Criminal Investigator - Medicaid Fraud

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 position filled through this announcement will serve in the Investigations section of our Medicaid Fraud Division.

Duties & Responsibilities

Investigators conduct health care fraud investigations. Assist criminal justice personnel, including, but not limited to, Analysts, Auditors, and Prosecutors in conducting on-site health care fraud and patient abuse investigations.

Develop necessary knowledge and skills for using computer software programs in unit investigations. Maintain and apply professional knowledge of current trends and developments related to work unit assignments. Positions require current proof of 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 and planning 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.
• Will be issued a firearm 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, healthcare 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 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…