Standing on the cusp of my final nursing semester, I felt uncertainty. Unlike my classmates, their futures neatly mapped out with dream hospital placements, I had no clear path. My previous clinical internships, while valuable in direct patient care, hadn’t ignited a specific passion. Determined to find my niche, I embarked on a self-directed exploration of healthcare possibilities. Scouring LinkedIn, a single listing caught my eye: Healthcare Fraud Shield (HCFS). Intrigued, I knew I had to apply.
With the pandemic shutting down many hospital internships, I stumbled upon a unique opportunity. HCFS was seeking their first-ever intern. Seizing the moment, I poured my heart into the interview, emphasizing my eagerness to learn despite my limited knowledge. Karen Weintraub, the executive vice president, saw my potential and took a chance on me. Those first few months were an immersion course under the guidance of HCFS’s experts. Working closely with the Special Investigative Unit (SIU) team, I absorbed everything they could teach me. Healthcare fraud, a completely new territory, quickly revealed its insidious impact not just on providers, but on patients as well. This realization struck a chord – here was an indirect way to make a positive difference in patients’ lives. It opened my eyes to the complex financial realities of healthcare, a whole new side I never knew existed.
At HCFS, I gained an internship experience unlike any typically offered to new nursing graduates. The remote work environment fostered a work-life balance that many in my field dream of, something I’ll forever be grateful for. It opened doors to a different lifestyle than the one my nursing school peers might experience. But the most impactful aspect of the internship was the deep dive into healthcare fraud itself. My background in nursing school proved invaluable here. Having a strong foundation in medical terminology, procedures, and diagnoses gave me a unique lens to understand the different types of fraud schemes, from upcoding and unbundling services to falsifying diagnoses and medical identities. The SIU team meticulously showed me how to identify red flags in medical billing data, a skill that felt like cracking a secret code. My nursing knowledge allowed me to quickly grasp the medical aspects hidden within these schemes, making it easier to identify inconsistencies and potential fraud. Witnessing the impact of these schemes on both healthcare providers and patients solidified my resolve to be part of the solution.
My dedication and hard work during the internship paid off. Karen Weintraub, impressed by my progress, offered me a fantastic opportunity to continue my journey with HCFS as a full-time SIU Investigator Analyst upon graduation. This wasn’t just a job; it was a chance to delve deeper into the field I was now passionate about and contribute meaningfully to HCFS’s mission. Now, as a valued member of the team, I actively participate in fraud investigations, utilizing the skills I honed during the internship to identify and prevent fraudulent activity.
Looking back, this internship journey has been a whirlwind of discovery and growth. It not only exposed me to the complexities of healthcare fraud but also revealed a passion within me I never knew existed. My nursing background proved to be a powerful asset, allowing me to understand the medical aspects of fraud schemes with ease. The internship also instilled in me the importance of work-life balance, a valuable lesson I’ll carry throughout my career. Most importantly, it ignited a fire within me to safeguard the integrity of the healthcare system and ensure patients receive the care they deserve. With my newfound knowledge and unwavering dedication, I’m confident in my ability to make a positive impact as a Healthcare Fraud Analyst and contribute to a more ethical and financially sound healthcare landscape.
Paula Clemente, RN, BSN, CPC
SIU Investigator
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