Jeff Sells

My background in fraud investigations and training in healthcare make me an asset. I have over 24 years of investigative experience, with over 10 years being dedicated to detecting healthcare fraud and healthcare compliance investigations. As a healthcare fraud investigator and supervisor, I have been involved in resolving numerous fraud investigations involving Medicare, Medicaid, and commercial lines of business. I have identified millions of dollars in inappropriate over-payments. I have led investigations that have been referred to various law enforcement entities, to include the FBI, OIG, and various state Attorney General's Offices. These referrals have assisted in the successful prosecution of healthcare fraud. I have over a year of exclusively working compliance cases for a national healthcare provider. My compliance investigative experiences have included privacy and security, physician behavior, regulatory matters, and identity theft. I have been able to investigate compliance matters, identify the root cause, and assist in mitigating the violation. My positions and experiences have allowed me to work with multiple teams to produce the best product for customers. Strong communication skills have assisted in presenting these results, whether it be via a written report or in-person to customers to fully convey findings. My knowledge of healthcare services includes Part A, Part B, Part C, Part D, home health, hospice, laboratory services, pharmaceuticals, medical equipment, and behavioral health. These experiences have led to a passion for the work I do and the teammates who help produce high-quality end results. I have a strong understanding of healthcare terminology, including CPT, HCPCS, DRG, and ICD. I have extensive experience in Microsoft Suite software including Excel, Word, PowerPoint, and OneNote. I am skilled in using Excel functions such as VLOOKUP, pivot tables, and formulas to fully analyze data and produce thorough, clear data reports. I am capable of utilizing data to detect aberrant behavior and fraudulent activity. I was able to obtain the Accredited Healthcare Fraud Investigator (AHFI) designation through NHCAA in 2017. Additionally, I have experience utilizing the Compliance360 case management system.