Fraud Investigator – Federal Court Expert Witness, Medicare, Medicaid

🔥 12 minutes ago

🇺🇸 United States – Remote

💵 $86k - $138k / year

⏰ Full Time

🟠 Senior

🔴 Lead

🚨 AML and Financial Crime

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Peraton

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

Peraton is a mission-focused enterprise that supports national security initiatives through advanced IT and cyber services. They provide capabilities in areas such as cyber defense, cloud operations, engineering, and intelligence. With a commitment to solving complex challenges, Peraton integrates data-driven technologies to ensure mission success for their military and government clients.

📋 Description

• Support prosecution of cases within the SE UPIC • Act as liaison between the SE UPIC, HHS OIG, State Medicaid Agencies (SMA), and the Department of Justice (DOJ) • Understand and develop expertise in Medicare and Medicaid policies to prepare cases for prosecution • Assist investigators with case development • Respond to requests from USAO and DOJ • Travel extensively within the USA • Monitor timeliness of case updates and escalate to management as necessary • Monitor investigation and case progress to ensure use of available remedies, including suspension, pre-pay reviews, and revocation • Mentor team members in identifying previously undetected fraud, waste, or abuse through research, analysis, and development • Conduct training on case development for prosecution, including best practices and lessons learned • Attend regional meetings with HHS OIG, FBI, SMA, and other Federal/State agencies • Coordinate coverage with designated leads when necessary

🎯 Requirements

• Minimum of 8 years with BS/BA; minimum of 6 years with MS/MA; minimum of 3 years with PhD • Healthcare investigative experience required • Previous experience testifying in Federal Court in related healthcare prosecutions • Strong communication and organization skills • Strong PC knowledge and skills • Ability to travel within the US as needed • Applicant must be a U.S. citizen • Knowledge of Medicare and Medicaid requirements, laws, rules and regulations related to payment for services billed the Program • Experience in reviewing claims, performing medical reviews, and/or developing fraud cases • Documented experience working in a law enforcement environment specific to the Medicare and Medicaid Programs • Documented experience in preparing and testifying for cases associated with Medicare and Medicaid rules, policies, and program requirements • Ability to perform research and draw conclusions • Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government • Ability to organize a case file and accurately and thoroughly document all steps taken • Ability to compose correspondence, reports and referral summary letters • Ability to educate providers, provider associations, law enforcement, other contractors and beneficiary advocacy groups on program safeguard matters • Ability to communicate effectively, internally and externally • Ability to interpret laws and regulations • Ability to handle confidential material • Ability to report work activity on a timely basis • Ability to work independently and as a member of a team • Ability to attend meetings, training, and conferences; overnight travel required • Document QC results in WMM according to record type • Master’s Degree preferred • CFE or AHFI certification preferred

🏖️ Benefits

• Medical insurance • Dental insurance • Vision insurance • Life insurance • Health savings account • Short-term disability • Long-term disability • Employee assistance program (EAP) • Parental leave • 401(k) • Paid time off (PTO) for vacation • Company paid holidays • Potential overtime • Shift differential • Discretionary bonus

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