Criminal Investigator Medicaid Fraud Control Unit

DC Office of the Inspector General

Job Summary

This Criminal Investigator (CI) position is located in the Medicaid Fraud Control Unit (MFCU) within the District of Columbia Office of the Inspector General (OIG), an organization responsible for promoting the economy, efficiency, and effectiveness of, and preventing and detecting corruption, fraud, waste, abuse, and mismanagement in the District Government.  MFCU is charged with investigating and prosecuting (or referring for prosecution) violations of all applicable District or Federal criminal and civil statutes with respect to various healthcare fraud schemes and patient abuse or neglect in the provision or administration of the Medicaid program and funds.

For purposes of MFCU’s authority, healthcare fraud schemes include any act that constitutes criminal or civil fraud violations for healthcare services and activities by providers of such services through any Medicaid funded healthcare program, such as billing for excessive/unnecessary services or services not rendered; double billing for services rendered, etc. Such cases are worked jointly with federal and local partners, and prosecuted by the Department of Justice (Main Justice) or the District’s U.S. Attorney’s Office. Civil fraud cases are presented to the District’s Office of the Attorney General for prosecution under the District’s False Claims Act or other civil authorities.  The CI works under the direction of a Supervisory Criminal Investigator.

Duties and Responsibilities

Independently plans, organizes, and conducts high impact investigations involving allegations of healthcare fraud schemes in violation of federal and District of Columbia criminal or civil laws and regulations; reviews and analyzes appropriate business, financial, and healthcare records for suspected criminal or civil fraud violations;

Prepares administrative or Federal Grand Jury subpoenas to obtain appropriate records to support potential criminal or civil violations; and when necessary, participate in the execution of Federal search warrants for seizure of evidence;

Provides oral testimony and present information/documents before Federal grand jury or criminal court or civil proceedings; prepares well written investigative plans to reflect the appropriate criminal/civil offenses, depth and scope, and current activities and developments in the investigation.

Performs other related duties as assigned.

Qualifications and Education

The duties of positions in this series require moderate to arduous physical exertion involving walking, standing, and running, use of firearms, and exposure to inclement weather. Manual dexterity with comparatively free motion of finger, wrist, elbow, shoulder, hip, and knee joints is required. Arms, hands, legs, and feet must be sufficiently intact and functioning in order that applicants may perform the duties satisfactorily. Sufficiently good vision in each eye, with or without correction, is required to perform the duties satisfactorily. Near vision, corrective lenses permitted, must be sufficient to read printed material the size of typewritten characters. Hearing loss, as measured by an audiometer, must not exceed 35 decibels at 1000, 2000, and 3000 Hz levels. Because the duties of these positions are exacting and responsible, and involve activities under trying conditions, applicants must possess emotional and mental stability. Any physical condition that would cause the applicant to be a hazard to himself/herself or others is disqualifying.

This position requires the applicant to take and pass a pre-employment physical examination.

This position requires the CI to take and pass an annual medical examination.

Applicants must have at least one (1) year of specialized experience equivalent to the CS-11 grade level, or its non-District equivalent. Examples of specialized experience include: having expertise with using/performing data analytics/techniques, digital/computer forensics, forensic accounting; conducting, assisting, or participating in criminal or noncriminal investigations involving persons and/or business entities that were prosecuted or suspected of engaging in fraudulent claims or billing, financial crimes, or white collar crimes,  including  collusion, conspiracy, forgery, kickbacks, money laundering, embezzlement, theft, and giving false, fictitious or fraudulent information; and developing facts and evidence, gathering information and intelligence, conducting interviews and interrogations, making arrests and conducting searches and seizures.

Bachelor’s degree preferred.

Demonstrates a high degree of integrity and professionalism in appearance and conduct at all times.

This position prefers the CI be a graduate of the Federal Law Enforcement Training Center (FLETC) Criminal Investigator Training Program or have other comparable law enforcement training.

Work Environment

The work is performed in a fast-paced environment with constantly changing priorities; an office setting with adequate lighting, heating, and ventilation. However, duties may require frequent visits to areas with high crime rates to conduct interviews of suspects and surveillance operations, which may include exposure to extreme weather conditions outside in the elements (i.e., rain, heat, cold, etc.). CI is required to carry a firearm.

Other Significant Facts:

Promotion Potential: Competitive status

Duration of Appointment: Career Service Appointment

Pay Plan, Series and Grade:  CS-1811-12

Collective Bargaining Unit (Non-Union):  This position is not represented by a collective bargaining unit.

Position Designation:  This position will be subject to enhanced suitability screening pursuant to Chapter 4 of DC Personnel Regulations, Suitability – Safety Sensitive.

This position requires the CI to frequently handle multiple subjects simultaneously in a fast paced, time sensitive environment with frequently changing priorities.

This position does not provide federal law enforcement retirement and/or Law Enforcement Availability Pay (LEAP).

Tour of Duty: This position has a standard tour of duty, but may require the CI to work extended work hours.

The District of Columbia Government does not discriminate in employment on the basis of race, color, religion, sex including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

Submission of a resume alone is NOT a complete application. This position may require the completion of additional form/s and/or supplemental materials. Failure to provide the required information and/or materials will result in your application not being considered for employment.

This position requires the CI to possess, upon appointment, and maintain a valid U.S. driver’s license.

This position requires the CI to successfully qualify with the use of a firearm within 90 days of appointment and maintain all established requirements for carrying and using firearms, and following use of force guidelines in accordance with investigative policies and procedures. Firearms qualification is mandatory as part of assigned duties.

“If the position you are applying for is in the Career, Management Supervisory, or Educational Service at an annual salary of one hundred fifty thousand dollars ($150,000) or more, you must establish residency in the District of Columbia within one hundred eighty (180) days of the effective date of the appointment and continue to maintain residency within the District of Columbia throughout the duration of the appointment.”

The District of Columbia Government does not discriminate in employment on the basis of race, color, religion, sex including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an employee organization, retaliation, parental status, military service, or other non-merit factor.

Submission of a resume alone is NOT a complete application. This position may require the completion of additional form/s and/or supplemental materials. Failure to provide the required information and/or materials will result in your application not being considered for employment.

To apply for this job please visit careers.dc.gov.