Healthcare Fraud Investigator
2 weeks ago
Wits Solutions Inc. (WITS) is a SBA certified 8(a) company with headquarters in the metropolitan Washington D.C. area. WITS has been providing best-in-class solutions in professional IT and administrative consulting to various Federal, State, Local and commercial customers. At WITS, we believe in working not for our clients but with them. This is why right from the beginning; our analysts and solution-builders work closely with our clients to ensure that the project outcomes continue to deliver value long into the future.
Job Description:
Work Experience Mandatory:
- At least ten years of federal law enforcement experience.
- At least five years of federal health care fraud investigative experience in a similar position.
- At least five years of forensic accounting experience.
Education/ Certification Mandatory:
- Bachelor's Degree or higher.
- Must have valid Kentucky driver's license and dependable vehicle.
- U.S. Citizenship.
Education/Certifications nice to have:
Certified Fraud Examiner, Financial Crime Certification, or Certified Health Care Fraud Investigator credentials are preferred.
References/Certificates/Diplomas Required:
- 3 professional references
Security Clearance:
- Eligible for Clearance
Roles and Responsibilities:
- Assists AUSAs in developing an investigative plan in all cases and matters assigned and ensure that investigative goals are clearly stated and met.
- Working with the assigned AUSAs and/or supervisory attorneys, determines applicable criminal law, and identifies possible violations or causes of action.
- Develops an understanding of all applicable federal, state, or local laws to the extent necessary to make sound decisions on direction and scope of investigations. Determines proof required to assist in affixing legal responsibility for litigation, and devises methods for obtaining, preserving, and presenting evidence to greatest effect.
- Assists AUSAs in deciding the most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required.
- Assists AUSAs with audit and financial investigations, typically involving one or more violators who are highly successful, professional, or recognized community business leaders; or financial entities having substantial business operations outside the immediate locality with a large number of activities, operations, and transactions whose interrelationships are difficult to establish;
- Effects financial accounting examination of the books, records, computer tapes, data processing material, and activities of persons subject to investigation, including contractors. In the absence of records, obtains detailed financial information from other sources to include interview of business associates, firm employees, and competitors. Reconstructs partial or inadequate records are to the extent necessary for the purpose of investigation.
- Obtains evidence through the interrogation of a large number of employees, business people, and other persons throughout the area who have knowledge of the operations.
- Prepares concise and accurate audit reports, including criminal reference reports involving assembling, correlating, and analyzing the facts obtained and prepares detailed charts and schedules as necessary.
- Assists AUSAs with conducting conferences and interviews with members, officers, directors, and representatives of financial institutions, law enforcement agents of the state and city governments and other branches of the Federal government, Certified Public Accountants, and attorneys
- Performs a variety of ancillary investigation-related services in direct support of litigation. Support activities include one or more of the following:
- Initiates contacts with federal, state, and local officials, and other organizations and individuals related to the subject of investigation, for the purpose of gathering facts, obtaining statements, learning sequences of events, obtaining explanations and otherwise advancing investigative objectives. Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statements, and otherwise build proof necessary for successful litigation.
- Utilizes laboratories and other forensic services to identify handwriting, fingerprints, questioned documents and substances, sound and video recordings, and other physical evidence. Arranges for secure storage, preservation, organization, and indexing of voluminous documentary evidence.
- Conducts in-person and/or telephonic interviews of witnesses. Identifies the need for service of warrants and subpoenas, and secures participation of appropriate law enforcement agents in executions of same. Types hand scribed notes from interview discussions.
- Coordinates surveillance of suspects with appropriate law enforcement/investigative agencies. Occasional surveillance activities personally performed occur in locations that are open and accessible to the public where there is little or no risk of physical harm to incumbent or others. The incumbent does not have arrest authority nor is authorized the use of deadly force. "Undercover" work characteristically does not involve physical interaction with the subject or target of a criminal investigation.
- 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, or other aspects of case.
- Assists in compilation of documents and physical evidence, and creation of charts, graphs, videotapes, and other audio-visual materials for use by AUSAs in motions and at trial. Provides advice to AUSAs on selection of witnesses and ensures their attendance through subpoena or otherwise. Testifies in court regarding investigations, as required.
- Performs other related duties as assigned
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