Marcelino Rodriguez

Certified Fraud Examiner (CFE) with a strong background and experience dealing with investigations related to employee integrity, Payment Integrity, Compliance, Healthcare fraud, waste, and abuse (FWA).

• Former Special Agent and Criminal Investigator with the US Secret Service and the OIG, US Department of Labor, Office of Investigations (GS-13).
• Conducted investigations dealing with employee integrity issues to include embezzlement, conversion of assets for personal use.
• Was awarded a Bronze Star and Army Commendation Medal for exemplary service while under a hostile environment during Desert Storm.
• Investigated allegations of employees obtaining briberies and things of value in exchange for official acts, destruction of records, false travel expenditures, time and attendance fraud.
• Graduated from the U.S. Treasury Agent School.
• Graduated from the U.S. Secret Service Agent School.
• Conducted interviews of providers, beneficiaries, and witnesses as part of the investigative process.
• Experienced dealing with reporting requirements to regulatory agencies.
• Worked on an everyday basis with ICD-10.
• Prepared in conjunction with the Compliance Officer an Anti-Fraud plan to conduct fraud investigations, to detect and prevent incidents of fraud and to coordinate investigations with enforcement agencies understanding organizational strategies and objectives of related areas.
• Responded to allegations of violations of rules, regulations, Code of Conduct and recommending initiation of investigations.
• Assembled documentation, write reports and organize evidence to support adjudication and make decisions regarding work methods requiring minimal supervision.
• Experienced in training employees in Healthcare FWA and in Compliance.
• Identified more than $12 million dollars in overpayments because of inappropriate claims.
• Implemented actions to include placing providers on pre-payment status, payment suspension and revocation of provider participation in healthcare programs.
• Conducted onsite audits/reviews of provider records to ensure proper billing practices.
• Prepared investigative and other reports of a complex nature and include summaries that present metrics, trends, and evidence to superiors and stakeholders to include enforcement agencies.
• Conducted a training seminar for fraud investigators in Diagnostic Fraud for the NHCAA during annual conference in Las Vegas.
• Conducted a training seminar in Diagnostic Fraud for all the CMS regions in the United States.
• Management experience of more than fifteen (15) years to include supervision of investigators.

• Over 25 years as an agent, with the US Secret Service and Special Agent with the Office of Inspector General of the US Department of Labor, Office of Investigations, GS-13.
• Conducted investigations related to rules and regulations dealing with employee benefit plans, fiduciary standards, prudent man rule, Federal Employee Compensation Act, bribery of government officials accepting things of value in exchange for official acts.
• Time and attendance fraud, expense voucher false claims, misuse of government vehicles and misuse of government property.
• Testified before grand and petit jurors, arrested individuals suspected of being involved in felonies.
• Review financial records to uncover embezzlement of funds.
• Assisted other law enforcement officers in joint investigations.
• Worked as an undercover agent infiltrating individuals and groups engaged in criminal activities.
• Served during active duty in the US Army during Desert Storm operations in Southwest Asia
• Served in the capacity of Finance Operations Sergeant Major (E-09).
• Conducted operations dealing with Budget operations to include assignments, appropriations, and expenditure of funds.
• Conducted accounting and charged disbursements to proper accounting classifications.