Medicaid Fraud Investigator

Location: Wake County, NC

Agency

Dept of Justice

Division

DOJ Legal Services

Job Classification Title

Financial Investigator I (NS)

Position Number

60010403

Grade

NC16

About Us

The North Carolina Department of Justice, led by the Attorney General of North Carolina, represents the state, state agencies, and elected officials, and defends the rights of the people of North Carolina. The Department handles all state criminal appeals cases and assists district attorneys with complex criminal cases at their request. Additionally, the Department of Justice includes the North Carolina State Crime Lab, the North Carolina Justice Academy, and the Sheriffs’ and Criminal Justice Education and Training Standards Divisions.

Description of Work

Recruitment Range: $57,983 - $69,000

IMPORTANT NOTE: This posting closes at 11:59:59 PM the night BEFORE the End Date listed.

The primary purpose of these positions is to perform investigations in the area of criminal and civil Medicaid fraud schemes, patient abuse or neglect, and misappropriation of recipient funds by conducting and participating in wide variety of case investigations involving financial analysis. Work requires knowledge of applicable state and Federal laws and regulations.

Position manages investigative assignments and/or projects by

• Conducting complex criminal and civil investigations involving Medicaid provider fraud and patient abuse and neglect.
• Data analysis of Medicaid claims.
• Reviewing financial documents, including bank statements, cancelled checks, corporate and individual income tax returns, etc.
• Reviewing medical records and service notes of Medicaid Recipients.
• Interviewing witnesses, including Medicaid Recipients, current and former employees, Medicaid Policy administrators, DHHS employees, DSS employees, etc.
• Interviewing individuals suspected of committing Medicaid provider fraud and patient abuse and neglect.
• Preparing detailed reports from the results of interviews conducted.
• Working with Federal, State and local law enforcement agencies, including AUSAs.
• Testifying in State and/or Federal court.
• Understanding of the Rules of Evidence in criminal investigations.

Some travel, including some occasional overnight stays are required

The selected candidate is subject to a background investigation.

The Medicaid Investigations Division (MID) 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. MID works closely with district attorneys’ offices, US Attorneys’ offices, federal, state and local agencies across the State. The damages in a Medicaid fraud case can range from a few thousand dollars to tens of millions of dollars. MID’s enforcement actions protect and recover taxpayer funds and help ensure access to needed medical services for Medicaid enrollees.

Knowledge Skills and Abilities/Management Preferences

Law enforcement experience

Healthcare industry investigator or analyst experience

Familiarity with healthcare terminology and policy

Accounting and/or financial background

Interviewing and report writing experience