The Fraud Examiner

Integrity, Ethics and Discipline are Foundation of CFE's Career

May 2016

ACFE Member Profile
Matthew Lynch
Director of Special Investigations Unit 

One would think that Matthew Lynch, CFE, Director of Special Investigations Unit for Healthfirst, was raised to be a fraud fighter. “I’m the product of Catholic school and Military College discipline and education — with emphasis on the discipline,” said Lynch. “The Citadel taught me the importance of integrity, ethics and discipline — lessons that were reinforced by my Marine Corps training, which have been the foundation of my career.” It is also not surprising that he is a strong believer in the importance of a collaborative fraud-fighting community. “There is great value in the perspective of others,” says Lynch. Under his direction his team ensures due diligence through teamwork and discussions of on-going investigations. “Learning to listen to others before making conclusions is critical.”

How did you transition from the Marine Corps into the investigations field?

As a cadet at The Citadel, I was in the Marine Corps scholarship program. The combination of a shoulder injury and the end of the Vietnam War ended my military career but not before multiple attempts after graduation (on my part) to change their mind! This prompted a change in direction for me and led me to follow the steps of other family members to go into law enforcement.

My investigative training took a long and winding road: an unusual blend of private and public investigative experience crossing multiple industries and countries. I have been a Deputy Sheriff in Charleston and Columbia, South Carolina; an Ombudsman Investigator handling cases of abuse, neglect and financial exploitation of the elderly; a Medicare anti-fraud investigator; a lead special audit investigator for a Fortune 100 global corporation conducting international internal, financial and FCPA investigations; and a Director of a Special Investigations Unit (SIU).

What is a challenging aspect of investigations within the health care insurance industry?

Health care fraud investigators have the added challenge of having to understand the taxonomy and language associated with these frauds and their interactions. On top of being a skilled fraud investigator, they need to be part nurse, part claims specialist and part financial analyst. All of which is complicated by varying regulations governing Medicare, Medicaid and commercial lines of business.

How does your corporate investigations unit operate?

Our SIU functions under “corporate legal” and has four separate investigative components: Marketing Incidents Investigations involving marketing and sales representatives; Healthcare Fraud, Waste and Abuse (FWA) Investigations of member complaints; Healthcare FWA Proactive Data Analytic Investigations of providers, vendors, suppliers; and Internal/Corporate Investigations in support of Legal, Human Resources and Compliance. While my investigators and fraud examiners have specific investigative assignments, the majority are cross-functional.

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