Departmental Analyst 9-P11 - Healthcare Fraud Investigator (Multiple Counties) - MDHHS OIG

State of Michigan; Michigan; Hybrid; USD 45,000 - 70,000; Full time

Job summary

An established industry player is seeking a Healthcare Fraud Investigator to join their team. In this role, you will be responsible for investigating allegations of fraud, waste, and abuse in health services programs. Your expertise will help ensure the integrity of Michigan's Medicaid and other health services programs. This position offers the opportunity to work in a dynamic environment where your contributions will directly impact the community's health and safety. If you are passionate about making a difference and have a keen eye for detail, this role is perfect for you.

Benefits

State-provided computer

Remote work options

Flexible work schedule

Professional development opportunities

Qualifications

• Bachelor's degree in any major; preferred in Accounting, Criminal Justice, or medical field.
• Experience in fraud investigation or health services programs is beneficial.

Responsibilities

• Investigate allegations of health services fraud and abuse.
• Prepare cases and provide testimony for administrative hearings.
• Develop techniques for detecting fraudulent billing practices.

Skills

Investigation Skills

Analytical Skills

Communication Skills

Knowledge of Health Services Programs

Education

Bachelor's Degree

Juris Doctorate

Job description

The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. For more information, please visit ourMDHHS Diversity, Equity, and Inclusion Plan.

OFFICE OF INSPECTOR GENERAL (OIG) - CAREER BROCHURE

This posting will be used to fill multiple vacancies located throughout the state, excluding the Metro Detroit Region (Macomb, Oakland and Wayne).

As a Healthcare Fraud Investigator of the Office of Inspector General, this position investigates allegations of health services fraud, waste, and abuse for referral for administrative action and prosecution. This position assists in the overall planning, development, and direction of fieldwork, including fraud prevention and investigation involving programs administered by the Department of Health and Human Services (DHHS) for referral for criminal prosecution and/or civil recovery and repayment actions.

This position has the responsibility for complex investigations into allegations of fraud, waste and abuse involving Michigan's Health Services Programs, including Michigan's Medicaid Program, Mental Health Program, MIChild Program and Children's Special Health Care Services Program.

These investigations may result in referral to law enforcement agencies (e.g., Attorney General Health Care Fraud Division) for criminal prosecution.

The powers and duties of the Office of Inspector General include, but are not limited to, the following:

• Solicit, receive, and investigate complaints related to fraud, waste, and abuse in health services programs.
• Undertake and be responsible for MDHHS' duties under federal law with respect to fraud, waste, and abuse for the administration of the health services programs in Michigan.
• Actively seek out fraudulent billing practices of providers and develop techniques and procedures for detecting suspect billing patterns through the use of existing database resources managed by MDHHS and available from federal sources.
• Pursuant to Section 8 of The Social Welfare Act, 1939 PA 280, MCL 400.8, subpoena and enforce the attendance of witnesses, administer oaths or affirmations, examine witnesses under oath, and take testimony as the Inspector General deems relevant or material to an investigation, examination, or review undertaken by the Office.
• Require and compel the production of such books, papers, records, and documents as the Inspector General deems to be relevant or material to an investigation, examination, or review undertaken by the Office.
• Examine and copy or remove documents or records of any kind related to health services programs or necessary for the Office to perform its duties and responsibilities that are prepared, maintained, or held by, or available to, any state agency or local unit of government entity or contractor to a state agency or local unit of government.
• Pursue administrative and civil enforcement actions or collections against any individual or entity that engages in fraud, abuse, or illegal or improper acts or unacceptable practices perpetrated within health services programs, including but not limited to:
  • Referring information and evidence to regulatory agencies and licensure boards.
  • Excluding providers, vendors, and contractors from participation in the Medicaid program.
  • Imposing administrative sanctions and penalties in accordance with state and federal laws and regulations.
  • Pursuing any other formal or informal enforcement action relating to fraud, waste, and abuse that MDHHS is authorized to take under state or federal law, including, but not limited to, any actions under Sections 111 a to 111 h of The Social Welfare Act, 1939 PA 280, MCL 400.111 a to 400.111 h, or 1979 AC, R 400.3401 to 400.3425.
• Promptly provide information and evidence relating to suspected criminal acts to the Medicaid Fraud Control Unit of the Department of Attorney General, or any successor entity, to the extent required by federal law.
• Prepare cases, provide testimony, and support administrative hearings and other legal proceedings.

Position Description
Job Specification

To be considered for this position you must:

• apply for this position online via NEOGOV; click on "Apply" in the job posting for instructions on submitting your electronic application. Hard copy applications are not accepted.
• document relevant experience and/or education referred to in the supplemental questions in your cover letter, resume, transcript and/or application to allow for accurate screening.
• attach a one-pageresume identifying specific experience and dates of employment. Dates of employment should include month and year and hours per week.
• attach a one-page cover letter.
• If applicable, attach a copy of an official transcript(s). We accept scanned copies of official transcripts. We do not accept web-based, internet, or copies of unofficial transcripts. Official transcripts provide the name of the institution, confirmation that a degree was awarded and on what date, and the registrar's signature. Please review Civil Service's guidelines regarding Official Transcripts: Official Transcripts (michigan.gov)
• attach a writing sample (not to exceed two pages) that you have authored.

Failure to complete any of the above may result in your application being screened out as incomplete. See instructions for attaching files here: Instructions

Education
Possession of a bachelor’s degree in any major.

Bachelor's degree in Accounting, Criminal Justice, or a skilled medical related field, or a Juris Doctorate from an ABA accredited law school is preferred.

Experience

Departmental Analyst 9 - No specific type or amount is required.

Departmental Analyst 10 - One year of professional experience.

Departmental Analyst P11 - Two years of professional experience, including one year of experience equivalent to the intermediate (10) level in state service.

Departmental Analyst 9 - 12
Educational level typically acquired through completion of high school and the equivalent of at least two years of full-time active-duty experience at or above the E-6 level in the uniformed services may be substituted for the education requirement.The use of artificial intelligence (AI) software of any kind is prohibited in all areas of the selection process; including, but not limited to, responses to application questions, and responses to interview questions or exercises.

If you previously held status in this classification and departed within the last three (3) years, please contact Human Resources regarding your interest in a potential reinstatement. Reinstatement is not guaranteed or required.

Your application for any position does not guarantee you will be contacted by the Department/Agency for further consideration. Only those applicants interviewed will be notified of the results.

Position Location/Remote Office: The office location for this position will be at an MDHHS facility located near the selected incumbent's county of residence. Based on operational needs and within established limits, remote work and alternate or hybrid work schedule requests for this position may be considered.

Selected candidates who have been approved to work remotely or a hybrid schedule must complete that work within Michigan. Candidates should confirm work location and schedule at the time of interview.

Employees will be provided computers to perform state work. Phones may also be provided for necessary communications. If working remotely, employees will be responsible for providing other components of a remote office at their own expense, including:

• A secure work location that allows privacy and prevents distractions.
• A high-speed internet connection of at least 25 Mbps download and 5 Mbps upload.
• Suitable lighting, furniture, and utilities.

As a Condition of Employment:this position requires successful completion of a background investigation and a criminal records check.Due to the nature of this position, an additional extensive background checkwill be conducted on candidates being considered for the vacancy.

The Department of Health and Human Services reserves the right to close this posting prior to its original end date once a sufficient number of applications have been received.

For information about the specific position, please [e-mail]. Please reference the job posting number in subject line.

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