Health Care Fraud Investigator

ROLE

We are seeking an experienced Health Care Fraud Investigator to support the U.S. Attorney’s Office (USAO) Western District of Kentucky (WDKY). Your scope of work focuses on criminal and civil investigations of healthcare matters.

This is a full-time opportunity in which we'll provide competitive pay, comprehensive benefits, and job stability and security.

Apply today!

RESPONSIBILITIES

• Assist AUSAs in developing and implementing an investigative plan
• Ensure investigative goals are clearly stated and met
• Work with AUSAs and supervisory attorneys to identify applicable laws and potential violations
• Gain an understanding of all applicable federal, state, and local laws to guide investigations
• Determine necessary proof and devise methods for obtaining, preserving, and presenting evidence
• Help decide the best methods for planning and conducting investigations
• Identify resources that may be required for investigations
• Assist with audit and financial investigations of people with high profile backgrounds
• Examine financial records (i.e., books, records, computer tapes, data processing materials etc.)
• Gather financial information from other sources (i.e., interviews of business associates, firm employees, and competitors)
• Obtain evidence through interviews and interrogations with various stakeholders
• Prepare audit reports and criminal reference reports
• Assemble, correlate, and analyze facts obtained and prepare necessary visuals (i.e., charts, schedules) for reports
• Help conduct conferences/interviews with stakeholders (i.e., financial institution reps., law enforcement, CPAs, etc.)
• Initiate contacts with federal, state, and local officials, organizations, and individuals related to investigations
• Gather facts, obtain statements and explanations, and learn sequences of events
• Advance investigative objectives through proactive engagement with relevant officials and organizations
• Examine records (i.e., books, ledgers, payroll, cost reports, billing statements, invoices, correspondence, computer data)
• Establish and verify relationships among facts and evidence to build a strong case
• Use laboratories and other forensic services to analyze physical evidence (i.e., handwriting, fingerprints)
• Manage the storage and organization of voluminous documentary evidence securely
• Conduct in-person or telephonic interviews of witnesses and coordinate legal actions (i.e., serving warrants, subpoenas)
• Type hand-scribed notes from interview discussions
• Coordinate with law enforcement agencies to survey suspects
• Prepare comprehensive reports on investigation progress
• Prepare interim/final reports on the progress of investigations (i.e., findings, conclusions, assessments, witnesses, etc.)
• Compile evidence and create materials for trial and court presentations
• Advise AUSAs on witness selection and ensure their presence in court
• Testify in court regarding investigations if required

KNOWLEDGE & SKILLS

• Knowledge of legal and law enforcement terms and procedures
• Knowledge of investigative techniques
• Proficient in database programs (i.e., Lexis/Nexis, Accurint, AutotrackXP, Westlaw, Credit Bureau Reports, and PACER)
• Excellent written and oral communication skills
• Knowledge of medical billing policies and procedures (preferred)

BACKGROUND

• 10 years of federal law enforcement experience
• 5 years of federal healthcare fraud investigative experience
• 5 years of forensic accounting experience

EDUCATION

• Bachelor’s degree required

LOCATION

• U.S. Attorney’s Headquarters Office, Criminal Division — 717 W. Broadway, Louisville, KY 40202

TELEWORK

• N/A

CLEARANCE

• U.S. citizenship is required since this role supports the U.S. federal government
• Valid Kentucky driver’s license

CLIENT

• Department of Justice (DOJ)

TRAVEL

• Travel within the district is required on frequent basis

WORK HOURS

• 40 hours per week
• 8 hours per day

EMPLOYMENT CLASSIFICATION

• Employment Classification Eligibility — Exempt

RELOCATION

• Not eligible for relocation benefits

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KMRG, LLC is an Equal Opportunity/Affirmative Action (EEO/AA) employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex, gender identity, sexual orientation, ancestry, national origin, age, marital or civil partnership status, mental disability, physical disability, medical condition, pregnancy, maternity status, political affiliation, military or veteran status, genetic information, traits historically associated with race, or any other basis prohibited by federal, state, and/or local law.

Other Considerations. Applicants will be subject to a background investigation. Individual’s primary workstation is located in an office area. The noise level in this environment is low to moderate. Regularly required to sit for extended periods up to 100% of the time; frequently required to move about to access file cabinets and use office equipment such as PC, copier, fax, telephone, cell phone, etc. Occasionally required to reach overhead, bend, and lift objects of up to 10 lbs. Specific vision abilities required by this job include the use of computer monitor screens up to 100% of the time.