Investigation Supervisor, WV Medicaid Fraud Control Unit (MFCU)
The Investigation Supervisor plans and monitors cases for a team of investigators in multifaceted criminal and civil investigations. The Investigation Supervisor reviews, edits, and finalizes reports of investigation and civil recovery memos, including recommendations for corrective action. The Investigation Supervisor is responsible for managing and directing the day-to-day investigative operations of the MFCU.
RESPONSIBILITIES AND DUTIES
• Managing and directing a team of Investigators conducting sensitive and complex criminal and civil investigations of suspected Medicaid fraud, abuse, and neglect by healthcare providers.
• Participating in investigations as a team leader or as an Investigator conducting highly complex and extremely sensitive investigations. Develop and implement strategic plans for investigations, identify investigative targets, and coordinate with prosecutors and other law enforcement agencies.
• Manage and train investigators and other staff, providing guidance, assigning cases, and ensuring high-quality investigative work. Prepare and review detailed written reports, supporting exhibits, and other documentation related to investigations.
• Providing field-level direction to MFCU investigators in planning, coordinating, and conducting investigations related to allegations of Medicaid fraud by health care providers, as well as allegations of abuse, neglect, and financial exploitation of incapacitated adults.
• Reviewing investigative reports to ensure completeness and accuracy before prosecution referral.
• Managing the caseloads of assigned subordinate MFCU investigators and investigative assistants.
• Planning, developing, implementing, and overseeing office policies and procedures, as well as assuring team members’ compliance with office policies and procedures.
• Resolving issues related to investigative operations.
• Identifying and/or developing necessary training materials and programs to provide MFCU staff members with adequate and effective educational and professional development opportunities, including personally conducting staff training programs as needed.
• Consulting and collaborating with the other members of the MFCU leadership team and the Office of the Attorney General to enhance the Unit’s ability to use its resources efficiently and effectively.
• Offering input, suggestions, and recommendations to the MFCU Director, Deputy Director, Chief Investigator, and Chief Auditor regarding appropriate policies, procedures, work processes, and methods as needed to maximize the MFCU’s effectiveness, in accordance with the Attorney General’s directives and instructions.
• Direct the gathering, examination, and preservation of evidence, and assist in executing subpoenas and search warrants as needed.
• Establish and maintain working relationships with federal, state, and local law enforcement agencies, prosecutors, healthcare regulatory agencies, as well as other community groups, to enhance the MFCU's mission.
• May be required to testify in civil, criminal, and administrative proceedings regarding investigations.
Key Skills and Qualifications
• Proven experience in supervising or managing a team of professional and/or administrative staff.
• Experience in conducting complex criminal and/or civil investigations, ideally with specific experience in healthcare fraud.
• Excellent organizational and analytical skills.
• Knowledge of investigative techniques, including surveillance, undercover operations, interviewing, search warrants and more.
• Excellent written and verbal communication skills to effectively manage staff, draft reports, and communicate with partners and prosecutors.
• High ethical standards and the ability to maintain confidentiality.
• Ability to coordinate with external agencies and build effective working relationships.
Preferred Qualifications
• Thorough knowledge of state and federal healthcare fraud statutes, investigative procedures, rules of evidence, and civil recovery actions.
• Proficiency in reviewing and analyzing financial and medical records.
• A bachelor's or advanced degree in a related field.
• Preferred certifications include Certified Fraud Examiner (CFE), Certified Public Accountant (CPA), or others relevant to fraud investigations.
• Experience in healthcare fraud investigations, auditing, and/or financial analysis.
• Familiarity with fraud detection tools and data analysis techniques.
To apply, please submit a cover letter, resume, and preferred salary range to jobs@wvago.gov with "Investigation Supervisor - MFCU" in the subject line.
Data Analyst, WV Medicaid Fraud Control Unit
The Medicaid Fraud Control Unit (MFCU) is charged with investigating, prosecuting and obtaining criminal and civil remedies against individuals and corporate entities responsible for improper or fraudulent Medicaid billing schemes, as well as investigating and prosecuting allegations of abuse and neglect of residents in nursing homes and other residential healthcare facilities. To fulfill these obligations, the MFCU works to identify and investigate fraud committed by hospitals, nursing homes, pharmacies, home health agencies, transportation providers, clinics, hospitals, doctors, dentists, nurses, and other Medicaid providers – as well as individuals, who, for their own financial benefit, interfere with the quality of healthcare, or exploit Medicaid beneficiaries.
