Senior Civil Health Care Fraud Investigator

Contact Government Services•Harrisburg, PA

16d•Onsite

About The Position

CGS is seeking a Senior Civil Health Care Fraud Investigator to join their team supporting the legal mission of a large federal agency in Harrisburg, PA. This position will allow candidates to demonstrate expertise in fraud investigations while supporting a federal agency. CGS brings motivated, highly skilled, and creative people together to solve the government’s most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. CGS offers an environment in which employees feel supported, and professional growth is encouraged through various learning opportunities.

Requirements

Bachelor’s degree in law enforcement, criminal justice, accounting, finance or related field.
Minimum ten (10) years of experience in any combination of law enforcement, criminal justice experience, and health care fraud investigation.
Experience testifying in court matters
Proficient in Microsoft Office software programs (i.e., Word, Excel, Outlook, etc.)
U.S. Citizenship and ability to obtain adjudication for the requisite background investigation

Nice To Haves

CPA Certification
Experience working with a federal or state law enforcement entity

Responsibilities

Supports the planning and conduction of investigations
Assists Assistant United States Attorneys (AUSAs) in the investigation of matters in conjunction with federal agents, to determine whether there have been violations of Federal Statutes, e.g., False Claims Act, Stark Law, and Anti-Kickback Act.
Works and regularly communicates with AUSAs to identify possible violations or causes of action, determines proof required to assist in affixing legal responsibility, and devises methods for obtaining, preserving, and presenting such evidence
Decides upon the most effective methods for planning, scheduling, and conducting investigations, and identifies required resources.
Recommends methods for conducting investigations, including interviews, subpoenas, and depositions.
Secures participation of appropriate law enforcement agents in execution of these investigative methods
Identifies and presents AUSAs with potential investigations through review of the news, databases, and regular communications with representatives of Government agencies and private industry.
Contacts federal, state, and local officials, as well as business representatives, to gather information, documents, and statements on current or potential investigations, as well as coordinate investigative activities.
Assists AUSAs with the identification, locating, and interviewing of witnesses.
Conducts surveillance of suspects with appropriate law enforcement agencies.
Communicates with counsel of subjects and witnesses
Prepares appropriate memos and reports on contacts, interviews, and surveillance
Examines, analyzes, presents, and secures evidence such as documents, emails, policies, text messages, payrolls, financial statements, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation.
Research and reviews laws, rules, regulations, and policies to determine whether health care billings were improper.
Identifies and interviews any relevant Governmental or business representative pertaining to the propriety of the billings
Traces funds derived from fraud and identifies assets of subjects
Confirms authenticity of documents, corroborates witness statements, and otherwise builds proof necessary for successful litigation
Arranges for the integrity of evidence through secure storage, preservation, organization, and indexing of voluminous physical and electronic evidence.
Regularly updates AUSAs on status of case.
Prepares interim and final reports on progress of investigations for use by AUSAs and supervisory attorneys. Includes significant findings and conclusions, recommendations for additional investigative actions, and candid assessments of strengths and weaknesses of witnesses, documentary evidence, and other aspects of case
Assists AUSAs with preparation for litigation and trial
Provides analytical advice and assistance with compiling documents and physical evidence, and creating charts, graphs, videotapes, and other audio-visual materials for use by AUSAs in motions and at trial
Provides advice to AUSA on selection of witnesses and ensures their attendance through subpoena or otherwise.