Michelle Hutchinson

Professional with experience in student enrollment, database management and customer service. Expertly manages database software and systems and provides superior support for diverse needs. Knowledgeable about student information management systems and best practices in education.

• Benefits Integrity Division: Assessment of the Fraud Investigation Section Operating Model – November 2021. Recommendation 5: Alternative pathways for lower risk cases:
• Developed the Preliminary Investigation Tip-off Analysis Pathways document. The procedures were implemented by Health Provider Fraud Section (HPFS) in June 2022.
• The document details alternative pathways for lower risk cases and implement a robust method of triaging cases.
• Implemented the Triaging Officer role within HPFS in January 2023:
• Created a robust triaging process prior to cases assigned for Investigation Analysis, using tip-off information, priority scoring assessment, claiming data, DETECT tool.
• Resulted in early intervention of non-compliance cases, administration errors and low-value non-provision.
• Meets strategic priorities in addressing non-provision and system fraudulent behaviours.
• Approved by the Department’s Audit and Risk Committee.
• Developed the policy and procedures for Administrative Investigations (AI) within Benefits Integrity Division, Investigation Section (now Health Provider Fraud Section):
• Managed and drafted a proposal for the: Treatment of Non-Provision Investigation cases under $10,000 as an AI. Procedures to be implemented into Investigation’s workflow within CWMS.
• The procedures were approved by the Director of Investigation but were not implemented due to the change in strategic direction by the Executive.
• Acting Team Leader. I successfully manage the team with competing priorities with my case workload, guiding, assisting, and supporting team members and Assistant Director.
• Provide guidance and advice to team members. Coaching to new and less experienced staff, and staff seconded to the PII team to conduct Investigation Analysis.
• Mentored staff member with performance issues. Provided training and support which resulted in successfully delivering outcomes.
• Adapted to changing work environment due to the COVID-19 pandemic. Working from home enabled me to streamline my work processes and increase productivity, develop new work practice initiatives to meet Department expectations and goals.
• Member of a geographically dispersed team where tasks are completed independently within agreed timeframes and priorities, to a high standard.
• Complex analysis and use of investigative techniques resulted in identifying provider fraud.
• Provider submitted false claims for services not provided to the patient. The provider breached Section 128B of HIA 1973, where a ‘where a false and misleading statement has been knowingly made to claim a benefit.’
• Result: Recovery initiated under 129AC of HIA 1973, due to a low volume of services did not meet the criteria for referral to Investigation.
• Search Warrant for Investigation. Participated in a search warrant in the role of Videographer.
• Result: Received positive feedback from Warrant Holder - the role was conducted professionally and to a high standard.
• National changes to Notice to Produce (NTP) guidelines were implemented due to the outcome of a complex audit case.
• Drafted and submitted a proposal to implement changes to the Health Provider Guidelines for time-based MBS items for external stakeholders to refer to.
• Discovery of Bulk Bill Incentive (BBI) items associated with Unsolicited Voluntary Acknowledgements (uVA) services when analysing provider's claims data.
• Result: National procedural changes for the recovery of uVA services i.e: mandatory to identify and recover associated BBIs associated with uVA services.
• Using excellent communication, investigative and interpersonal skills to negotiate with providers during audits leading to Voluntarily Acknowledgements of non-compliant services and significant recoveries.
• Identified MBS Identity Fraud – complex analysis identified one member of the public registered to multiple Medicare cards in multiple names with different Personal Identification Numbers.
• Result: All Medicare cards were cancelled, and the case referred to Australian Federal Police.
• Identified provider pathology fraud when conducting pathology audit.
• Result: All Medicare cards were cancelled, and the case was referred to Australian Federal Police.