Qualified applicants must possess good judgement and experience demonstrating the following:
• Exhibit proficient computer skills to utilize case management systems and other computer databases.
• Experience utilizing Microsoft Excel functions to manipulate large data sets by means of aggregating, grouping, sorting, and filtering.
• Experience analyzing large and complex data sets to identify trends/patterns.
Under supervision of the Chief Forensic Auditor, the Data Analyst will collect, compile, analyze, and interpret trends or patterns in complex medical data sets or other available information. They will formulate analyses and prepare reports, in addition to testifying in court as needed. They will also be responsible for performing other duties as assigned. The Data Analyst will perform work at an advanced level by assisting with investigations of crimes related to the medical programs of the state. They will be responsible for the collection, compilation and analysis of information obtained from databases, source documents, medical and financial data, and other relevant sources. They will gather data from various databases and sources such as earnings information, medical billing data, various licensure statuses, participant eligibility in federal healthcare programs, business records, timecards, financial records, and social service information. They will be able to compile source data into a usable format for examination and/or investigation. They will analyze Medicaid billing data to identify trends and anomalies that may support or define allegations of fraud, as well as organize results and create memos or reports outlining findings and conclusions. They will present their findings to the Chief Forensic Auditor, assist in the interpretation and presentation of findings, and may be required to testify in court. The Data Analyst may also be required to prepare visualizations or presentations of their analysis utilizing excel, tableau, power BI, and other analytical software. The ideal applicant will be able to transform complex data and analyses into clear, concise actionable insights. The Selected Applicant shall complete necessary training as required by federal, state, department and unit policies and must be able to communicate clearly and effectively in verbal and written form with others
Minimum Qualifications
The applicant must have graduated from an accredited college or university with a bachelor’s degree with a minimum of twelve semester hours or equivalent in accounting, business administration or finance, and eighteen months of full-time professional auditing or analytical experience. Consideration will be given to work experience in auditing or analytical work involving preparation of financial statements or analysis of financial data.
To apply, please submit a cover letter, resume, and preferred salary range to jobs@wvago.gov with "Data Analyst" in the subject line.
Paralegal, Consumer Protection
The Consumer Protection and Antitrust Division of the Office of the WV Attorney General seeks a paralegal to assist with the resolution and investigation of consumer complaints and businesses. Experience with litigation is preferred. The paralegal will perform legal research and drafting; analysis of case fact situations for legal issues, assist attorneys with identification and development of legal strategy. The position encompasses daily use of the office database, Lawbase, to assist with tracking attorneys’ workloads. The paralegal has to organize and save legal documents in the document management system and utilize Microsoft Access and Excel to create databases for major cases. The paralegal will perform document review for inhouse and multistate enforcements; assist attorneys by working with consumers and other state agencies in preparation for legal filings, including exhibits and affidavits, and assist at hearings, mediations, and trial from coordinating witnesses and documents to providing testimony of my review of documents. The paralegal is responsible for obtaining abstracts of judgment and assessing collection options for judgment when needed. Along with other staff, the paralegal provides phone coverage for the receptionists as needed.
Please send your cover letter, resume, and preferred salary range to jobs@wvago.gov with "Consumer Protection Paralegal" in the subject line.
Administrative Assistant, Consumer Protection - Martinsburg, WV Office
The Consumer Protection and Antitrust Division of the Office of the WV Attorney General seeks a highly organized, reliable person to provide administrative office support for the Martinsburg, WV Office, including receptionist duties and works closely with onsite legal team. The duties include ordering supplies, answering phones and greeting walk-ins, reviews files, verbal and written communications with consumers and businesses at the direction of the legal team, processing mail, and other office functions as needed. Requires excellent written and oral communication skills, organization and ability to work in a team. Proficiency using Microsoft Office Products, a document management system and database is required.
Please send your cover letter, resume, and preferred salary range to jobs@wvago.gov with "Consumer Protection Administrative Assistant" in the subject line.