Christy Warner

Healthcare Fraud Data Analyst
Consultant

With more than 25 years of experience in healthcare fraud detection and forensic data analysis, Christy Warner is retained by attorneys, government contractors, and federal agencies when complex Medicare and Medicaid claims data must be transformed into decisive, prosecution-ready results. Ms. Warner is an expert in designing and deploying the statistical algorithms that power large-scale fraud identification — including her work as a senior developer for the Centers for Medicare & Medicaid Services (CMS) Fraud Prevention System, one of the federal government’s principal tools for stopping fraudulent payments before they are made.

Healthcare Fraud Detection. Ms. Warner has dedicated her career to identifying Medicare and Medicaid fraud, waste, and abuse through advanced data modeling. As lead model developer and subject matter expert for the CMS Fraud Prevention System — supporting the General Dynamics IT (GDIT) contract — she built the statistical models used to flag aberrant billing patterns across the entire Medicare and Medicaid populations. Her models have targeted opioid fraud, durable medical equipment abuse, facet joint injection schemes, HIV high-payment drug manipulation, and dozens of other fraud typologies. Among her most consequential results: Ms. Warner identified $2.5 billion in Medicare urinary catheter fraud within five days of beginning her analysis — one of the largest single-analyst fraud discoveries in the program’s history.

Forensic Case Support. Ms. Warner has been retained as a forensic data analyst by some of the country’s foremost expert witnesses and litigation consultants, most notably Bruce Dubinsky — widely recognized as one of the nation’s preeminent forensic accountants. In that capacity, Ms. Warner has been hand-selected as lead analyst on matters involving healthcare fraud, royalty disputes, election compliance, accounts payable fraud, and terrorist watch-list screening under the Patriot Act. Her clients in this capacity have included the Red Cross, the University of Southern California Keck Hospital, and the Saudi Arabian Cultural Mission, among others. A notable case — Sensormatic Security Corp v. Sensormatic Electronics Corporation — concluded with a settlement of $81 million, with Ms. Warner’s commission reconciliation analysis serving as a central evidentiary element.

Government & Agency Work. Ms. Warner has served in senior data roles for leading government contractors and healthcare analytics firms throughout her career. As Deputy Project Director for Thomson Reuters on the Medicaid Integrity Contract (MIC) Audit for the Northeast United States, she managed a team of 15 analysts and clinicians and developed more than 20 fraud-detection algorithms that identified $11.8 million in potential Medicaid overpayments across eight states within four months of project initiation. She also co-authored and co-presented the technical proposal that helped win a $19 million federal contract. At Ingenix (Optum/United Health Group), she personally developed more than 30 fraud-detection algorithms and was a key contributor to implementing pre-payment claims edits that saved United Health Group $700,000 per day in denied fraudulent claims.

Technical Expertise. Ms. Warner is an expert in SAS (Base SAS, SAS Studio, SAS/MACRO, PROC SQL, SAS/STAT, SAS/GRAPH) and is proficient in Python, PySpark, Databricks, Snowflake, AWS, and Power BI. She has a deep working knowledge of Medicare and Medicaid claims structures, CPT and HCPCS codes, DRG, and ICD-10. Ms. Warner is also recognized as a specialist in entity resolution and fuzzy matching — including Levenshtein distance, Generalized Edit Distance, Soundex, and proprietary algorithms she has developed — enabling her to connect disparate datasets and surface fraud patterns that elude conventional analysis. She has presented her research at the SAS Users Group (SESUG) conference and has been published in Fraud Magazine, New Perspectives, and AuditNet.

Highlighted results:

• Identified $2.5 billion in Medicare urinary catheter fraud within five days of data analysis
• Identified $11.8 million in potential Medicaid overpayments across eight states within four months as Deputy Project Director on the MIC Audit
• Key contributor to saving United Health Group $700,000 per day through pre-payment fraud edit implementation
• Co-authored technical proposal that secured a $19 million federal Medicaid Integrity Contract for Thomson Reuters
• Forensic data support for Sensormatic litigation that concluded in an $81 million settlement

Education

• James Madison University — Bachelor of Science in Mathematics, Minor in Statistics (1992)

Selected Publications

• Warner, C. “Accounts Payable Fraud: 10 Ways to Identify It.” AuditNet; New Perspectives (Association of Healthcare Internal Auditors), Summer 2007.
• Warner, C. “Using PROC FCMP To Improve Fuzzy Matching.” South East SAS Users Group (SESUG) Conference, October 2016.
• Warner, C. and Hyder, C. “Death Fraud: This Identity Theft is Alive and Kicking.” Fraud Magazine, September/October 2010.
• Warner, C. and Dubinsky, B. “Uncovering Accounts Payable Fraud: Welcome to a Fuzzy World.” Fraud Magazine, July/August 2006.
• Warner, C. “Automating Predictive Analysis to Predict Medicare Fraud.” SAS Users Group Conference, Philadelphia, PA, April 2005.