SmartLight Analytics recently welcomed Bill Young to its team of analytics and clinical experts as the new head of the clinical operations. Young brings a wealth of knowledge, including 20 years of federal healthcare fraud investigative experience, to the SmartLight Analytics mission of helping self-funded employers reduce healthcare spending by identifying and eliminating fraud, waste, and abuse in healthcare claims.
Young spent the last 13 years with HHS/OIG supervising and conducting criminal and civil investigations of waste, fraud and abuse in Medicare and Medicaid programs. He has comprehensive knowledge of investigative techniques, best practices and HHS Compliance Guidance.
“Bill’s experience will be extremely valuable to SmartLight and our customers,” said SmartLight Analytics CEO Asha George. “We are continually working to bring a new level of depth to our analytical, clinical and data expertise. Bill’s background in working with Medicare and Medicaid will give us great insight in working with these claims. He is also a great addition to our leadership team.“
“Having worked on the government side of healthcare, I am looking forward to taking the lessons learned from 21 years of working with public insurers and applying those lessons to the private paying community,” Young said of his new role.
Young has a law degree from Saint Louis University and served as an adjunct instructor at the Federal Law Enforcement Training Center in Glynco, GA. He served as Lead Special Agent assigned to white-collar/healthcare fraud investigations for HHS for seven years. He spent 13 years as Assistant Special Agent in Charge for the HHS Office of Inspector General Office of Investigations supervising and conducting criminal, civic and administrative investigations of waste, fraud, and abuse related to HHS programs including Medicare and Medicaid. His team of investigators produced 357 criminal convictions and civil monetary recoveries in excess of $334 million.
Young will work with a team of analysts to review model output to identify fraud, waste and abuse in clients’ claims data and communicate those findings to the client’s administrative partner to ensure the issues identified are addressed.
SmartLight Analytics uses advanced inferential analytics coupled with expert clinical claims review to drive cost-cutting solutions for large, self-insured employers. As a partner with the Health Transformation Alliance, SmartLight works with some of the nation’s largest employers. With expertise in statistical analysis, healthcare data, and clinical medicine, SmartLight helps organizations prevent unnecessary fraud, waste, and abuse in employee healthcare claims.