Healthcare Fraud Investigator Job at Ardelle Associates, Nashville, TN

SUI1UTV2QUR5d1FlZElzWEF0VTBVd1UxK3c9PQ==
  • Ardelle Associates
  • Nashville, TN

Job Description

Ardelle Associates is seeking Healthcare Fraud Investigator to support the United States Attorney’s Office, in Nashville, TN. The investigator will provide investigator services to the USAO Assistant (AUSA) in connection with healthcare fraud matters, with particular emphasis on civil healthcare investigations and litigation pursued under the False Claims Act. These services will include, without limitation:

Duties

  • Performs a variety of ancillary investigation-related services in direct support of litigation. Support activities include one or more of the following:
  • Working with the assigned Assistant United States Attorney and/or supervisory attorneys, determines applicable administrative statutory and regulatory law, and identifies possible violations or causes.
  • 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 effects.
  • Decides upon most efficacious methods for planning, scheduling, and conducting investigations, and identifies any resources that may be required.
  • Refers evidence of criminal activities to appropriate criminal investigators or sworn law enforcement office.
  • 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.
  • Arranges for secure storage, preservation, organization and indexing of voluminous documentary evidence, including electronic storage.
  • 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.
  • Reviews, analyzes, and summarizes documents.
  • Plans and 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 AUSA on selection of witnesses and ensures their attendance through subpoena or otherwise. Testifies in court regarding investigations, as required.
  • Develops and analyzes evidence that comes from other investigators, analysis and law enforcement officers, and collects information relating to this evidence or legal matters under consideration from appropriate primary and secondary sources. Analysis is for the purposes of clarifying the target or organizations' pattern of operations, to identify information relevant to the legal issues involved and to recommend valuable approaches to the AUSA or other members of the investigative team. Analysis is also for the purpose of developing and refining proof required to assist in determining legal responsibility for violation(s), and for devising methods for effectively obtaining, preserving, and presenting evidence.
  • Gathers and analyzes facts including statements, timelines, scientific or technical data, for the purpose of advancing prosecutorial objectives. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statement, and otherwise build proof necessary for successful litigation.
  • Provides specialized investigative analysis relevant to HCF matters. Identifies sources of information and multiple variables. Prepares interim and final comprehensive reports on progress of investigations for use by AUSAs, supervisory AUSAs and the investigative team. 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 the case.

Experience & Education

  • 4 year undergraduate degree or higher in criminal justice, finance, project management or other related field.
  • 3 years of healthcare fraud investigation Experience or other related investigative field of work
  • Familiarity with medical, pharmacies or healthcare experience
  • Thorough knowledge of Medicare reimbursement program, CPT Codes, and common healthcare fraud schemes.
  • Experience drafting legal processes for obtaining information relevant to ongoing investigations, such as subpoenas, affidavits in support of search warrants, or written discovery requests.
  • Must have a valid drivers license and dependable vehicle
  • Experience with MS office products

Must be a US Citizen

Federal background check required before start date.

Job Types: Full-time, Contract

Pay: $33.65-$38.62 per hour

Benefits:

  • 401(k)
  • Dental insurance
  • Health insurance
  • Paid time off
  • Vision insurance

Schedule:

  • 8 hour shift
  • Monday to Friday

Ardelle Associates, a veteran-owned company providing Consulting and Support Services to government agencies and contractors. This position offers an opportunity to work in a dynamic environment that values quality service and professionalism. Join us in delivering exceptional legal support services while upholding our commitment to excellence.

Job Tags

Hourly pay, Full time, Contract work, For contractors, Interim role, Local area, Shift work, Monday to Friday,

Similar Jobs

Northrop Grumman

Staff Agile Coach - 12387-1 Job at Northrop Grumman

 ...we have the right opportunities to fit your life and launch your career today.Northrop Grumman Defense Systems is seeking Staff Agile Coach - 12387-1. This position will be located in Huntsville, Alabama, Bellevue, NE, Roy, Utah or Colorado Springs, CO and will support... 

Perfect Placement Group, LLC

Non-CDL Delivery Driver Job at Perfect Placement Group, LLC

 ...Position Title: Non CDL TransferDriver Location:10 Kenwood Circle| Franklin,MA02038 Department:Logistics Pay Rate Range:$2...  ...individual who takes pride in ensuring the safe and efficient delivery of our high-quality auto parts to our valued customers. As... 

Advantage Home Care

Personal care aide/Caregiver/ Home Health aide Job at Advantage Home Care

 ...an email will be sent with official application! Please follow the link to fill out the official application!* We are hiring aides in Champaign, Farmer City, and Monticello, Illinois. Offering Daily Pay! Benefits: Competitive Pay Weekly paychecks... 

Series Next Solutions

Accounting Project Specialist Job at Series Next Solutions

 ...accounting function for $2mm-$10mm revenue companies.Our fractional CFOs lead our client relationships, but they rely heavily on our internal accounting and analysis teams to build tools and processes that make our relationships run. What is SNS looking for? Heres... 

SGI Logistics

ROUTE Box Truck Owner/Operator Job at SGI Logistics

 ...Cities: Dothan, AL Niceville, FL Destin, FL Fort Walton, FL About Us Welcome to SGI Logistics! Locally owned and operating right here in Alabama! We are a trusted logistics partner offering a comprehensive range of services including efficient courier...