Anthony Spaventa joined T&M in December of 2016 and currently serves as Director of Health Care Fraud & Abuse. On behalf of major health insurance companies, he manages audits of providers using analytics to uncover aberrant billing practices. He advises clients on ways to prevent and detect fraudulent claims, isolate outlier providers and establish compliance protocols. As an expert on health care industry best practices, he evaluates medical billing for adherence to industry standards, conducts audits and negotiates settlements.
A subject matter expert for health care fraud, Mr. Spaventa's testimony in civil litigation has helped recover millions in settlements.
Before joining T&M, Mr. Spaventa was a Special Investigations Unit (SIU) investigator with Fidelis Care, the largest Medicaid managed health plan in New York State. At Fidelis Care he identified and investigated aberrant providers, resulting in substantial recoveries and referrals to regulatory or law enforcement agencies. Prior to that, Mr. Spaventa was a Special Investigator for Affinity Health Plan and before that, an Associate Special Auditor Investigator for the New York State Office of the Attorney General Medicaid Fraud Control Unit, where he worked for more than a decade.
While with the NYS Office of the Attorney General, Mr. Spaventa specialized in complex Medicaid fraud investigations involving hospitals, clinics, pharmacies, doctors, transportation companies and Medicaid member doctor shopping. Mr. Spaventa also worked as a Senior Accountant with a leading New York forensic accounting firm which specializes in the audits of healthcare facilities to determine compliance with Medicare and Medicaid regulations. While with this firm, he performed Medicare cost report audits for Medicare Administrative Contractors, program safeguard contractors and fiscal intermediaries.
Mr. Spaventa received his Bachelor’s Degree in Accounting in 2000 from St. John’s University. He has been a Certified Fraud Examiner (CFE) since 2012 and was certified as an Accredited Health Care Fraud Investigator (AHFI) in 2017.