Management

Sandra S. Love, MS, Chief Operating Officer
Ms. Love is a health information professional with 28 years of progressive executive management experience, including extensive teaching and consulting experience in the field of medical coding and billing. Her responsibilities as the Chief Operating Officer for Health Integrity include budget preparation and monitoring, executive management for over 180 FTEs and over 100 subcontractor employees, new business development, project design and implementation and external client management. Ms. Love joined Delmarva Foundation in 1996, specializing in consulting with providers to improve coding and medical record management. She strategically guided the Delmarva National contracts division which included the Medicare Program Safeguard Contracts the Western Integrity Center that is responsible for statistical analysis, medical review and fraud case development. As the Chief Operating Officer for Health Integrity, LLC, Ms. Love has overall responsibility of the LLC reporting directly to the Health Integrity Board of Directors. Contracts under Ms. Love’s oversight include the National Benefit Integrity MEDIC, the Zone Program Integrity Contract, Zone 4, and the Chicago and Atlanta Region Audit Medicaid Integrity Contracts (Audit MICs).  Ms. Love has earned a Bachelor’s Degree in Health Record Administration from York College of Pennsylvania and a Master’s Degree in Health Care Administration from Wilmington College, Georgetown, Delaware.

Pam Foster, RN, MS, Quality Director
Mrs. Foster is an experienced health care professional with 25 years of managed health care experience that includes directing utilization management, case management and network development departments.  She worked in the PBM industry as the Director of Disease Management programs and Drug Utilization Review.

Mrs. Foster was an NCQA surveyor for 8 years, during which time she performed accreditation reviews for many large managed care organizations.  Most recently, before joining Health Integrity LLC, she worked at CMS in the Office of Clinical Standards and Quality (OCSQ) on the Medicare Part D benefit.  Mrs. Foster joined Health Integrity in 2005 as the Part D SME and Director of Quality.  She is a Registered Nurse with a Masters Degree from Johns Hopkins University. 

Fredia Stovall Wadley, MD, FAAP, MSHPA, Medical Director
Dr. Wadley’s experience includes private practice, public health leadership, multiple academic positions, and healthcare quality improvement work with the Delmarva Foundation. She has been Medical Director of the QIO beneficiary protection services; the CMS MEDIC contract to analyze prescription data for Medicare fraud, waste, and abuse; and multiple External Quality Improvement contracts with state Medicaid Agencies.

Dr. Wadley has also been content expert for two AHRQ quality improvement contracts, one assisting the state of Vermont in the evaluation design for a statewide chronic disease initiative. She has knowledge of quality improvement measures for evaluating physician performance, including the Physician Quality Reporting Initiative (PQRI), HEDIS, and the 26 measures used in the Medicare Care Management Performance Demonstration. She has a thorough understanding of the Medicare Pay for Performance incentives and calculations, the patient centered medical home model and reimbursement, and the Chronic Care Model components.

Dr. Wadley, who maintains a current State of Maryland medical license, received her Medical Degree from the University of Tennessee Health Science Center. She also has a Master’s in Health Planning and Administration from the University of Cincinnati.

Diana O’Brian, JD (Chase Consulting). Diana O’Brien is a healthcare attorney whose professional background includes Medicare fraud and abuse enforcement and compliance as well as regulatory/legislative analysis and healthcare policy development. As a consultant with Chase Consulting Group, LLC, Ms. O’Brien currently provides legal support to Health Integrity, LLC’s MEDIC South program as Chief Legal Counsel, and assists the Chief Legal Counsel for Health Integrity, LLC’s Zone 4 ZPIC program.  Ms. O’Brien began her work in Medicare fraud and abuse enforcement  as an Associate (and then Senior) Counsel with the Office of Counsel to the Inspector General, U.S. Department of Health and Human Services (OCIG), handling a wide spectrum of Medicare fraud and abuse cases. The cases ranged from prosecuting provider exclusion appeals and EMTALA violations to civil monetary penalty cases resulting in significant dollar recoveries for the Medicare Trust Fund. After leaving OCIG, Ms. O’Brien worked for CSC first as the Conflict Of Interest Compliance and HIPAA Privacy Compliance Officer, and then as Chief Legal Counsel for two Medicare integrity-related contract programs.

Ms. O’Brien has also worked in healthcare policy development, focusing on state Medicaid programs and patient access to care. As the Vice President for Federal Regulatory and Legislative Affairs with the National Patient Advocate Foundation she helped shape the organization’s national agenda, and supported Congressional lobbying efforts. Focusing on access to healthcare, Ms. O’Brien drafted comments to CMS on proposed reimbursement-related regulations and wrote white papers on policy issues in support of legislative initiatives. As a health policy analyst with the American Public Welfare Association (now the American Public Human Services Association), Ms. O’Brien helped to support state Medicaid directors, focusing on managed care, third-party liability and litigation developments.

