Healthcare Fraud Auditor (HCF)

The Auditor:

Performs a variety of ancillary audit-related services in direct support of litigation. Support activities include one or more of the following:

- Provides general auditing and accounting services in support of fraud investigations involving potentially complex financial transactions and complex organizations attempting to evade detection.

- Assists with the planning of investigations, including performing quantitative and qualitative analyses to identify potential witnesses and relevant documents, to include financial documents.

- Works with the assigned AUSAs and/or supervisory attorneys, determines applicable administrative statutory and regulatory law, and identifies possible violations or causes of action.

- Reviews all applicable laws and evidence, providing insights to assist in affixing legal responsibility for litigation while allowing final decisions on investigations and evidence presentation methods to be made by the appropriate authorities

- Reviews and advises on effective methods for planning, scheduling, and conducting investigations, and identifies any necessary resources
- Analyzes, organizes, and presents a large volume of data such as bank records, financial records, healthcare claims, tax records, correspondence, policies, other documentary evidence, etc., using common software programs.

-Initiates contacts with federal, state, and local officials, and other organizations and individuals related to the subject of investigation, for the purpose of gathering facts, obtaining statements, learning sequences of events, obtaining explanations, and otherwise advancing investigative objectives. Examines books, ledgers, payrolls, cost reports, billing statements, invoices, correspondence, computer data, and other records pertaining to the transactions, events, or allegations under investigation. Establishes and/or verifies relationships among all facts and evidence obtained or presented to confirm authenticity of documents, corroborate witness statements, and otherwise build proof necessary for successful litigation.

- Meets with the ACE Coordinator and designated federal agency personnel, state and local officials as needed throughout investigations.

-Utilizes electronic databases to identify assets, documents, and other physical evidence. 

-Arranges for secure storage, preservation, organization and indexing of voluminous documentary evidence, including electronic storage.

- Identifies the need for service of subpoenas and presents to AUSA for approval.

-Reviews, analyzes, and summarizes documents.

- Analyzes an individual or corporation’s ability to pay monetary penalties based on financial disclosures and independent investigation of assets and liabilities.

-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, or other aspects of case.

-Assists in compilation of documents, data, and physical evidence, and creation of charts, graphs, summaries, videotapes, and other audio-visual materials for use by AUSAs in presentations, motions, or at trial. Provides advice to AUSA on selection of witnesses. Testifies in court regarding audits, as required.

-Provides specialized investigative analysis relevant to Healthcare and Government Fraud matters. Identifies sources of information and multiple variables. Prepares interim and final comprehensive reports on progress of investigations for use by AUSAs, supervisory AUSAs and the investigative team. Includes significant findings and conclusions, recommendations for additional audit actions, and candid assessments of strengths and weaknesses of witnesses, documentary evidence, or other aspects of the case.

- Discusses cases with AUSAs and recommends further courses of action such as closing of the case, further investigation, and institution of civil proceedings.

o Performs quantitative, qualitative, statistical, or other analysis of relevant facts to support the litigative mission of the USAO.

o Analyzes Medicare Part A, Part B, and Part D databases and Medicaid claims databases. Designs data techniques for fraud detection with Medicare/Medicaid and other databases. Develops data techniques to demonstrate and prove fraud in health care fraud cases.