Agent - Medicaid Fraud Control

Job Posting Title

Agent - Medicaid Fraud Control

049 ATTORNEY GENERAL

Office of Attorney General

Refer to the date listed at the top of this posting, if available. Continuous if date is blank.

Note:

Applications will be accepted until 11:59 PM on the day prior to the posting end date above.

Full time

Regular

Salary Range: $68,000 - $90,000, commensurate with experience and qualifications

Title:

Agent

Unit:
Medicaid Fraud Control Unit

Location of Work:
Oklahoma City, OK

FLSA Status:
Non-exempt

Schedule:

Full-time

Position

Description:

The Oklahoma Medicaid Fraud Control Unit (MFCU) is a state law enforcement division within the Oklahoma Attorney General’s Office, and its mission is to investigate and pursue enforcement actions against health care providers who have defrauded the Medicaid program or who have engaged in abuse, neglect, and/or exploitation of persons in the Medicaid system or residential health care facilities. The MFCU has both civil and criminal enforcement powers.

The successful candidate for this position will work as a member of an interdisciplinary team of investigative agents, auditors/analysts, attorneys, and administrative personnel, seeking civil remedies such as financial restitution and penalties, divestment or forfeiture, and exclusions from the Medicaid system, and/or pursuing criminal enforcement actions such as fines, incarceration, and exclusions from the Medicaid system. The successful candidate for this position should have sound judgment, strong investigative, research, and analysis skills.

The Agent serving in this position will consult with attorneys and analysts, take part in crafting and executing investigative plans, gather and review evidence, provide evidence and other information to attorneys and analysts, and testify as needed. Additionally, the position will involve taking part in investigations and enforcement actions conducted jointly with Federal counterparts at any of the three U.S. Attorney Offices located in Oklahoma.

This position may also involve assisting Medicaid Fraud Control Units in other States and Territories across the country as may be needed.

The Agent serving in this role will also assist Unit leadership in a variety of administrative and compliance areas including, but not limited to the following:

• Quality Control of MFCU Investigations
• Compliance with 42 CFR Part 1007 et seq.
• Making effective and efficient use of investigative tools and resources
• Providing training specific to the health care fraud sector
• Participating in Case Reviews and audits of MFCU case work to help determine and address areas of need for things like training or supplemental effort
• Assisting Supervisory Agents with determinations about Intake assessments and referrals
• Serving as an additional point of contact for external stakeholders such as the Health Care Fraud Task Forces, the United States Attorneys Offices, the Oklahoma Health Care Authority, the Oklahoma State Department of Health, and US Department of Health and Human Services
• Investigating MFCU cases, and partnering with other MFCU Agents in active investigations for purposes of both assessment and improvement of field work and office work
• Conducting or facilitating investigations of particularly sensitive nature, as needed
• Partnering with MFCU Section Chief in communications within Unit and external to Unit
• Assisting MFCU Section Chief and MFCU Leadership with implementation of directions for MFCU team in pursuit of the MFCU mission
• Identifying and addressing training needs
• Serve as MFCU Field Training Agent and coordinate the program
• Conduct training specific to health care fraud investigations and enforcements
• Assist MFCU in recruiting, training for, and retaining Agents possessing the Certified Fraud Examiner (CFE) designation
• Assist MFCU Leadership in discerning trends and statistics on subjects like effective Agent/Attorney combinations, success rates for MFCU Agents across particular types of investigations, and then assisting MFCU Leadership in making adjustments to personnel assignments as warranted

Agents of the Oklahoma…