Ms. O’Brien earned her J.D. from Columbia Law School in 1989 and is currently admitted to practice law in Connecticut, Massachusetts, and New York

MEDIC

Patrick Doyle, MS, Program Director - National Benefit Integrity MEDIC
Mr. Doyle joined Health Integrity as National Benefit Integrity MEDIC Program Director in October 2009 after serving 31 years in law enforcement. He spent 22 years with the Health and Human Services Office of Inspector General (OIG), Office of Investigations, the last five as Special Agent in Charge (SAC) of Region III, which included Pennsylvania, Maryland, Delaware, Virginia, West Virginia and the District of Columbia. Under his leadership as SAC, Region III produced over 300 criminal convictions and returned over $4 billion to the Government through Civil settlements and Criminal fines and penalties. During his OIG career, he was the recipient of many awards, including the HHS Secretary’s Award for Distinguished Service, two OIG Cooperative Achievement Awards, the President’s Council for Integrity and Efficiency Excellence Award and the Federal Executive’s Board Bronze and Silver Medals.  As the Program Director for the National BI MEDIC, Mr. Doyle has oversight of the National Benefit Integrity MEDIC Program of the entire United States.  This includes contract performance; including day to day activities, client management with the Centers for Medicare and Medicaid Services, deliverables management, hiring, training, and serving on the Quality Steering Committee.  Mr. Doyle holds a Bachelor of Science degree in Criminal Justice from King's College in Wilkes‑Barre, Pennsylvania and a Master of Science degree in Criminal Justice from St. Joseph's University in Philadelphia.

Patricia Serio, Deputy Director of Data – National Benefit Integrity MEDIC
Mrs. Serio brings over 15 years experience in many facets of the health care industry. Her experience includes the full spectrum of the health care delivery cycle beginning with clinical care at a group physician practice. Mrs. Serio moved on to spend many years monitoring the many facets of health payor work, including utilization review, claims payment, and healthcare informatics to bring an understanding of health care claims data and information systems to her work. Mrs. Serio’s work experience includes performing data analysis and claims analysis from private insurance carriers and government payers, management of analytical and claims staff, and project management. Mrs. Serio serves as the Deputy Director of Data for the National Benefit Integrity Contract (MEDIC). She has oversight of data analysis including proactive analysis, accurate reporting on Request for Information from external and internal sources, client management with the Centers for Medicare and Medicaid Services and Law Enforcement, workload reporting, dashboard metrics, hiring, training, and serving on the Quality Steering Committee. Mrs. Serio holds a Bachelor’s of Science in Information Systems Management from the University of Maryland and is currently pursing a Master’s of Science in Health Care Administration at the University of Maryland.

Tasha Trusty, RN, MHSA, Deputy Director of Administration – National Benefit Integrity MEDIC
Ms. Trusty is a registered nurse with more than a decade of experience in the clinical and administrative setting. She serves as the Deputy Program Director for the national Benefit Integrity Contract (MEDIC) and is responsible for is responsible for managing day to day activities on the MEDIC contract; including oversight of the Call Center and Medical Review staff. She assists with the collection, interpretation and reporting of data, and with the writing of the reports. Previously Ms. Trusty was a Quality Improvement Coordinator for Delmarva, where she managed the development, implementation, and monitoring of focused clinical studies.  From 2002 to 2005, Ms. Trusty was a Practice Administrator for Johns Hopkins Community Physicians, Laurel Health Center. She was responsible for the daily operation of the health center, which included budget management, hiring, supervision, staffing, and evaluation.  Ms. Trusty has a Bachelor of Science in Nursing and a Master of Science in Health Care Administration.

MIC

Jaysen Eisengrein, Program Director- Audit Medicaid Integrity Contractor
Mr. Eisengrein has recently retired from HHS-OIG-Office of Investigations after a 30 year career with the Department of Health and Human Services (HHS). At Health Integrity, LLC, Mr. Eisengrein is the Program Director of Benefit Integrity of the Audit Medicaid Integrity Contractor (MIC). His HHS career began with the Social Security Administration. He was promoted to a position with CMS (then HCFA), as a Program Analyst specializing in Medicaid program integrity. At HCFA, he focused on evolving issues of income and eligibility verification systems, third party liability initiatives, “pay and chase” mitigation, electronic claims authorizations and quality assurance measures. In 1989, Mr. Eisengrein was a Special Agent with the OIG in New York. In 1999 he was promoted to Assistant Special Agent In Charge of Region II. He remained active in investigating Medicaid fraud his entire 17 years with the OIG in New York. In 2006, he became the Director and Special Agent in Charge of four highly important OIG Headquarters’ branches. From 2008 to January 2009, Mr. Eisengrein served as the OIG’s liaison to CMS and set up new lines of communications and collaborative efforts. In addition to Medicare staff in OFM and the PIG, Mr. Eisengrein worked with the Medicaid Integrity Group.   As the Program Director for the Audit MIC, Mr. Eisengrein has oversight of 23 states and the District of Columbia, for Audit MIC Task Order 1R and Audit MIC Task Order 5.   To accomplish the mission, Mr. Eisengrein manages day to day activities, client management with the Centers for Medicare and Medicaid Services, deliverables management, hiring, and training and directs a staff or more than 50 full and part-time personnel, utilizing in-house staff and sub-contractor personnel.

