Healthcare Fraud Investigator/Case Developer

Job Description

Job Description

SGI Global is seeking a Healthcare Fraud Investigator/Case Developer to provide investigative support services to the United States Attorney's Office (USAO) for the Eastern District of Oklahoma (EDOK). The Investigator/Case Developer will support the Criminal Division's Healthcare Fraud and Abuse Control Program by conducting investigations involving healthcare fraud, fraud and abuse affecting federal healthcare programs, opioid diversion, and other criminal fraud matters within the jurisdiction of the USAO.

Position is contingent upon award

• Assist Assistant United States Attorneys (AUSAs) in conducting complex criminal investigations involving healthcare fraud and abuse.
• Review, analyze, and assess allegations, anonymous tips, agency referrals, complaints, and other reports of fraud or unlawful conduct.
• Determine applicable laws and identify potential criminal violations in coordination with assigned AUSAs.
• Develop an understanding of applicable federal, state, and local laws necessary to support investigations and case development.
• Plan, schedule, and conduct investigations involving healthcare fraud and related criminal matters.
• Provide investigative analysis and specialized support related to healthcare fraud investigations.
• Assist in the preparation of training materials intended to reduce opioid abuse and healthcare fraud.
• Initiate contacts with federal, state, and local agencies, organizations, and individuals to gather facts, obtain statements, and advance investigative objectives.
• Prepare draft subpoenas, written discovery, and other requests for information.
• Review and analyze Medicare, Medicaid, and TRICARE claims data, financial records, corporate documents, books, ledgers, payroll records, cost reports, billing statements, invoices, correspondence, computer data, and other documentary evidence.
• Verify the authenticity of documents, corroborate witness statements, and establish relationships between facts and evidence.
• Secure, preserve, organize, file, and index documentary evidence.
• Utilize electronic databases to identify assets, verify employment, and conduct financial analyses related to monetary penalties.
• Prepare interim and final investigative reports, including findings, conclusions, recommendations, and assessments of investigative strengths and weaknesses.
• Prepare summaries and digests of depositions, transcripts, and other investigative materials.
• Assist in preparing charts, graphs, audiovisual materials, and other litigation support materials.
• Coordinate witness appearances and assist with witness preparation for hearings, depositions, mediations, and trials.
• Testify regarding investigations, as required.
• Meet and coordinate with federal agencies, state and local officials, and other stakeholders in support of healthcare fraud investigations.
• Perform other related duties as assigned.

• Bachelor's degree required; emphasis in accounting preferred.
• Minimum of ten (10) years of law enforcement experience with an understanding of evidence, criminal procedure, admissibility of evidence, and elements of the crimes under investigation.
• Experience testifying in court-related matters.
• Knowledge of legal and law enforcement terminology and procedures.
• Experience reviewing complex and voluminous records; knowledge of medical billing procedures is preferred.
• Working knowledge of current research and investigative techniques, including the use of commercial databases and other information sources.
• Ability to analyze, organize, and present large volumes of data using common software programs; experience with CaseMap, I-Pro, STARS, or similar software is preferred.
• Self-motivated with the ability to work independently, organize evidence, and prepare written reports.
• Possess specialized skills or experience in forensic accounting, healthcare fraud, nursing, legal, and/or law enforcement.
• Proficient in Microsoft Office applications, including word processing and spreadsheet software.
• Excellent written and oral communication skills.
• Valid driver's license.
• Ability to successfully complete a Public Trust (Risk Level 3) background investigation.

SGI Global provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.