Medicaid Fraud Investigator, 3 positions
State of North Carolina
 Raleigh, NC

Description of Work

THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF $48,051.00 to $68,637.00. Salary offers for the selected candidate are based on the candidate's education and experience related to the position, as well as our agency budget and equity.

This position is located in the Medicaid Investigations Division of the Department of Justice. The Attorney General's Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees. These cases also protect our most vulnerable elderly and disabled citizens.

Our Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff. MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations. This position has the opportunity to work cases in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC State Bureau of Investigations, Sheriff's Offices, and Police Departments

The Medicaid Investigations Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,348,028 for Federal fiscal year (FY) 2021. The remaining 25 percent, totaling $2,116,008 for FY 2021, is funded by the State of North Carolina.

MID has recovered more than $900 million in restitution and penalties. MID has helped convict hundreds of persons who defrauded Medicaid or abused patients in facilities receiving Medicaid funds.

The Attorney General's office and the Medicaid Investigations Division are committed to ending Health Care Fraud. The link below is provided for your information.

This position will perform professional/analytical and law enforcement work in the detection, investigation and punishment of fraudulent and non-fraudulent violation of applicable civil and/or criminal laws (such as those pertaining to fraud in the administration of the Medicaid program, fraud by Medicaid providers, and, as authorized by the office of the Inspector General, the investigation of Medicare and other federal health care fraud cases which are primarily related to Medicaid fraud).

The position will conduct and participate in wide variety of case investigations involving complex financial analysis. Work requires knowledge of applicable state and Federal laws and regulations.

Position manages investigative assignments and/or projects by:

  • conducting detailed analysis of Medicaid and Medicare claims and reimbursement data;
  • preparing detailed spreadsheets and charts;
  • reviewing medical records;
  • preparing written investigation reports, serving subpoenas, and preparing witness statements and/or affidavits;
  • researching public records;
  • analyzing facts and complex documents;
  • interviewing and coordinating witnesses;
  • communicating and consulting with subjects, law enforcement and judicial personnel, Federal and state agencies, and others;
  • testifying in judicial proceedings;
  • maintaining confidentiality and discretion in the course of conducting business;
  • working individually and/or with others; and adapting to change and circumstances.

Position will lead, participate in, or assist with collection and storage of evidence (to include electronic data and evidence), arrests, execution of search warrants, undercover investigation, and other law enforcement operations pursuant to the case.

The selected candidate is subject to a background investigation.

This posting is for 3 positions - 60090011, 65012752 and 60010498. Knowledge, Skills and Abilities / Competencies

Knowledge of generally accepted accounting principles (GAAP) and financial systems and practice as evidenced by a bachelor's degree with 18 credit hours of accounting coursework or gained from two years of experience of auditing or investigating white-collar, financial crimes.

Ability to learn federal and state laws, rules and regulations relevant to Medicaid provider fraud and patient abuse investigations during case assignments; ability to recommend apparent Medicaid provider fraud and patient abuse violations to supervisor; ability to learn legal issues and consult with supervisor and MID attorney on legal issues and procedures.

Ability to learn investigative and examination techniques, processes, and procedures used during investigations; ability to learn latest applicable technology to meet work needs.

Ability to learn to conduct and complete Medicaid provider fraud and patient abuse investigations.

Ability to learn how to locate resources of generally accepted accounting principles, communication and report writing skills, how to conduct Medicaid provider fraud and patient abuse investigations and gather information from relevant sources, conducts field investigations, interview witnesses, report findings, and make decisions based on facts.

Ability to learn how to clearly communicate to others general knowledge of accounting principles and financial systems in order to conduct analyses.

Ability to clearly communicate verbal and written information and to learn to prepare for and conduct interviews in order to facilitate Medicaid provider fraud and patient abuse investigation; ability to listen and understand messages from others and respond with consistent applicable laws and policies.

Ability to develop writing skills, learn investigative documentation standards and requirements, and prepare and organize written investigative reports under close supervision. Basic knowledge of how to develop and maintain professional working relationships with co-workers, supervisors, witnesses and other law enforcement personnel, witnesses, attorneys, court personnel, experts, and others.

Ability to learn to prepare for testimony in judicial proceedings.

Ability to develop consistently sound and accurate conclusions based on general knowledge of accepted financial systems; ability to learn established procedures to identify, gather, organize, understand and analyze financial information and evidence in order to understand financial and business operations of suspects.

Ability to learn established procedures in order to determine if applicable laws and regulations were violated; ability to participate in evidence collection, and related case research.

Ability to recognize and identify common provider fraud and patient abuse violations; ability to recognize and respond accordingly to unusual activity; ability to draw conclusions and prepare written reports supported by facts.

Ability to learn to determine if Medicaid provider fraud and patient abuse laws were violated.

Ability to learn to conduct investigations and completes assigned within prescribed timeframes; ability to maintain confidentiality in investigations.

Minimum Education and Experience Requirements

Bachelor s degree in accounting, finance, business administration or criminal justice from an appropriately accredited institution, with 18 credit hours of accounting coursework and two (2) years of experience auditing or investigating white-collar financial crimes;

  • r equivalent combination of training and experience. A combination of working knowledge of accounting and financial/tax laws and a background in law enforcement or investigations is preferred.

May require certification as a Law Enforcement Officer or Special Agent in accordance with the provisions of the North Carolina Criminal Justice Training and Standards Commission or the ability to achieve certification within one (1) year of employment.

Supplemental and Contact Information

Computer literacy is an important component of all DOJ jobs, we encourage you to apply electronically. All applicants must complete and submit a State application for employment using the NEOGOV Online Job Application System for the State of North Carolina.

To receive credit for your work history and credentials, you must list the information on the online application form. Any information not included on the application form cannot be considered for qualifying credit. Embedded or attached resumes are not accepted as a substitution for a completed application. Credit for foreign degrees will only be given if verification of degree certification is attached. Transcripts for foreign degrees have to be evaluated by an organization like World Education Services to determine US equivalency.

Any licenses or certificates must be included in the appropriate section of the application form.

Applicants seeking Veteran's Preference must attach a copy of their DD-214 or discharge orders.

The NC Department of Justice is an Equal Opportunity Employer. The NC Department of Justice uses Merit-Based Recruitment to select from among the most qualified applicants to fill positions subject to the State Human Resources Act. Once the position has been filled, all on-line applicants will be notified via the e-mail provided at the time of application.

CONTACT INFORMATION:

NC Department of Justice

Human Resources Office

Lisa Sasser, Recruitment Specialist

114 W. Edenton Street

Raleigh, NC 27603

919-716-6490