Gary F. Coley, Deputy Director – Medicaid Integrity Contract TO1R
Mr. Coley joined Health Integrity as Medicaid Integrity Contract (MIC) Deputy Director, Task Order 1R in November 2009 after retiring from State service.  While serving as the Deputy Director of the Medicaid Investigations Unit of the North Carolina Department of Justice, Mr. Coley’s primary responsibility was for the law enforcement organization for investigation and prosecution of medical assistance provider fraud.  His supervisory responsibilities was for the Units’ staff in both the administrative and investigative areas, which included four senior investigators, sixteen financial investigators, one nurse investigator, one IT person and two office assistants.  Mr. Coley assisted with the Federal Health Care Task Force in the Eastern, Middle, and Western Districts of the United States Department of Justice.  Mr. Coley was the recipient of commendations from the FBI, United States Department of Justice Eastern District, National Association of Medicaid Fraud Control Units, as well as The Office of Inspector General’s Exceptional Achievement Award and Integrity Award.  As Deputy Director of Medicaid Integrity Contract, TO1R he has technical oversight to all phases of the contract, ensures systems are in place for contract compliance and direct and coordinate activities of project personnel to ensure the contract progresses on schedule and within the prescribed budget. He supervises two lead auditors / investigators and seven auditor / investigators.  Mr. Coley has a Bachelors Degree in Business Administration and Economics from North Carolina State University.

ZPIC

David A. Duhaime, Zone Program Integrity (ZPIC) Contract Director
Mr. Duhaime has over 18 years of experience directly related to tasks associated with the ZPIC.  He currently manages a team of 107 Investigators, Fraud Analysts, Nurses, and Data Analysts tasked with investigating providers suspected of submitting fraudulent claims or developing schemes to defraud the Medicare Trust Fund in TX, NM, CO, and OK.   Mr. Duhaime oversees the  operations, budget, staffing, and communications of this multi-million dollar contract. While a Sr. Fraud Investigator for a Government Program Safeguard Contractor, Mr. Duhaime conducted investigations of providers, subscribers and employees in Managed Care and Indemnity Plans suspected of submitting fraudulent claims. He predicted and developed high-profile data-driven investigations and was the Lead Investigator to the Medi-Medi matching program to identify providers attempting to defraud both systems. Mr. Duhaime earned his BA in Criminal Justice Studies from Norwich University, Military College of Vermont.  He also holds several certifications including Computer Forensics Certified Examiner (CFCE), Certified Fraud Examiner (CFE), and Certified Forensic Electronic Evidence Collection Specialist. 

James R. Hargrove, Zone Program Integrity Contract (ZPIC), Fee For Service Director
Mr. Hargrove brings over 37 years of experience in the auditing and investigations field for the Medicare and Medicaid programs.  He has taught various aspects of governmental auditing for 30 years.  Mr. Hargrove received the DHHS Office of Inspectors General highest award, the Thomas E. Morris Leadership Award in 1998, for his leadership in re-establishing the Oklahoma City Office of Audit Services after the Alfred P. Murrah Federal building bombing. A survivor of the blast, Mr. Hargrove has received numerous other achievement awards including Audit Manager of the Year in 1984. Mr. Hargrove has presented on governmental accounting to the Seattle Chapter of the Association of Governmental Accountants in 2004, the Indian Health Service, Oklahoma City Area Office in 2003 and has taught courses on accounting communication and supervision throughout the United States and Europe.  As the ZPIC Fee for Service Project Director Mr. Hargrove has technical oversight of all phases of the Fee for Service contract; ensuring that contract requirements are met and all production standards are achieved.  Mr. Hargrove is responsible for managing five supervisors and for the supervision and direction of 30 registered nurses, 20 investigator and 6 administrative staff. Mr. Hargrove has a B.B.A. in accounting from the University of Oklahoma, Norman, Oklahoma.