Agent - Medicaid Fraud Control

Oklahoma State Government•Oklahoma City, OK

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About The Position

The Oklahoma Medicaid Fraud Control Unit (MFCU) is a state law enforcement division within the Oklahoma Attorney General’s Office, and its mission is to investigate and pursue enforcement actions against health care providers who have defrauded the Medicaid program or who have engaged in abuse, neglect, and/or exploitation of persons in the Medicaid system or residential health care facilities. The MFCU has both civil and criminal enforcement powers. The successful candidate for this position will work as a member of an interdisciplinary team of investigative agents, auditors/analysts, attorneys, and administrative personnel, seeking civil remedies such as financial restitution and penalties, divestment or forfeiture, and exclusions from the Medicaid system, and/or pursuing criminal enforcement actions such as fines, incarceration, and exclusions from the Medicaid system. The successful candidate for this position should have sound judgment, strong investigative, research, and analysis skills. The Agent serving in this position will consult with attorneys and analysts, take part in crafting and executing investigative plans, gather and review evidence, provide evidence and other information to attorneys and analysts, and testify as needed. Additionally, the position will involve taking part in investigations and enforcement actions conducted jointly with Federal counterparts at any of the three U.S. Attorney Offices located in Oklahoma. This position may also involve assisting Medicaid Fraud Control Units in other States and Territories across the country as may be needed. The Agent serving in this role will also assist Unit leadership in a variety of administrative and compliance areas including, but not limited to the following: Quality Control of MFCU Investigations Compliance with 42 CFR Part 1007 et seq. Making effective and efficient use of investigative tools and resources Providing training specific to the health care fraud sector Participating in Case Reviews and audits of MFCU case work to help determine and address areas of need for things like training or supplemental effort Assisting Supervisory Agents with determinations about Intake assessments and referrals Serving as an additional point of contact for external stakeholders such as the Health Care Fraud Task Forces, the United States Attorneys Offices, the Oklahoma Health Care Authority, the Oklahoma State Department of Health, and US Department of Health and Human Services Investigating MFCU cases, and partnering with other MFCU Agents in active investigations for purposes of both assessment and improvement of field work and office work Conducting or facilitating investigations of particularly sensitive nature, as needed Partnering with MFCU Section Chief in communications within Unit and external to Unit Assisting MFCU Section Chief and MFCU Leadership with implementation of directions for MFCU team in pursuit of the MFCU mission Identifying and addressing training needs Serve as MFCU Field Training Agent and coordinate the program Conduct training specific to health care fraud investigations and enforcements Assist MFCU in recruiting, training for, and retaining Agents possessing the Certified Fraud Examiner (CFE) designation Assist MFCU Leadership in discerning trends and statistics on subjects like effective Agent/Attorney combinations, success rates for MFCU Agents across particular types of investigations, and then assisting MFCU Leadership in making adjustments to personnel assignments as warranted Agents of the Oklahoma Attorney General’s (OAG) Office are commissioned state law enforcement officials tasked with investigating violations and alleged violations of criminal and civil Oklahoma state statutes. As the sole state law enforcement entity under the Oklahoma Attorney General, OAG Agents have the unique investigative and prosecutorial advantage of working with, and collaborating with, state OAG Assistant Attorneys General on a daily basis. As commissioned state law enforcement officials, OAG Agents are automatically enrolled in, and designated beneficiaries of, the Oklahoma Law Enforcement Retirement System (OLERS). To help ensure OAG Agents can fulfill their responsibilities to the citizens of Oklahoma as state law enforcement officials, OAG Agents are subject to medical and physical fitness evaluations. The agent accepting this position must maintain the integrity of the Attorney General’s Office, as well as the confidentiality of information as required by the Oklahoma Attorney General. In-state travel, including some overnight travel, is expected. Also, out-of-state training opportunities will be available.

Requirements

Qualified individuals must: Be a CLEET certified peace officer in Oklahoma, or eligible to become a CLEET certified peace officer through reciprocity or successfully meeting and completing the standards and requirements of the Council on Law Enforcement Education and Training (CLEET) to become a certified peace officer in Oklahoma. (This may include successful admission to, and completion of, the CLEET Academy)
Possess a valid Oklahoma driver's license

Nice To Haves

The Certified Fraud Examiner (CFE) designation
A bachelor’s degree, particularly in a related field such as Accounting or Finance
Accounting or Statistics experience
Courtroom testimony experience
Experience investigating matters within the healthcare and/or medical fields
Experience with complex financial matters
Experience investigating financial crimes
Experience investigating fraud
Experience investigating situations involving vulnerable victims such as the elderly, children, or the mentally and/or physically impaired
Experience training investigators and/or law enforcement officers on investigating fraud
Experience working as a member of an interdisciplinary or multidisciplinary team
Experience working with members of federal law enforcement
Proficiency with Excel and the creation and use of spreadsheets

Responsibilities

Develop investigative plans and investigate cases as part of a team of Agents, Supervisory Agents, Analysts, and Assistant Attorneys General as part of the MFCU team
Communicate and collaborate with other Agents, Supervisory Agents, Analysts, and Assistant Attorneys General as part of the MFCU team
Attend MFCU-specific training programs on an ongoing basis
Interview witnesses, victims, and suspects, and then document investigative efforts and findings
Maintain organized and complete records of investigative work and time expended
Effectively and professionally research, prepare, analyze, and understand complex information and legal issues.
Effectively manage a varying caseload of investigations of different types and levels of urgency
Maintain the integrity of the Attorney General’s Office as well as the confidentiality of information as required by the Attorney General.
Exercise sound judgment, and exhibit excellent report writing skills
Prepare and provide testimony in courtroom settings
Execute search and arrest warrants
Maintain safety protocols of the Office of Attorney General
Compliance with 42 CFR Part 1007.1, 42 CFR Part 1007.13, and 42 CFR Part 1007, and related regulations governing the Medicaid Fraud Control Units and their personnel
Other duties as assigned