Investigative Auditor

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 financial records for evidence of theft and tracks assets to locate and identify fraud-related assets.
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 as well as settlement positions.
6. Conducts interviews of witnesses, healthcare providers, Medicaid recipients, and state agents to develop evidence to uncover fraudulent activities.
7. Prepares a final written report of investigation activities, and detailed reports of investigations setting forth allegations and evidence.
8. Testifies in grand jury and court proceedings.

Minimum Qualifications: A minimum of a bachelor’s degree from an accredited college or university with a major in either accounting, finance, economics, computer science, applied statistics, or business is required.  Candidates may substitute full-time professional experience working in the following (or closely related) fields on a year-for-year basis for the required education: accounting, auditing, health care insurance, financial investigations, law enforcement, Medicaid or Medicare.  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.  Ability to work in person at assigned OAG work location.  

Preferred Experience: Certification as a Certified Fraud Examiner or CPA.  Knowledge of the healthcare industry, medical coding concepts, and/or experience analyzing health care claims data.  A bachelor’s degree and three years of work experience in white collar investigations, forensic accounting, or fraud examination in health insurance fields is preferred.

RHODE ISLAND OFFICE OF THE ATTORNEY GENERAL

INVESTIGATIVE AUDITOR

CRIMINAL DIVISION/MEDICAID FRAUD CONTROL UNIT

PAYGRADE 8726 ($68,709 – $77,573)

March 12, 2025 – March 28, 2025

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.

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 conduct complex criminal and civil investigations into suspected fraud committed by health care providers receiving Medicaid funds.  Investigations and audits involve sensitive matters and probe allegations of fraud in the administration, billing and provision of services under the RI Medicaid Program, the misuse of patient personal funds, and allegations of abuse, neglect and mistreatment of residents in Medicaid funded facilities.  Preference will be given to candidates who are Certified Fraud Examiners or who possess relevant accounting and investigation experience.  

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.