Auditor (Healthcare Fraud)

Department of Justice

For more information on the Department of Justice and the United States Attorneys' Offices, visit http://www.justice.gov/usao/. As needed, additional positions may be filled using this announcement. This position is also being announced to applicants eligible to apply through Merit Staffing procedures under 26-AZ-13033814-MS.

• The United States Attorney's Office (USAO) District of Arizona is seeking a Health Care Fraud Auditor to work within the Office's Affirmative Civil Enforcement (ACE) unit. The auditor uses knowledge of medical terminology, medical procedures and processes, and medical insurance (Federal/State/private) reimbursement procedures to perform audit activities related to the detection of health care fraud, waste, or abuse for civil fraud investigations and litigation by the ACE unit. These complex investigations encompass government contractors, health care providers, grant recipients, and other recipients of federal monies, but primarily involve the Centers for Medicare & Medicaid (CMS) and Tri-Care. Typical work assignments will include: Conducting audits and investigations to identify violations of federal law (primarily the False Claims Act, 31 U.S.C. §§ 3729-3733, the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b)(1)(A), and the Stark Law, 42 U.S.C. § 1395nn(a)) involving health care fraud against the Government; Analyzing Medicare and Medicaid claims data (as well as, on occasion, data involving other, similar government programs) and designing data techniques to detect fraud using CMS databases; Researching a variety of informational resources to query, gather and analyze patient-level data related to the provision of and reimbursement for health care services; Conducting investigations to make net worth determinations regarding the ability of individuals and organizations to pay settlements and judgments; and Preparing concise and accurate audit reports, charts, summaries, and schedules that draw conclusions from your analysis and investigation. Responsibilities will increase and assignments will become more complex as your training and experience progress.

Read the full announcement on USAJOBS