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Clinical Special Investigator Kathleen Lindner Certified as Accredited Health Care Fraud Investigator

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Cardinal Innovations Healthcare Clinical Special Investigator Kathleen Lindner recently became certified as an Accredited Health Care Fraud Investigator (AHFI) by the National Health Care Anti-Fraud Association (NHCAA).

Lindner, who joined Cardinal Innovations on July 1, 2016, as part of the Triad Community Office transition, works as a Clinical Special Investigator in the Special Investigations Unit at Cardinal Innovations.

While at CenterPoint, Lindner was part of a team that identified and helped recoup $1.5 million in fraud, waste and abuse.

“I think Kathleen goes the extra mile to thoroughly investigate her cases," said Jelore Little, Lindner's supervisor in the Corporate Compliance Department. “She goes deep to find the root cause and mitigate any liability for the company."

Little worked with Lindner at CenterPoint and was part of the team that recouped the $1.5 million in fraud, waste and abuse along with Ed Ekland, who also now works for Cardinal Innovations as a Clinical Special Investigator.

To achieve the AFHI designation, Lindner, who is also a licensed professional counselor, had to complete a minimum of 75 hours in health care anti-fraud training in the four years prior to applying for the accreditation. She also had to get a passing score on the four-hour AHFI® Examination, which tested her knowledge of the nature and scope of the United States healthcare system, medical/health insurance termination, the types of fraud and fraud indicators, detection and investigation skills as well as the legal, statutory and regulatory aspects of health care fraud.

Lindner also was required to have three years of relevant professional experience in health care fraud detection, investigation and prosecution and three letters of recommendation from individuals qualified to attest to her professional skills and competency in the field.

The NHCAA was founded in 1985 by private health insurers and federal and state government officials to fight against health care fraud. The AHFI program was established in 2002 to provide a unique designation to individuals who meet specific qualifications related to investigating health care fraud.

While she is not required to be certified as an AHFI for her job at Cardinal Innovations, Lindner said it was a goal she set for herself in 2014. Others who have achieved the AHFI designation include Jelore Little and Corporate Compliance Officer Amber Burris.

“Anyone who has been around Kathy for any length of time can clearly see that she brings a passion and dedication to her work and to our members," Burris said. “She has a personal commitment to protecting the individuals we serve from providers who intend to take advantage of them and/or the Medicaid system. Through her diligent efforts, she has been able to help Cardinal Innovations reduce fraud, waste and abuse in our network. We are proud to have her as a part of the Special Investigations Unit at Cardinal Innovations."

Lindner also has more than 20 years of experience in behavioral health and has held positions in clinical practice and administration. She has worked in crisis intervention, behavior modification, program management, program integrity/corporate compliance, fraud investigation and utilization management in the public and private sector. She also has provided services to individuals, families and groups in a variety of settings including emergency department, community and behavioral health hospitals, office, community-based, and in the home.

Lindner has written articles for the Piedmont Parent Magazine, offering tips for helping children deal with stress. She also was a contributing author and consultant in the Percensys CORE Learning Series, which is a collection of over 500 measurable skill building activities for use by individuals, their families and supporting professionals.

In the fall, Lindner was asked to be part of a team that helped provide mental health crisis assistance for the nearly 7,000 participants at the American Association of Christian Counselors (AACC) World Conference in Nashville, Tenn. The AACC World Conference drew thousands of counselors, pastors and coaches from all 50 states and several counties to the Opryland Hotel. The event included more than 220 workshops.

“As a member of the team that was made up of other professionals, I was accountable for responding to any mental health crisis for more than 6,000 participants at the AACC Conference," Lindner said. “We assisted conference attendees and spouses in dealing with any issues that may surface while participating in the training, which may include a personal crisis, suicidal/homicidal ideation, a physical health crisis, accompanying a person to the hospital or announcing a death that occurred at home."

As a Clinical Special Investigator for Cardinal Innovations, Lindner's job involves investigating allegations of fraud, waste and abuse. She said the most common type of fraud she has investigated while working for Cardinal Innovations is providers billing for services not rendered.

“As team lead, I'm responsible for formulating a plan, determining the investigation scope and breadth, conducting interviews, summarizing findings, and making recommendations for sanctions," Lindner said, adding that tasks related to her job include researching claims, gathering information related to the complaint, communicating with stakeholders, documenting findings, maintaining electronic files and presenting findings through administrative dispute process including court procedures.

“Kathleen is a hard worker with a good heart who is always able to lend a hand," Little said.

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