Scott D. Kline
Sumner
Summary
Dynamic leader with extensive experience at CVS Health-Aetna, subject matter expert (SME) compliance reporting and healthcare fraud prevention. Proven track record of over $10 million in recoveries, leveraging critical thinking and team leadership to enhance provider relations and mentor colleagues. Knowledge in medical coding and billing practices.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Manager, Special Investigations Unit
CVS Health- Aetna
Dallas
07.2024 - 09.2025
- Manager for Aetna Better Health SIU functions; seven investigators, internal and external compliance reporting, and case management. Areas of expertise: Staff development, Mentoring, Governmental Health Insurance Programs and Critical Thinking.
- Secured over $10 million in total recoveries.
- Engaged C-Suite health plan executives on recoveries and provider challenges, developing strategies that enhanced provider member relations.
- Advised C-Suite executives regarding contractual language and plan responsibilities.
- Consulted and developed training initiatives on anti-fraud policies and procedures.
- Collaborated with Certified Professional Coders to address provider claims, ensuring compliance and accuracy in submissions.
- Aetna Better Health of Texas Compliance Team Member that ensured accurate reporting to Texas HHSC-OIG regarding recoveries.
- Collaborated with Texas HHSC-OIG Investigators regarding FWA provider investigations.
Associate Manager, Special Investigations Unit
CVS Health- Aetna
Dallas
01.2023 - 07.2024
- Associate Manager for Aetna Better Health of Texas' SIU functions; investigators, internal and external compliance reporting, and case management. Areas of expertise: Staff development, Mentoring, Governmental Health Insurance Programs and Critical Thinking.
- Achieved over $5 million in overpayment recoveries for Aetna Better Health of Texas.
- Presented to C-Suite health plan executives on recoveries and provider challenges; developed strategies that enhanced provider-member relations.
- Mentored CVS Health colleagues on career development, fostering professional growth and skill enhancement.
FWA Investigator-Medicare and Medicaid
Qlarant Integrity Solutions, Inc.
Dallas
09.2021 - 11.2022
- Healthcare Fraud Investigator for the Department of Health and Human Services, Center for Medicare, and Medicaid Services contractor. Areas of expertise: Analytical Thinking, Data Analytics, Trend Analysis and OSINT.
- Directed Medicaid and Medicare fraud investigations across Texas, Louisiana, Kansas, and Arkansas, enhancing regional compliance and accountability.
- Collaborated with U.S. Health and Human Services, Office of Inspector General to support civil or criminal actions, improving inter-agency cooperation.
- Conducted data analytics and statistical sampling through comprehensive provider and patient interviews, identifying patterns and assessing fraud risk.
- 1 million+ in identified recoveries.
Program Manager, Undercover Operations (Retired)
United States Department of Homeland Security
Dallas
06.2020 - 09.2021
- Program Manager for a national business operation that required forward thinking methodologies, finance expertise and proven customer service skills. Areas of Expertise: Personnel, Program and Budgetary Management.
- Direct oversight of 10 undercover operators and 4 undercover business platforms.
- Oversaw multimillion-dollar programs with coordination of five funding sources, ensuring effective resource allocation.
- Conducted investigations for Homeland Security, contributing to national safety and compliance with security protocols.
- Performed annual employee performance assessments. Provided guidance regarding institutional metrics and actionable methods for improvement.
Special Agent, Counter-Proliferation and Identity Fraud Project Manager
United States Department of Homeland Security
Dallas
09.2008 - 09.2021
- Case Project Manager to drive operational advancement to protect America's technology and financial systems from internal and external adversaries. Focus on leveraging project management skills, communicating initiatives, building industry relationships. Areas of expertise: Team Leader, ACH Fraud, AML, BSA, CTF, OFAC, ITAR, FinCEN.
- Developed methodologies to identify threats and executed operational plans involving 200+ personnel, resulting in successful apprehension of over 100 subjects.
- Conducted investigations for Homeland Security to address threats and enforce laws.
- Led team of 12 direct reports, established goals, monitored institutional metrics, and conducted annual evaluations to enhance team effectiveness.
- Mentored new special agents during onboarding, providing policy guidance to facilitate smooth integration into operations.
- Government regulatory expertise: OFAC, ITAR, EAR, and CMS.
Special Agent and Recruitment Project Manager
United States Secret Service
05.2000 - 09.2008
- Expertise in recruitment, interviewing, background investigations of Special Agent and Uniformed Officer applicants. Human Resources and Personal Security Division team members.
- Coordinated recruitment for Special Agent and Uniform Division positions, streamlining applicant selection.
- Led panel interviews for 50+ applicants, assessing qualifications and fit for the role.
- Conducted background reference interviews, identifying 150+ non-listed contacts to enhance candidate evaluation.
- Conducted comprehensive research utilizing open-source documentation.
Education
BS - Accounting
Manchester University
North Manchester, IndianaSkills
- Fraud prevention
- Compliance reporting
- Medicaid compliance
- Government compliance
- Data analytics
- Performance analysis
- Case management
- Team leadership
- Staff development
- Training initiatives
- Executive communication
- Public speaking
- Critical thinking
Websites
Subject Matter Expert
- Fraud Prosecutions
- Court testimony
- Training
Professional Awards
- Valor, 2018
- Excellence in Public Service, 2017
Certification
Certified Fraud Examiner
Timeline
Manager, Special Investigations Unit
CVS Health- Aetna
07.2024 - 09.2025
Associate Manager, Special Investigations Unit
CVS Health- Aetna
01.2023 - 07.2024
FWA Investigator-Medicare and Medicaid
Qlarant Integrity Solutions, Inc.
09.2021 - 11.2022
Program Manager, Undercover Operations (Retired)
United States Department of Homeland Security
06.2020 - 09.2021
Special Agent, Counter-Proliferation and Identity Fraud Project Manager
United States Department of Homeland Security
09.2008 - 09.2021
Special Agent and Recruitment Project Manager
United States Secret Service
05.2000 - 09.2008
BS - Accounting
Manchester University