State of Michigan - Various, MI
posted 5 days ago
About the position
The MDHHS mission is to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for residents to be self-sufficient. We are committed to ensuring a diverse workforce and a work environment whereby all employees are treated with dignity, respect and fairness. This posting will be used to fill multiple vacancies in the following counties of the Integrity Division: Macomb, Oakland, Wayne, Central Region (Clinton, Eaton, Ingham), Thumb Region (Gratiot, Saginaw, Isabella, Midland, Bay, Clare, Gladwin, Arenac, Shiawassee, Genesee, Lapeer, Tuscola, Huron, Sanilac, St. Clair, Roscommon, Ogemaw, Iosco, Crawford, Oscoda, Alcona, Otsego, Montmorency, Alpena, Cheboygan, and Presque Isle), and Southern Region (Livingston, Jackson, Washtenaw, Hillsdale, Lenawee, Monroe). As a Healthcare Fraud Investigator of the Office of Inspector General, this position investigates allegations of health services fraud, waste, and abuse for referral for administrative action and prosecution. This position assists in the overall planning, development, and direction of fieldwork, including fraud prevention and investigation involving programs administered by the Department of Health and Human Services (DHHS) for referral for criminal prosecution and/or civil recovery and repayment actions.
Responsibilities
- Solicit, receive, and investigate complaints related to fraud, waste, and abuse in health services programs.
- Undertake and be responsible for MDHHS' duties under federal law with respect to fraud, waste, and abuse for the administration of the health services programs in Michigan.
- Actively seek out fraudulent billing practices of providers and develop techniques and procedures for detecting suspect billing patterns through the use of existing database resources managed by MDHHS and available from federal sources.
- Pursuant to Section 8 of The Social Welfare Act, 1939 PA 280, MCL 400.8, subpoena and enforce the attendance of witnesses, administer oaths or affirmations, examine witnesses under oath, and take testimony as the Inspector General deems relevant or material to an investigation, examination, or review undertaken by the Office.
- Require and compel the production of such books, papers, records, and documents as the Inspector General deems to be relevant or material to an investigation, examination, or review undertaken by the Office.
- Examine and copy or remove documents or records of any kind related to health services programs or necessary for the Office to perform its duties and responsibilities that are prepared, maintained, or held by, or available to, any state agency or local unit of government entity or contractor to a state agency or local unit of government.
- Pursue administrative and civil enforcement actions or collections against any individual or entity that engages in fraud, abuse, or illegal or improper acts or unacceptable practices perpetrated within health services programs.
- Promptly provide information and evidence relating to suspected criminal acts to the Medicaid Fraud Control Unit of the Department of Attorney General, or any successor entity, to the extent required by federal law.
- Prepare cases, provide testimony, and support administrative hearings and other legal proceedings.
Requirements
- Possession of a bachelor's degree in any major.
- Bachelor's degree in Accounting, Criminal Justice, or a skilled medical related field, or a Juris Doctorate from an ABA accredited law school is preferred.
- Departmental Analyst 9 - No specific type or amount is required.
- Departmental Analyst 10 - One year of professional experience.
- Departmental Analyst P11 - Two years of professional experience, including one year of experience equivalent to the intermediate (10) level in state service.
- Educational level typically acquired through completion of high school and the equivalent of at least two years of full-time active-duty experience at or above the E-6 level in the uniformed services may be substituted for the education requirement.
Benefits
- Remote work and alternate or hybrid work schedule requests may be considered.
- Employees will be provided computers to perform state work.
- Phones may also be provided for necessary communications.
