![]() ![]() ![]() Performs/originates chargebacks on POS/ATM PIN cases to ensure recovery and minimize loss to clients according to the facts of the case. Communicates with internal team members, members, and/or vendors via phone, email, and in-person to obtain additional investigation information working to maintain account holder privacy and data integrity while avoiding 3rd party disclosure. Processes account maintenance, including placing flags and holds on accounts and cards to minimize loss exposure to the client Takes action to ensure that regulatory (Reg E and Z and any other applicable Regulation) and compliance requirements are met with respect to the card case, and remediating immediately if they are not being met Performs investigations on card cases categorized as fraud, accessing necessary information and platforms to bring investigation to a resolution. Works cases accurately, comprehensively, and timely to case completion Receives inbound calls from cardholders claiming unauthorized transactions Conducts outbound calls to merchants and/or cardholders to complete reasonable investigation within regulatory timeframes Assesses incoming card fraud cases to determine impact to client and cardholder, prioritizing those cases that have particular monetary or reputational impact, and taking action to ensure those cases are worked accurately, comprehensively, and timely so that no opportunities are missed Logs, investigates, updates, and maintain card cases accurately in case management platform. This may involve direct communication with merchant and cardholder as part of the investigation and as such proper communication and demeanor skills are critical. Work card fraud cases through the lifecycle of the case to maximize outcome for cardholder and client, including and not limited to intake of calls. United States Attorney Announces $907,074.Position Summary: An Investigator on the Fraud Investigation and Recovery team researches and examines fraud or abuse related to account holder information for our clients.In this role, primary responsibilities will include working and investigating card fraud cases, triaging cases, and identifying card fraud cases for investigatory follow-up. Richmond Assisted Living Facility Owner Sentenced for Health Care Fraud Mother and Daughter Pharmacy Owners Charged with Health Care Fraud and Kickback CrimesĪtlantic County Firefighter Convicted on Four Counts in Multi-Million-Dollar Health Care Fraud Conspiracy Nixa Physician Sentenced After Taking Bribes from Drug Manufacturer Lowell Nurse Pleads Guilty in $100 Million Home Health Care Fraud and Kickback Scheme Long Beach Dockworkers Charged in Conspiracy to Fraudulently Bill Union's Health Plan for Sexual Services Vice President of Raleigh Healthcare Company Pleads Guilty to Making and Using Fake Physician Orders in Medicare Auditįlorida Businessman Pleads Guilty in Three Cases Involving Conspiracies to Commit Health Care Fraud, Pay and Receive Unlawful Kickbacks, and Money Laundering Doctor shopping: Visiting multiple providers to get prescriptions for controlled substances or getting prescriptions from medical offices that engage in unethical practices.Diversion: Diverting legal prescriptions for illegal uses, such as selling your prescription medication. ![]() Forgery: Creating or using forged prescriptions.Impersonating a health care professional: Providing or billing for health services or equipment without a license.Identity theft/identity swapping: Using another person’s health insurance or allowing another person to use your insurance.Bogus marketing: Convincing people to provide their health insurance identification number and other personal information to bill for non-rendered services, steal their identity, or enroll them in a fake benefit plan.Upcoding: Billing for a more expensive service than the patient actually receivedįraud Committed by Patients and Other Individuals.Unbundling: Submitting multiple bills for the same service.Phantom billing: Billing for a service visit or supplies the patient never received.Double billing: Submitting multiple claims for the same service. ![]()
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