Fraud Investigator

For more than 165 years, the Office of the Indiana Attorney General (OAG) has been committed to serving the best interests of the State and all Hoosiers. OAG employees have earned an outstanding reputation for meeting the highest professional standards, providing great service, and demonstrating courageous leadership and commitment to excellence to the people of Indiana. If you share our determination to make Indiana a better place to live and work, we invite you to join over 400 of the very best employees and seek a career with the Office of the Indiana Attorney General.

Investigators are assigned cases under the direction of the Fraud Team Supervisor.  The Indiana Medicaid Fraud Control Unit Investigator shall investigate provider fraud from the Indiana Medicaid Program.  The Investigator works independently or as part of a team. The primary location of this position is in the Hobart office in Lake County.

• Obtain various documentation from the fiscal intermediary;  
• Obtain documents such as bank records, medical records, patient files, business records, and other records to be used as evidence in judicial proceedings;  

• Research the documentation for patterns of billing and illegal activity, and develop schedules of provider billing activities;

• Locate, conduct surveillance, and interview witnesses and suspects;  
• Identify and interview expert witnesses;  
• Evaluate statements for credibility;
• Conduct undercover operations;
• Prepare comprehensive investigation reports for presentation to a deputy attorney general, or state or federal prosecutor, for criminal referrals;
• Assist the deputy attorney general or state or federal prosecutor in preparing the case for court;  
• Locate and serve subpoenas on witnesses;  
• Testify in criminal and administrative proceedings;  
• Complete any required component of the Indiana Law Enforcement Academy training;  
• Participate in investigator training and perform other work as required;  
• Analyze Medicaid claims and medical records;        
• Conduct case related research involving diseases and related procedures including medical publications;
• Access Web site information for ICD-10, CPT and HCPS information.  
• Conduct on-site and off-site audits of Medicaid providers;  
• Conduct financial analyses including tracing of illicit funds for forfeiture purposes;  
• Maintain proper procedures for seizing and storing of evidence and maintaining the chain of custody;  
• Maintain internal control documents including mileage entries, Sales Force entries, time tracking and travel reports;  
• Such travel as the assignment of duties may necessitate, usually consisting of frequent trips totaling more than 1000 miles per month, for the following purposes:
• Conduct investigations at the business and home locations of Medicaid providers and at the home locations of Medicaid recipients. 
• Travel to state offices, jails, police departments, sheriff’s departments, courthouses, offices of businesses contracting with healthcare providers, and such other locations as may be necessary for the purpose of obtaining documents, statements, and other evidence necessary to an investigation. 
• Travel to surveillance locations and conducting surveillance from a vehicle for extended periods of time in all types of weather and at all times of day or night.
• Travel to and assist in serving search warrants and seizing evidence at such times as is best for the purposes of the investigation, including times beyond normal duty hours, and to transport to such sites the supplies and tools, including storage boxes and document scanners, as may be required.
• Travel directly from home to the office of a healthcare provider under investigation, to an office of the Medicaid Fraud Control Unit other than the assigned duty station, or to other locations required by an investigation, as may be necessary to the efficient and effective completion of an investigation.

To perform the job successfully the individual should demonstrate the following competencies:

• Analytical - Synthesizes complex or diverse information.  
  1. Collects and researches data
• Problem Solving – Gathers and analyzes information skillfully.
• Technical Skills - Pursues training and development opportunities and strives to continuously build knowledge and skills.
• Interpersonal - Maintains confidentiality.
• Oral Communication – Speaks clearly and persuasively in positive or negative situations.
  1. Listens and gets clarification.
  2. Responds well to questions.
• Written communication - Writes clearly and informatively.
  1. Able to read and interpret written information.
• Quality Management - Looks for ways to improve and promote quality.   
  1. Demonstrates accurateness and thoroughness.
  2. Proven case management skills.
  3. Applies feedback to improve performance.
  4. Monitors own work to ensure quality.
  5. Must be organized and highly motivated.
• Ethics – Treats people with respect and follows through on commitments.
  1. Inspires the trust of others and works ethically with integrity.
  2. Upholds organizational values.
• Dependability – Follows instructions.
  1. Responds to management direction.
  2. Takes responsibility for own actions.
  3. Commits to long hours of work when necessary to reach goals.
  4. Completes tasks on time or notifies appropriate person with an alternate plan.
• Professionalism – Approaches others in a tactful manner.
  1. Reacts well under pressure and treats others with consideration regardless of their status or position.
• Organization Skills
• Prioritizing assignments and time management skills
• Integrity

• The qualified candidate must have a four-year degree from an accredited college or university or a minimum of four years law enforcement experience. 
• Computer skills – working knowledge of Microsoft Word, Excel
• Preferred candidate will have experience in law enforcement and health care industry, with emphasis on health care fraud investigations.

Work Environment

• Ability to work inside and outside an office atmosphere
• Ability to drive an automobile to locations inside and outside the State of Indiana for work and training purposes
• Schedule varies depending on the type and stage of the investigation

Essential Functions

• Valid Indiana Driver’s License
• Review and analyze documents containing writings in the English language
• Accurately compile and calculate numeric information

The Office of the Indiana Attorney General is an Equal Opportunity Employer.