Senior Civil Health Care Fraud Investigator

The USAO regularly investigates and litigates matters involving fraud committed on public health care benefits programs including Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program. These investigations and cases often require additional investigative support, working in conjunction with the assigned federal agents, to investigate the facts and circumstances underlying the fraud, as well as litigate the cases. A Senior Civil Health Care Fraud Investigator is necessary for the USAO to pursue these types of cases. 

The Contractor shall provide one Senior Civil Health Care Fraud Investigator. Specific duties shall include the following:

- Supports the planning and conduction of investigations

- Assists Assistant United States Attorneys (AUSAs) in the investigation of matters in conjunction with federal agents, to determine whether there have been violations of Federal Statutes, e.g., False Claims Act, Stark Law, and Anti-Kickback Act.

- Works and regularly communicates with AUSAs to identify possible violations or causes of action, determines proof required to assist in affixing legal responsibility, and devises methods for obtaining, preserving, and presenting such evidence.

- Decides upon the most effective methods for planning, scheduling, and conducting investigations, and identifies required resources. Recommends methods for conducting investigations, including interviews, subpoenas, and depositions. Secures participation of appropriate law enforcement agents in execution of these investigative methods.

- Identifies and presents AUSAs with potential investigations through review of the news, databases, and regular communications with representatives of Government agencies and private industry.

- Contacts federal, state, and local officials, as well as business representatives, to gather information, documents, and statements on current or potential investigations, as well as coordinate investigative activities.

- Assists AUSAs with the identification, locating, and interviewing of witnesses. Conducts

surveillance of suspects with appropriate law enforcement agencies. Communicates with counsel of subjects and witnesses.

- Prepares appropriate memos and reports on contacts, interviews, and surveillance.

- Examines, analyzes, presents, and secures evidence such as documents, emails, policies, text messages, payrolls, financial statements, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation.

- Research and reviews laws, rules, regulations, and policies to determine whether health care billings were improper. Identifies and interviews any relevant Governmental or business representative pertaining to the propriety of the billings.

- Traces funds derived from fraud and identifies assets of subjects.

- Confirms authenticity of documents, corroborates witness statements, and otherwise builds proof necessary for successful litigation.

- Arranges for the integrity of evidence through secure storage, preservation, organization, and indexing of voluminous physical and electronic evidence.

- Regularly updates AUSAs on status of case. 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, and other aspects of case.

- Assists AUSAs with preparation for litigation and trial.

- Provides analytical advice and assistance with compiling documents and physical evidence, and creating 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.

- Other related duties as assigned and within scope