Stephanie J. Wroten, MS/FM ’05, RN, LNC Nurse Investigator, State of New Jersey Office of the State Comptroller – Division of Medicaid Fraud, Trenton, New Jersey In the late 1990s, Ms. Wroten was employed by a major healthcare organization that went bankrupt—— a victim of intentional fraud, waste and abuse of financial assets. The experience served as a catalyst for the registered nurse of 21 years: “Healthcare fraud and the lack of ethical consciousness impacted so many during that time. Several hospitals and healthcare facilities in Philadelphia, the surrounding suburbs and the tri-state area at large were forced to close their doors or to reorganize/consolidate. Many of my colleagues lost their jobs. I opted to pursue a master’s degree in forensic medicine, buoying up my nursing experience with medical-legal investigative training and knowledge of regulatory compliance.” Ms. Wroten presently serves as a nurse investigator for the New Jersey Office of the State Comptroller – Division of Medicaid Fraud, which works to maintain the integrity and efficiency of the government health program. In this capacity, she conducts investigations to secure evidence in cases of reported healthcare
fraud, waste and abuse. Allegations that are substantiated to have criminal components are referred to the Attorney General’s office and/or other appropriate government agencies. Other cases require various corrective actions. “In essence, my division serves as the watchdog over both providers and recipients of Medicaid service. In order to ensure that healthcare services are delivered in a quality manner, we monitor medical billing, coding and compliance with the established Medicaid guidelines,” Ms. Wroten says. She believes in her avocation and furthermore, that the “elimination of healthcare fraud would fix healthcare disparities experienced by at-risk populations, particularly those living in disadvantaged communities.” Recent estimates from the Centers for Medicare and Medicaid Services likewise point to this end: $97 billion a year is lost to fraud through federal health programs, mainly Medicare and Medicaid.
P HI LA D ELPH I A COLLE GE OF OSTEOPATH IC MEDI CINE
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