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Healthcare Fraud information

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How much do healthcare fraud jobs pay per hour?

As of Jun 14, 2026, the average hourly pay for healthcare fraud in the United States is $18.82, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $19.47 per hour, depending on experience, location, and employer.

What is healthcare fraud?

Healthcare fraud is the act of intentionally deceiving or misrepresenting information to obtain unauthorized benefits or payments from healthcare programs, such as Medicare or private insurance. This can include billing for services not provided, upcoding procedures, falsifying patient records, or accepting kickbacks. Healthcare fraud can be committed by providers, patients, or even insurance companies, and it not only results in financial losses but can also compromise patient care and trust in the healthcare system.

What is the difference between Healthcare Fraud vs Medical Billing Specialist?

AspectHealthcare FraudMedical Billing Specialist
Required CredentialsNone mandatory, but certifications like Certified Fraud Examiner (CFE) can helpHigh school diploma or equivalent; certifications like Certified Medical Billing Specialist (CMBS) are common
Work EnvironmentHealthcare organizations, government agencies, compliance departmentsMedical offices, hospitals, billing companies
Employer & Industry UsageUsed in compliance, legal, and auditing roles within healthcareUsed in healthcare administration and billing departments
Common Search & ComparisonHealthcare FraudMedical Billing Specialist

Healthcare Fraud involves detecting and preventing illegal billing practices and fraudulent activities within healthcare. In contrast, a Medical Billing Specialist focuses on processing and managing legitimate medical claims and billing procedures. While both roles work within the healthcare industry, Healthcare Fraud professionals focus on compliance and legal issues, whereas Medical Billing Specialists handle day-to-day billing operations.

What are the most common challenges faced by professionals working in healthcare fraud investigation roles?

Professionals in healthcare fraud investigation often encounter challenges such as navigating complex healthcare regulations, staying updated with evolving fraud schemes, and managing large volumes of sensitive data. Collaboration across departments like compliance, legal, and IT is crucial to successfully identify and address fraudulent activities. Investigators may also face tight deadlines and must maintain a high level of accuracy and confidentiality in their work.

What are the key skills and qualifications needed to thrive as a Healthcare Fraud Investigator, and why are they important?

To thrive as a Healthcare Fraud Investigator, you need strong analytical skills, knowledge of healthcare laws and regulations, and experience in auditing or investigations, often supported by a relevant degree or certifications such as Certified Fraud Examiner (CFE). Familiarity with data analysis tools, electronic health record (EHR) systems, and case management software is typically required. Exceptional attention to detail, critical thinking, and effective communication are vital soft skills for gathering evidence and presenting findings clearly. These skills and qualifications are crucial for accurately detecting fraudulent activity, minimizing financial losses, and ensuring compliance within the healthcare industry.
More about Healthcare Fraud jobs
What cities are hiring for Healthcare Fraud jobs? Cities with the most Healthcare Fraud job openings:
What states have the most Healthcare Fraud jobs? States with the most job openings for Healthcare Fraud jobs include:
What job categories do people searching Healthcare Fraud jobs look for? The top searched job categories for Healthcare Fraud jobs are:
Healthcare Fraud jobs near you
Infographic showing various Healthcare Fraud job openings in the United States as of June 2026, with employment types broken down into 18% Locum Tenens, 27% As Needed, 46% Full Time, and 9% Part Time. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $39,156 per year, or $18.8 per hour.
Healthcare Fraud Investigator

Healthcare Fraud Investigator

Contact Government Services, LLC

Chicago, IL

$85K - $105K/yr

Full-time

Posted 18 days ago

Job description

Healthcare Fraud Investigator
Employment Type: Full-Time, Mid-Level
Department: Litigation Support

CGS is seeking a Healthcare Fraud Investigator to provide Legal Support for a large Government Project in Nashville, TN. The candidate must take the initiative to ask questions to successfully complete tasks, perform detailed work consistently, accurately, and under pressure, and be enthusiastic about learning and applying knowledge to provide excellent litigation support to the client. 

CGS brings motivated, highly skilled, and creative people together to solve the government's most dynamic problems with cutting-edge technology. To carry out our mission, we are seeking candidates who are excited to contribute to government innovation, appreciate collaboration, and can anticipate the needs of others. Here at CGS, we offer an environment in which our employees feel supported, and we encourage professional growth through various learning opportunities.

Responsibilities will Include:
- Review, sort, and analyze data using computer software programs such as Microsoft Excel.
- Review financial records, complex legal and regulatory documents and summarize contents, and conduct research as needed. Preparing spreadsheets of financial transactions (e.g., check spreads, etc.).
- Develop HCF case referrals including, but not limited to:
- Ensure that HCF referrals meet agency and USAO standards for litigation.
- Analyze data for evidence of fraud, waste and abuse.
- Review and evaluate referrals to determine the need for additional information and evidence, and plan comprehensive approach to obtain this information and evidence.
- Advise the HCF attorney(s) regarding the merits and weaknesses of HCF referrals based upon applicable law, evidence of liability and damages, and potential defenses, and recommend for or against commencement of judicial proceedings.
- Assist the USAO develop new referrals by ensuring a good working relationship with client agencies and the public, and by assisting in HCF training for federal, state and local agencies, preparing informational literature, etc.
- Assist conducting witness interviews and preparing written summaries.

Qualifications:
- Four (4) year undergraduate degree or higher in criminal justice, finance, project management, or other related field.
- Minimum three (3) years of professional work experience in healthcare, fraud, or other related investigative field of work.
- Proficiency in Microsoft Office applications including Outlook, Word, Excel, PowerPoint, etc.
- Proficiency in analyzing data that would assist in providing specific case support to the Government in civil HCF matters (E.g., Medicare data, Medicaid data, outlier data).
- Communication skills: Ability to interact professionally and effectively with all levels of staff including AUSAs, support staff, client agencies, debtors, debtor attorneys and their staff, court personnel, business executives, witnesses, and the public. Communication requires tact and diplomacy.
- U.S. Citizenship and ability to obtain adjudication for the requisite background investigation.
- Experience and expertise in performing the requisite services in Section 3.
- Must be a US Citizen.
- Must be able to obtain a favorably adjudicated Public Trust Clearance.
Preferred qualifications:
- Relevant Healthcare Fraud experience including compliance, auditing duties, and other duties in Section 3.
- Relevant experience working with a federal or state legal or law enforcement entity.

#CJ
$85,000 - $105,000 a year
We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.
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