This is my life, Carol A. Cagno

Current Employer: Cahaba Safeguards Administrators, LLC a/k/a/ Blue Cross and Blue Shield of Alabama Employer

Function: Medicare Program Safeguard Contractor performing benefit integrity functions to preserve and protect the Medicare Trust Fund against fraud, waste and abuse for Part A & B claims, as well as claims for home health care and hospice services.

Job Title: Senior Investigator

Time in Grade: 6 years

Job Responsibilities: Lead investigative activities on most difficult cases. Conduct onsite financial and medical review provider audits. Advise, consult and act as unit's liaison to law enforcement and other authorized federal and state organizations on a national basis. Provide expert testimony for federal criminal and civil prosecutions. Perform unit's quality review activities. Orient and mentor new investigative staff.

Beneficiary Outreach activities - my best and favorite activity Education and Prof Background: Registered Nurse licensed in Pennsylvania and New Jersey. My nursing practice specialized in public heath and community health nursing in the city of Philadelphia via the Health Districts, and then in private agencies servicing the city and suburban counties. During the time of my "hands on" nursing positions I had a particular interest in the geriatric population whose services were paid by Medicare. So, when I decided to expand and capitalize on my professional experience, it was a natural transition to go from providing Medicare services to eligible beneficiaries to monitoring the claims submitted by service providers. I did this as a Medicare Medical Review and Medicare Appeals/Fair Hearing Officer for (photo) Independence Blue Cross (IBC), Philadelphia, PA. When the Medicare contract was transitioned from IBC in 1997, the transitioning organization (another Blue Cross plan) offered me a position in the anti- fraud unit as an Investigator. Six years later, and I'm still there.

It can be said that I have lived and breathed Medicare for the past 30 years! Get a life, Carol.