Forensic Auditor: Investigate Complex Healthcare Fraud

Job title: Forensic Auditor: Investigate Complex Healthcare Fraud

Company: New York State


Job description: Duties Description Criminal Justice Division
Medicaid Fraud Control Unit, Civil Enforcement Division
Forensic Accountant/Auditor – Pearl River (Rockland County)
Reference No. MFCU/CED_PR_FAA_6381
Application Deadline: April 18, 2025
Salary is $66,964 + $3,400 in location pay
To be considered for this opportunity, submit a complete application online at ag.ny.gov/job-postings/otherThe Office of the New York State Attorney General’s (OAG) Medicaid Fraud Control Unit (MFCU) seeks a forensic accountant/auditor (FAA) for its Civil Enforcement Division in Pearl River. FAAs support the unit by working in partnership with its attorneys, detectives, data analysts, nurses, and legal support analysts to conduct complex, long-term healthcare fraud investigations.The Medicaid program provides health coverage to millions of New Yorkers, including low-income persons, children, elderly adults, and people with developmental disabilities. MFCU is the nation’s premier law enforcement agency charged with ensuring the financial integrity of New York state’s $96 billion Medicaid program by investigating healthcare providers, such as pharmaceutical companies, doctors, hospitals, and nursing homes, who engage in Medicaid billing schemes that cause harm to Medicaid recipients and the loss of millions of dollars to the state of New York. MFCU also works to protect elderly and disabled New Yorkers by investigating reports of abuse and neglect in nursing homes and other residential health care facilities in the state.Possessing both civil and criminal enforcement powers, MFCU uses various state laws to bring civil actions and criminal proceedings, including asset forfeiture actions. Many of MFCU’s investigations are conducted in coordination with other federal, state, or local government and prosecutorial agencies, and have resulted in large-scale criminal convictions and the recovery of millions of dollars of taxpayer money.Several recent matters that highlight MFCU’s important work include OAG’s report concerning neglect of nursing home residents across New York state during the COVID-19 pandemic, and the recent filing of four major lawsuits against nursing homes, including Centers Health Care, Cold Spring Hills Center for Nursing and Rehabilitation, The Villages of Orleans Health and Rehabilitation Center, and Fulton Commons Care Center, Inc.Additional significant cases include recoveries of $26.8 Million from drug manufacturer Mallinckrodt, nearly $7 Million from home health agencies for cheating workers and Medicaid fraud, and $22.7 Million from a pharmaceutical company for its kickback scheme.Minimum Qualifications Qualifications:

• A minimum of a four-year college degree, either specifically in accounting, finance, economics, applied statistics, or computer science with data analysis, or equivalent post-college work experience.
• Excellent analytical, communication, and organizational skills.
• The ability to function as an integral part of an investigative team and work in a group setting.
• Knowledge of fundamental computer applications such as Word, Excel, and Access.
• Proficiency with presentation software such as PowerPoint.

Preferred skills/experience:

• The ability to review financial records and advise or assist in the investigation of alleged fraud.
• Designation as a Certified Fraud Examiner.
• Experience with statistical sampling and/or advanced statistical training.
• Knowledge of the healthcare industry and medical coding concepts (CPT, ICD-9 / 10, DRGs) and/or experience analyzing health care claims data.
• A CPA is not required, but the position qualifies for CPA accreditation purposes.

Additional Comments The annual salary for this position is $66,964 + $3,400 in location pay. As an employee of OAG, you will join a team of dedicated individuals who work to serve the people of our state through a wide variety of occupations. We offer a comprehensive New York state benefits package, including paid leave, health, dental, vision, and retirement benefits, and family-friendly policies. Additionally, OAG offers a robust Workplace Flexibilities Program with multiple options for employees, including telecommuting (up to two days per week) and alternative work schedules.Candidates from diverse backgrounds are encouraged to apply. The OAG is an equal opportunity employer and is committed to workplace diversity.Some positions may require additional credentials or a background check to verify your identity.

Expected salary:

Location: New York City, NY

Job date: Fri, 21 Mar 2025 06:19:28 GMT

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