Q&A with Board Chair Ralph Carpenter

Ralph CarpenterRalph J. Carpenter, Director of the Special Investigations Unit (SIU) for Aetna has been elected the 2014 Chair of its Board of Directors. Carpenter joined Aetna in 2008, after serving 28 years in law enforcement and retiring as a Lieutenant Colonel from the Connecticut State Police. During his tenure with the State Police he held several ranks and positions that included assignments as Barracks Commander, State Police Academy Commandant, Public Information Officer, and Tactical Team member. As a detective in the Bureau of Criminal Investigations he ran undercover organized crime investigations as well as undercover auto theft investigations.

In addition, Carpenter worked in the Bureau of Special Investigations where as a detective he oversaw public corruption and fraud cases. In this capacity he worked on a number of FBI task force operations that resulted in the arrest and conviction of a numerous criminals.

At the time of his retirement from law enforcement, Carpenter was appointed by the Governor of Connecticut to serve as Commissioner of the Department of Motor Vehicles. Following that assignment, he was appointed as Commissioner of the Department of Transportation and in that role often assisted the FBI with investigations into possible fraudulent contracts.

For the past six years Carpenter has led Aetna's SIU as Director and currently oversees a staff of more than 140. His responsibilities include the oversight of all health care fraud investigations conducted by the SIU. He oversees multiple investigative teams, the SIU systems support unit, as well as the field analyst staff assigned to various locations throughout the country.

Carpenter was elected Board Chair of the NHCAA Board of Directors on November 18, 2013 at the NHCAA Annual Training Conference and succeeds out-going Chair Alanna Lavelle, Director of Enterprise Investigations for WellPoint, Inc.

The Institute Update spent time with Ralph in December to discuss the coming year and here's what he had to say:

NHCAA: You've held a multitude of positions over the years, can you tell us how they've prepared you for or enhanced your work in health care anti-fraud field?

Ralph Carpenter: Each one of my former positions presented me the opportunity to develop skills that have helped me as SIU Director. Early on in my role with the SIU, I would have likely told you that my years of experience conducting complex and sensitive investigations while working collaboratively with multiple local, state, and federal agencies most enhanced my health care anti-fraud work. Today, I would say that the opportunities to develop communication and interpersonal skills afforded to me through my previous positions have proven to be just as vital in my work today. In the health care anti-fraud world, where networking and communication are so critical, these skills allow me to leverage myriad resources and bring investigations and projects to successful conclusions.

NHCAA: What do you see as the most challenging issues in the health care anti-fraud arena in the coming year?

RC: The answer to the "what keeps me up at night?" question always seems to come back to concerns about what new fraud opportunities could emerge as a result of the Affordable Care Act. Identity theft and identity loaning as well as enrollment fraud are two challenges that I think we are going to be confronted with in the very near future. It is imperative that we work with our internal business partners such as our enrollment group, provider data services, contracting, and others so that we can put up the best defenses possible.

NHCAA: In these difficult economic times, where tighter budgets are juxtaposed with higher expectations for the SIU's return on investment (ROI), how do you think members can best capitalize on their NHCAA member benefits to meet goals?

RC: Rule #1 for me is to make sure SIU staff members are aware of, and use, all of the assets that NHCAA provides. Whether it is training opportunities, leveraging information from SIRIS, using the Peer Experience Resource Center, tapping into the information provided by Government Affairs, using the Anti-Fraud Management Survey, or one of the other host of resources NHCAA offers, it is critical that the leadership of our respective organizations has a clear view of all these benefits. To truly capitalize on these benefits one needs to show a direct relationship between the resource and the results.and I have never found that difficult to do!

NHCAA: Beyond the health care anti-fraud world, tell us a bit about your life outside of Aetna and NHCAA.

RC: Well, I think the simplest way to describe "life outside" is that I do not like to sit still. I love spending time with my family, traveling, or participating in some type of activity. I especially enjoy working outdoors; whether landscaping or building something, it provides me time away from the electronic world we have all found ourselves immersed in. I've done a deck or two and when the kids were young, ignored my indoor projects to build them a playhouse. I also enjoy fishing and kayaking and in the last few years have combined the two, allowing me, because of the small size of a kayak, to get pretty far into the wilderness and fish in untouched areas. This led me to try open water kayaking; I learned my lesson early on about watching the tides after having to fight against them to get back to shore one trip. It didn't scare me away though, I'm just more cautious!