Fraud Investigator/ Federal Court Expert Witness - (Medicare & Medicaid) (

Peraton•,

2d•$86,000 - $138,000•Hybrid

About The Position

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, and reduce fraud, waste, and abuse and to make referrals for recovery. The Fraud Investigator Advisor supports prosecution of cases within the SE UPIC and serves as a liaison among the SE UPIC, HHS OIG, State Medicaid Agencies, and the Department of Justice. The role requires developing expertise in Medicare and Medicaid policies to prepare cases for prosecution, exercising significant independent judgment within broadly defined policies and practices, and determining effective methods for achieving objectives. Telework is available from the contiguous United States, and extensive travel within the United States is required.

Requirements

At least 8 years of experience with a bachelor’s degree, 6 years with a master’s degree, or 3 years with a Ph.D.
Healthcare investigative experience.
Previous experience testifying in federal court in related healthcare prosecutions.
Strong communication and organizational skills.
Strong PC knowledge and skills.
Ability to travel within the United States as needed.
U.S. citizenship.
Ability to research and draw conclusions; present issues of concern and cite regulatory violations; organize and document case files; compose correspondence and reports; educate relevant stakeholders; interpret laws and regulations; handle confidential material; report work activity promptly; and work independently and collaboratively.
Ability to attend meetings, training, and conferences, including overnight travel.

Nice To Haves

Knowledge of Medicare and Medicaid requirements, laws, rules, and regulations related to payment for services billed to the programs.
Experience reviewing claims, performing medical reviews, and/or developing fraud cases.
Documented experience working in a law enforcement environment specific to Medicare and Medicaid programs.
Documented experience preparing and testifying in cases involving Medicare and Medicaid rules, policies, and program requirements.
Master’s degree preferred.
CFE or AHFI certification preferred.

Responsibilities

Assist investigators with case development.
Respond to requests from USAO and DOJ.
Monitor the timeliness of case updates and escalate issues to management as necessary.
Monitor investigation and case progress to ensure available remedies are used, including suspension, pre-payment reviews, and revocation.
Mentor team members in identifying previously undetected fraud, waste, or abuse through proactive or reactive research, analysis, and development.
Conduct training on case development for prosecution, including best practices and lessons learned.
Attend regional meetings with stakeholders, including HHS OIG, FBI, State Medicaid Agencies, and other federal and state agencies.
Research issues and draw conclusions; present concerns by citing regulatory violations and alleged schemes to defraud the government.
Organize case files and accurately and thoroughly document steps taken.
Compose correspondence, reports, and referral summary letters.
Educate providers, provider associations, law enforcement, other contractors, and beneficiary advocacy groups on program safeguard matters.
Interpret laws and regulations, handle confidential material, and report work activity on time.
Work independently and as part of a team to deliver high-quality work.
Attend meetings, training, and conferences; overnight travel is required.
Document QC results in WMM according to record type.
Coordinate with other designated leads when necessary to provide coverage during work hours.