product or package that supports the investigators in interpreting the analytic output.