Emily Wale, CPA, CFE
Member
“What we do is important. Millions of people depend on the government health care programs our clients provide. That’s why we always strive to be the best. We know people are counting on us.”
— Emily Wale
With over 29 years of experience, Emily has specialized in providing healthcare consulting and auditing services to state and federal governments. Her expertise spans a wide range of areas, including eligibility reviews, performance assessments, internal control evaluations, disproportionate share hospital (DSH) audits and consulting, nursing facility audits, hospital audits, and claims and billing reviews.
Emily has extensive experience working with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services, as well as the Centers for Medicare & Medicaid Services (CMS). She has served as an expert witness for state Attorneys General and the U.S. Department of Justice, demonstrating her deep knowledge and credibility in the field.
With more than a decade of experience in eligibility compliance auditing, Emily served as the inaugural Eligibility Review Manager for CMS’ Payment Error Rate Measurement (PERM) Eligibility Review Contractor (ERC), where she continues to oversee eligibility reviews. As of March 2026, she also helps oversee data processing claim reviews and eligibility review activities as part of CMS’ PERM Review Contractor.
In addition, Emily has supervised South Dakota’s Reporting Year (RY) 2024 and 2027 child care assistance improper payment reviews, further showcasing her comprehensive expertise in program integrity and benefit auditing.
Education
B.S., Accounting, Indiana University
Specialties
– Eligibility analysis for PERM.
– Benefit child care assistance compliance reviews.
– Claim compliance reviews of hospitals and mental health facilities.
– Reviews of hospital uninsured claims for DSH program.
– Medicaid cost report compliance audits of nursing facilities, intermediate care facilities, and hospitals.
– Billing reviews and audits of fiscal intermediaries and carriers.
– Performance evaluations of governmental entities.
– Analysis of internal controls and processes.
– Risk assessments.
– Expert witness in the areas of Medicaid and Medicare reimbursement systems.
