Healthcare Fraud Investigator

Job Description: We are seeking a highly skilled and motivated Healthcare Fraud (HCF) Investigator to join our team. The HCF Investigator will play a critical role in conducting thorough investigations of potential healthcare fraud violations, supporting legal proceedings, and collaborating with various federal and state agencies.

Key Responsibilities:

• Investigative Analysis: Analyze cases and legal issues assigned by Assistant United States Attorneys (AUSAs) to identify potential HCF violations and develop investigative plans. Working with the assigned AUSAs and/or supervisory attorneys, determines applicable criminal law, and identifies possible violations or causes of action.
• Requirement Gathering: Collaborate with stakeholders to gather, document, and analyze business requirements related to HCF investigations. Develops an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigations. Determines proof required to assist in affixing legal responsibility for litigation, and devises methods for obtaining, preserving, and presenting evidence to greatest effect.
• Solution Recommendation: Recommend alternative solutions to management to address identified healthcare fraud violations and meet organizational goals. 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, or other aspects of case.
• Financial Investigation and Audit Analysis: Assists AUSAs with audit and financial investigations, typically involving one or more violators who are highly successful, professional, or recognized community business leaders; or financial entities having substantial business operations outside the immediate locality with a large number of activities, operations, and transactions whose interrelationships are difficult to establish. Effects financial accounting examination of the books, records, computer tapes, data processing material, and activities of persons subject to investigation, including contractors. In the absence of records, obtains detailed financial information from other sources to include interviews of business associates, firm employees, and competitors. Reconstructing partial or inadequate records is to the extent necessary for the purpose of investigation. Obtains evidence through the interrogation of a large number of employees, business people, and other persons throughout the area who have knowledge of the operations. Prepares concise and accurate audit reports, including criminal reference reports involving assembling, correlating, and analyzing the facts obtained and prepares detailed charts and schedules as necessary.
• System Evaluation: Evaluate existing investigative systems to assess effectiveness and propose new systems to improve workflow and productivity. Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statements, and otherwise build proof necessary for successful litigation.
• Collaboration: Work closely with senior managers and personnel from various agencies to analyze operational procedures and address investigative challenges. Conducts in-person and/or telephonic interviews of witnesses. Identifies the need for service of warrants and subpoenas and secures participation of appropriate law enforcement agents in executions of same. Types hand scribed notes from interview discussions
• Analytical Techniques: Utilize various analytical techniques, including data analysis, decision analysis, and simulation, to assess requirements, procedures, and problems. Coordinates surveillance of suspects with appropriate law enforcement/investigative agencies. Occasional surveillance activities personally performed occur in locations that are open and accessible to the public where there is little or no risk of physical harm to incumbent or others.
• Documentation Management: Maintain accurate documentation of investigative processes, findings, and recommendations. Assists in compilation of documents and physical evidence, and creation of charts, graphs, videotapes, and other audio-visual materials for use by AUSAs in motions and at trial. Provides advice to AUSAs on selection of witnesses and ensures their attendance through subpoena or otherwise. Testifies in court regarding investigations, as required.
• Process Improvement: Identify opportunities for process improvement, system enhancement, and overall efficiency in healthcare fraud investigations.

Qualifications:

• Bachelor’s degree in criminal justice, Law, or related field.
• Minimum of 10 years of federal law enforcement experience.
• Minimum of 5 years of federal healthcare fraud investigative experience.
• Minimum of 5 years of forensic accounting experience.
• Strong analytical and problem-solving skills, with the ability to translate legal requirements into investigative actions.
• Knowledge of investigative methodologies and best practices.
• Experience in requirements gathering, process modeling, and workflow analysis.
• Proficiency in data analysis tools and techniques.
• Excellent communication and interpersonal skills, with the ability to collaborate effectively with diverse stakeholders.
• Familiarity with HCF enforcement systems or related domains is a plus.
• Relevant certifications (e.g., Certified Fraud Examiner, Certified Anti-Money Laundering Specialist) are desirable but not required.
• Must have a valid Kentucky driver’s license and dependable vehicle.
• U.S. Citizenship.

Application Process: To apply for the Healthcare Fraud Investigator position, please submit a resume, cover letter, and list of three professional references.

Location: Louisville, Kentucky