Civil Investigator (Healthcare Fraud and Opioid Matters)

Job Description

Job Description

SGI Global is seeking a Civil Investigator (Healthcare Fraud and Opioid Matters) to support Affirmative Civil Enforcement ("ACE") Program for the United States Attorney's Office for the Eastern District of North Carolina.

The investigator will be assigned cases and matters that vary in scope and complexity, but characteristically involve difficult and complex schemes, data analyses, record reviews, financial analyses, assisting with witness interviews and evidence-gathering activities, and coordination with relevant law enforcement agencies.

This position is contingent upon contract award

Responsibilities

• The Civil Investigator will assist in conducting thorough and systematic investigations relating to potential civil actions within the jurisdiction of the USAO-EDNC involving opioid-related health care fraud violations.
• Working with assigned Assistant United States Attorneys ("AUSA"), uses data, documents, data analytics, and other sources, tools, and methodologies to identify trends, potential cases, and investigative leads.
• Based on cases or broad legal issues assigned to one or more Assistant United States Attorneys, assists in developing investigative leads, and assists in planning and conducting investigations of a complex and difficult nature.
• In working with assigned Assistant United States Attorney(s), determines applicable statutory and regulatory law, and identifies possible violations.
• Assists in piecing together evidence that comes from data sources, witnesses, custodians, investigators, analysts, contractors, and law enforcement officers stationed throughout a large geographic area or several states.

From this evidence, recognizes the target suspect's or organization's pattern of operations in order to identify information of interest and anticipate events as they unfold.

• Initiates contacts with federal, state, and local officials and other organizations and individuals (including targets, subjects, and witnesses) related to the subject(s) of investigation for the purpose of gathering and analyzing facts, obtaining statements, learning sequences of events, obtaining explanations, and otherwise advancing investigative objectives.
• Identifies the need for, prepares for, and assists in conducting witness interviews, and prepares associated reports.
• Gathers and examines medical records, pharmaceutical records, claims data, prescription data, books, ledgers, payroll, cost reports, billing statements, invoices, bank records, business records, correspondence, data, public source information and documents, and other materials 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.
• Defines and conducts extensive research and analysis of data relating to suspected civil violations, such as healthcare fraud or other violations or offenses of special concern related to opioids and other controlled substances within the USAO-EDNC's jurisdiction.
• Analyzes information on target individuals and organizations by identifying relevant data and information sources, and gathering, extracting, analyzing, and validating data and other information.
• Prepares and disseminates information and analyses to federal, state, and local law enforcement agencies, courts, and other appropriate entities, in consultation with the assigned AUSA or other USAO staff.
• On a continual basis, monitors, reviews, and analyzes information from multiple sources.
• Identifies the need for further research, analysis, or investigation, and assists in making decisions concerning the consolidation and dissemination of information to various law enforcement agencies and other organizations, in consultation with the assigned AUSA or other USAO staff.
• 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, and other aspects of the case.
• Prepares written requests for information (including subpoenas and discovery requests) for AUSA review and otherwise assists in gathering evidence.
• In consultation and coordination with the assigned AUSA or other USAO staff, arranges for secure storage, preservation, organization, logging, tracking, and indexing of voluminous documentary evidence and other investigative materials.
• Compiles and analyzes documents, statements, and physical evidence, and creates of charts, graphs, summaries, demonstrative exhibits, illustrative exhibits, videotapes, and other audio-visual materials for use in motions, depositions, evidentiary hearings, trials, and other proceedings or internal meetings.
• Assists AUSA on selection of witnesses and ensures their attendance through subpoena or otherwise. Limited instances of testimony in civil proceedings (including deposition and trial) may be required.
• Works closely with the Assistant U.S. Attorneys, meets regularly with designated federal agency personnel, as well as state and local officials, for the purpose of generating and assisting with investigations, and coordinating responsibilities with regard to those investigations.

Qualifications

• Expected to work with and review highly complicated and highly technical, regulatory, and / or scientific data and documents, including medical records, medical claims data, prescription data, information pertaining to pharmaceuticals and pharmaceutical companies, and pharmacy records.
• Prior experience, training, education, or knowledge with or in the areas of medicine, medical practices, health care, pharmaceuticals, pharmacies, and / or pharmacy operations will be highly useful.
• Working knowledge and understanding of, and experience with, various aspects of the healthcare and pharmaceutical industry, including International Classification of Diseases codes ( e.
• g. , ICD-9 and ICD-10); Current Procedure Terminology codes ("CPT"); the Health Care Financing Administration's Common Procedure Coding System ("HCPCS");

medical and pharmaceutical practices; and healthcare billing is also a plus.

• Must have the ability to use MS Excel, MS Outlook, MS Word, MS PowerPoint, and Adobe Acrobat Professional, and ideally has experience reviewing documents and working in Eclipse, Relativity, Everlaw, and / or Casemap.
• Experience viewing, accessing, and searching healthcare specific databases, or other similar databases in which claims, payments, prescriptions, regulations, policies, guidelines, or other relevant data or materials are aggregated and reported, is a plus.
• The position requires working and interacting professionally and effectively with all levels of staff and Department of Justice personnel, including legal support staff, document management teams, and Assistant U.

S. Attorneys. It also requires working and interacting professionally and effectively with law enforcement and members of the public.

The ability to meet established deadlines and work as a team player in a professional office setting is also required. The position requires meeting and dealing with people in a courteous and tactful manner.

SGI Global provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws.

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