Investigator - Medicaid Fraud - Civil

The Office of the Attorney General

Department of Law

Medicaid Fraud Division - Civil Investigations

The mission of the Department of Law is to serve the citizens of the State of Georgia by providing legal representation of the highest quality to the agencies, officers and employees of state government and by honorably and vigorously carrying out the constitutional and statutory responsibilities of the Attorney General.  The Department of Law is organized into the Executive Office, five legal divisions, four specialty units and an operations division.  The position filled through this announcement will serve in the Investigations section of our Medicaid Fraud Division.

Duties & Responsibilities:

Investigators conduct health care fraud investigations. Assists criminal justice personnel, including, but not limited to, Analysts, Auditors, and Prosecutors in conducting on-site health care fraud and patient abuse investigations.  May be issued a firearm and/or less lethal equipment. *

Develops necessary knowledge and skills for using computer software programs in unit investigations.  Maintains and applies professional knowledge of current trends and developments related to work unit assignments.  Positions are typically non-POST and do not require POST Certification.

Responds to assignments and requests for assistance in health care fraud and patient abuse investigations in a timely manner.

·        Responds to assignments and requests for assistance by reviewing documentation, conducting interviews, and gathering intelligence information for health care fraud investigations and patient abuse investigations.

·        Participates in the planning and gathering of information for investigations involving health care fraud and patient abuse investigations.

·        Assists in executing on-site search warrants to obtain evidence of health care fraud and patient abuse. Assists in the identification and seizure of health care fraud evidence during the execution of on-site search warrants.

·        May be issued firearms and/or less lethal equipment (e.g.  pepper spray). *

·        Assists in preparing charts, schedules, and presentations for the prosecution of health care fraud cases.

·        Follows appropriate laws, guidelines, and policies in maintaining the chain of custody for evidence.

·        Collects, reviews, and evaluates the necessary documents to identify and investigate health care fraud and patient abuse, including medical records, health care providers' billing records, and records.

·        Assists in developing databases to analyze appropriate medical data. Enters data into databases and analyzes the data for evidence.

·        Assists in conducting source and expenditure analyses and cash flow analyses of suspects in health care fraud investigations and patient abuse investigations.

·        Assists in searching public records, governmental databases, and commercial databases for evidence of health care fraud and patient abuse allegations.

·        Assists the appropriate parties in identifying potential assets subject to seizure due to health care provider fraud.

·        Assists the appropriate parties in organizing, analyzing, and processing items of evidence and other documentation for investigation and prosecutorial purposes in health care fraud and patient abuse investigations.

Utilizes computers and the appropriate software to conduct health care fraud and patient abuse investigations.

·        Demonstrates a basic knowledge of computer software in creating databases, spreadsheets, graphs, and presentations.

·        Demonstrates the appropriate computer skills to conduct health care fraud investigations.

Prepares appropriate reports in a timely, thorough, and accurate manner.

·        Prepares thorough and accurate reports documenting interviews of witnesses and suspects in a timely manner.

·        Prepares thorough and accurate reports documenting the execution of search warrants and the seizure of evidence in a timely manner.

·        Prepares thorough and accurate reports documenting the analyses of financial databases and conclusions of the analyses in a timely manner.

·        Prepares thorough and accurate reports documenting public record and database searches and conclusions from the searches in a timely manner.

·        Prepares thorough and accurate case reports for all investigative activities in a timely manner.

·        Distributes copies of reports to the appropriate parties in a timely manner.

Presents courtroom testimony utilizing proper courtroom demeanor and assists prosecutors in coordinating pre-trial activities.

·        Provides accurate testimony concerning health care fraud investigations and patient abuse investigations.

·        Demonstrates knowledge of court system operations and methods of presenting testimony.

·        Coordinates and prepares courtroom testimony with the appropriate prosecuting attorney.

·        Demonstrates skills to be a witness and/or evidence coordinator on behalf of the prosecuting attorneys to ensure that all evidence and witnesses are available for presentation.

Maintains supplies, reports, equipment, and relationships with other agencies according to established Unit requirements.

·        Maintains assigned equipment based on Department policy and standards. Completes applicable reports in a timely manner.

·        Demonstrates skills that allow the development of relationships and liaisons with other agencies, departments, and the public.

Maintains professional knowledge of current trends and developments in the field and applies pertinent new knowledge to the performance of other responsibilities.

·        Participates in seminars and professional meetings when available and approved in advance.

·        Maintains professional knowledge by reading up-to-date articles, books, and periodicals.

·        Applies pertinent new knowledge to the performance of assigned responsibilities.

Interacts with all levels of state and local government in a way that promotes respect, encourages cooperation, and contributes to excellent performance.

·        Treats all other state and local personnel fairly, giving preferential treatment to no one.

·        Communicates accurate information to all other state personnel in a professional and courteous manner that conveys a willingness to assist.

·        Accepts direction and feedback from supervisors and follows through appropriately.

·        Accepts responsibility for mistakes and takes action to prevent similar occurrences.

·        Uses appropriate established channels of communication.

·        Maintains relationships and liaisons with other agencies, departments, and the public according to Unit requirements.

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this title.  They may not include all job duties performed by employees on this job title, and every position does not necessarily require these duties.

Minimum Qualifications:

Twelve months of fraud investigation or related experience.

Preferred Qualifications:

Preference will be given to applicants who possess one or more items below:

·        POST-Certification

·        Completion of a Bachelor’s degree from an accredited four-year college or university with a major in Criminal Justice, Healthcare Administration, Accounting, Business and Finance.

·        Certified Fraud Examiner

·        Digital Forensics Experience

·        Law enforcement experience

·        Demonstrated analytical skills.

*Requires State training and verification of course passing.

 Additional Information

Due to the volume of applications received, we are unable to provide information on application status by phone or e-mail.  All applicants will be considered but may be screened for the preferred qualifications of the position and may not necessarily receive an interview. 

Selected candidates are subject to a State of Georgia tax records check and a criminal background investigation. Only candidates chosen for interviews will be notified due to the high volume of applications.

The State of Georgia is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.