Senior Civil Health Care Fraud Investigator

Title: Senior Civil Health Care Fraud Investigator

Location: Harrisburg, PA

Security Clearance: Public Trust

Schedule: Due to the nature of law enforcement work and operation, position may require occasional support outside of core working hours, as well as intermittent weekend support, mission dependent

**Contingent upon Award**

About KACE:

When you make the decision to join KACE, you are choosing to work alongside talented professionals that have one thing in common; the passion to make a difference! KACE employees bring their diverse talents and experiences to work on critical projects that help shape the nations safety, security, and quality of life. The desire to have a career that is purposeful and forward thinking is woven into every KACE employeeits The KACE Way. KACE employees are; purpose driven, forward focused, open-minded, trustworthy, and invested. The KACE Way is our commitment to our employees, to our customers, and to our communities. Join KACE and make a difference!

Job Summary:

The USAO regularly investigates and litigates matters involving fraud committed on public health care benefits programs including Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program. These investigations and cases often require additional investigative support, working in conjunction with the assigned federal agents, to investigate the facts and circumstances underlying the fraud, as well as litigate the cases. A Senior Civil HealthCare Fraud Investigator is necessary for the USAO to pursue these types of cases.

Essential Functions and Responsibilities:

• Supports the planning and conduction of investigations
• Assists Assistant United States Attorneys (AUSAs) in the investigation of matters in conjunction with federal agents, to determine whether there have been violations of Federal Statutes, e.g., False Claims Act, Stark Law, and Anti-Kickback Act.
• Works and regularly communicates with AUSAs to identify possible violations or causes of action, determines proof required to assist in affixing legal responsibility, and devises methods for obtaining, preserving, and presenting such evidence.
• Decides upon the most effective methods for planning, scheduling, and conducting investigations, and identifies required resources. Recommends methods for conducting investigations, including interviews, subpoenas, and depositions. Secures participation of appropriate law enforcement agents in execution of these investigative methods.
• Identifies and presents AUSAs with potential investigations through review of the news, databases, and regular communications with representatives of Government agencies and private industry.
• Contact federal, state, and local officials, as well as business representatives, to gather information, documents, and statements on current or potential investigations, as well as coordinate investigative activities.
• Assists AUSAs with the identification, locating, and interviewing of witnesses. Conduct surveillance of suspects with appropriate law enforcement agencies. Communicates with counsel of subjects and witnesses.
• Prepare appropriate memos and reports on contacts, interviews, and surveillance.
• Examines, analyzes, presents, and secures evidence such as documents, emails, policies, text messages, payrolls, financial statements, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation.
• Research and reviews laws, rules, regulations, and policies to determine whether health care billings were improper. Identifies and interviews any relevant Governmental or business representative pertaining to the propriety of the billings.
• Traces funds derived from fraud and identifies assets of subjects.
• Confirms authenticity of documents, corroborates witness statements, and otherwise builds proof necessary for successful litigation.
• Arranges for the integrity of evidence through secure storage, preservation, organization, and indexing of voluminous physical and electronic evidence.
• Regularly updates AUSAs on status of case. 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, and other aspects of case.
• Assists AUSAs with preparation for litigation and trial.
• Provides analytical advice and assistance with compiling documents and physical evidence, and creating charts, graphs, videotapes, and other audio-visual materials for use by AUSAs in motions and at trial.
• Provides advice to AUSA on selection of witnesses and ensures their attendance through subpoena or otherwise.
• Other related duties as assigned and within scope.

Minimum Qualifications & Skills:

• Bachelors degree in law enforcement, criminal justice, accounting, finance, or related field.
• Minimum ten (10) years of experience in any combination of law enforcement, criminal justice experience, and health care fraud investigation.
• Experience testifying in court matters
• Proficient in Microsoft Office software programs (i.e., Word, Excel, Outlook, etc.)
• U.S. Citizenship and ability to obtain adjudication for the requisite background investigation
• Experience and expertise in performing the requisite services in Section 3

Preferred:

• CPA Certification
• Experience working with a federal or state law enforcement entity

Clearance:

Applicants selected may be subject to a government background investigation and may be required to meet the following conditions of employment.

Security Requirements/Background Investigation Requirements:

• Must be a U.S Citizen.
• Favorable credit check for all cleared positions
• Successfully passing a background investigation including drug screening.
• Residency requirement - 3 consecutive years in the last 5 years.

Physical Requirements/Working Conditions:

Ability to alternate between sitting and standing as needed.
Ability to walk and move about to attend meetings and access file storage areas.
Climbing/stooping/kneeling up to 10% of the time.
Lifting/pulling/pushing up to 10% of the time; occasional lifting of boxes/files up to 25 lbs.
Prolonged periods of computer and document review.

This job description reflects managements assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned. Management may revise duties as necessary without updating this job description.

For more information about the company please visit our website at www.kacecompany.com
KACE is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, disability or any other federal, state or local protected class.
KACE complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities.
If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to recruiting@kacecompany.com .