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Vacancy Search (VPOS)
HEALTH CARE SERVICES, DEPARTMENT OF
Title: FRAUD INVESTIGATOR, DEPARTMENT OF HEALTH SERVICES |
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Job Description: Fraud Investigators, Department of Health Services (DHS), are peace officers under California Penal Code, Section 830.3 (h) and perform investigative duties comparable to other peace officers. During the course of their employment, they are required to carry a firearm and be proficient in its use. Further, investigators must be knowledgeable in the area of non-lethal force, demonstrating appropriate use as prescribed in Departmental policy. 80% Conduct “full scope” criminal/civil investigations into allegations of fraud/abuse against the Medi-Cal program and various other programs that may involve overnight assignments and moderate to heavy travel. “Full Scope” is defined as gathering evidence as prescribed by law, interviewing/interrogating witnesses and suspects, preparing and executing search warrants and subpoenas, conducting surveillance and covert activities, preparing detailed reports and making recommendations based on federal and state law, the Code of Federal Regulations and the California Administrative Codes; testifying before grand juries, the courts and administrative proceedings. Investigations may include the following: organized criminal activity by Medi-Cal beneficiaries; violations of laws and regulations by Medi-Cal providers and their agents; criminal/civil investigations of violations of the Women, Infants, and Children program; cases involving the diversion of legally manufactured controlled substances for illicit use and sale; the illegal use of Medi-Cal documents to fraudulently obtain services; criminal fraud in the Vital Statistics program that involves illegal trafficking of documents; “Enhanced Enforcement Efforts” involving questionable deaths or abuse/neglect of beneficiaries in health care facilities; departmental internal investigations; confer with deputy district attorneys, city attorneys, attorney generals and federal prosecutors while presenting and preparing cases for court; plan and coordinate Medi-Cal enforcement activity involving state and federal law enforcement officers and allied health agency officials; provide training and technical assistance on the latest techniques of enforcement and investigation of criminal fraud to state, federal and local regulatory agencies; conduct background investigations on peace officer candidates and Medi-Cal providers; effect arrests of law violators; and gather intelligence data. 10% Assist in multi-agency investigations; provide back up to other investigators. 5% Prepare cases for referral to the Office of Legal Services to initiate suspension proceedings against Medi-Cal providers suspected of fraud or abuse of the program. 5% Perform other routine tasks as required; prepare time reports, vehicle logs, attend staff meetings, training, etc. 5-2006 RM Additional Information:
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