Investigative Auditor

Position Summary: Under supervision from the Supervising Investigator, the Investigative Auditor works collaboratively with other Medicaid Fraud and Patient Abuse Unit staff and other state and federal agencies to investigate cases of complex white collar financial crimes and schemes committed by providers of medical services to Medicaid recipients, cases of the misuse of patient personal funds, and cases of abuse and neglect. The Investigative Auditor is responsible for conducting financial examinations and investigations associated with the administration, billing and provision of services under the RI Medicaid Program and investigations of abuse, neglect and mistreatment of residents in Medicaid funded facilities. The Investigative Auditor designs and conducts full investigative audit and analysis procedures relating to criminal and civil investigative work involving methods of fraud examination and forensic accounting and the detection and investigation of violations of the Medicaid program.  The Investigative Auditor directs and supplies facts upon criminal and civil complaints and performs financial investigations ranging from the routine to the most sensitive, complex and difficult white-collar cases.  The Investigative Auditor works independently and/or with other investigators and attorneys in the MFCU.  Preference will be given to candidates who are Certified Fraud Examiners or who possess relevant accounting and investigation experience.

Examples of Work Performed:

1. Conducts investigative audits of health care provider documents that support Medicaid claims for evidence of false claims.
2. Conducts detailed analysis of a suspect’s bank records for evidence of theft.
3. Examines pertinent books and records, accountant work papers and other related financial documents for the purpose of analyzing and documenting targeted material deviations from Medicaid policies and procedures.
4. Reviews and evaluates system of internal controls of provider, where records and information make this possible.
5. Develops complex financial calculations to determine the impact of potentially fraudulent activity.
6. Conducts interviews of criminal suspects, provider personnel and others, to obtain preliminary and corroborative evidence.
7. Prepares a final written report of investigation activities, and detailed reports of investigations setting forth allegations and evidence.

Position Requirements: The knowledge, skills and abilities usually acquired through a combination of education and experience equivalent to a bachelor’s degree in accounting, finance, or business and a minimum of one year of experience in white collar investigations or fraud examination in health insurance fields is desired.  Substantial experience may be substituted for a college degree.  Must be proficient in Microsoft Office, including Word, Excel, Adobe and Power Point. Must also have familiarity with or knowledge of cloud-based case management software, database programs, presentation software, network applications, cost accounting and financial analysis software.

RHODE ISLAND OFFICE OF THE ATTORNEY GENERAL
INVESTIGATIVE AUDITOR
CRIMINAL DIVISION/MEDICAID FRAUD CONTROL UNIT
PAYGRADE 8726 ($68,709 – $77,573) 
November 18, 2024 – December 9, 2024
 
The Attorney General is seeking a highly motivated investigator to join his Medicaid Fraud Control and Patient Abuse Unit (MFCU) to investigate complex criminal and civil enforcement actions related to allegations of fraud against the state Medicaid program and allegations of abuse and neglect of residents of long-term care facilities.  
 
About the Office of the Attorney General: The Attorney General is the state’s top lawyer and law enforcement official, protecting and serving the people and interests of Rhode Island through a broad range of duties. Every day, the Office’s attorneys fight to ensure the public safety of the state’s communities, improve the economic security of its citizens, safeguard the state’s spectacular natural resources, and restore the public’s trust in government. Assistant and Special Assistant Attorneys General represent the people of Rhode Island in civil and criminal matters before trial courts, appellate courts, and the supreme courts of Rhode Island and the United States. The Office is unique among attorneys general offices across the country. Out of fifty states, only two other offices share the same broad criminal mission. The Office’s attorneys prosecute complex and violent crimes but also functionally serve as one of the nation’s largest district attorney’s offices, prosecuting all felonies throughout the state.
 
About the Unit: The mission of the Medicaid Fraud Control Unit (MFCU) for the State of Rhode Island is to investigate and prosecute fraud in the administration of the Medicaid program in Rhode Island, in the provision of medical assistance, or in the activities of providers of medical assistance pursuant to the Medicaid Program.  Further, the MFCU seeks to protect residents or patients in health care facilities by investigating and prosecuting allegations of abuse and neglect.   The MFCU is responsible for investigating and prosecuting (a) fraud by healthcare providers in the Rhode Island Medicaid program; (b) fraud in the administration of the Rhode Island Medicaid program; (c) the abuse, neglect, mistreatment of individuals who live in Rhode Island’s skilled nursing facilities and board and care facilities; and (d) to investigate and prosecute cases of abuse, neglect or mistreatment in “noninstitutional” settings where the abuse, neglect or mistreatment involves a Medicaid recipient.  The MFCU also works on cases arising under the Rhode Island False Claims Act involving Medicaid Fraud.  

If applying for the position via mail or email, there is no need to also apply through the online system.
 
Application Process: Applicants should submit a (1) cover letter summarizing why you are interested and describing the skills and abilities you possess that will enable you to succeed in this position, (2) resume, and (3) a list of three references:
 
Aida Crosson
Director of Administration
Office of the Attorney General
150 South Main Street Providence, RI 02903
acrosson@riag.ri.gov
 
Equal Opportunity Employer:  The Attorney General’s Office is stronger, more credible, and more capable when its employees bring diverse backgrounds, cultures, and perspectives to their work. The Office encourages all qualified applicants from all ethnic and racial backgrounds, veterans, LGBTQ individuals, and persons with disabilities to apply.
 
All qualified applicants will receive consideration without regard to race, color, sex, religion, sexual orientation, gender identity or expression, age, national origin, disability, or covered veteran status.
 
Other Information: Finalists will be subject to a full background investigation including reference checks.  All offers of employment are contingent upon successful completion of the background investigation.