Medicaid Fraud Auditor Jobs (NOW HIRING)

Employment Type: Full Time

Department: Litigation Support

CGS seeks a Fraud Analyst to provide financial, forensic, and investigative support to government attorneys in the investigation and litigation of complex civil and criminal fraud matters. The Fraud Analyst will analyze financial and medical claims data, conduct forensic audits, develop damages assessments, and prepare reports and evidence to support investigations, prosecutions, settlements, and recoveries. The ideal candidate is a Certified Public Accountant (CPA) with auditing experience, expertise in financial analysis and fraud investigations, excellent communication skills, and the ability to handle sensitive and confidential information in a government environment.

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.

• Assists the client in the investigation and trial preparation phases by conducting medical claims data analysis, forensic investigations, financial damages, statistical sampling, and ability-to-pay analyses, which serve a significant role in determinations regarding investigations, prosecutions, settlements, and recovery in these matters, which can be voluminous and complex.
• Investigations may well involve individually identifiable medical information, which the contractor will keep confidential, maintaining the privacy of the individuals who received the health care services or items.
• Confidentiality will also be maintained for matters under seal, such as qui tam lawsuits, and matters occurring before the grand jury. Investigations may concern sensitive matters, involve prominent individuals, organizations, or corporations within a client’s district, all of which the investigator will keep confidential.
• The Auditor shall perform comprehensive analytical, investigative, and financial examination duties in support of the client.
• Conduct audits in support of investigations and litigation involving the government's affirmative civil enforcement of federal laws, particularly the False Claims Act, 31 U.S.C. §§3729-3733, the Anti‑Kickback Statute, 42 U.S.C. § 1320a‑7b(b)(1)(A), and the Stark Law, 42 U.S.C. § 1395nn(a)
• Conduct similar audits in support of criminal investigations involving 18 U.S. Code § 641, 18 U.S.C. 1343—Elements of Wire Fraud, 18 U.S.C. § 1341, 18 U.S.C. § 1347, 18 USC 1956: Laundering of monetary instruments, 18 U.S.C. § 1957.
• Reviewing, analyzing, and interpreting complex data sets, including Centers for Medicare & Medicaid Services claims data, PPP loan data, and records associated with health care fraud, defense procurement fraud, and other government program fraud.
• Identifying outlier billings and other anomalies within health care claim codes and normalizing claims data across multiple benefit plans to support time studies and other analytical assessments.
• Detecting trends, patterns, and relevant information within investigative and discovery records and applying this analysis to test data under various conditions.
• Reinterpreting and extrapolating results from Statistically Valid Random Samples when modifications to sample review outcomes occur.
• Developing, documenting, and defending loss calculation methodologies and financial damage models for litigation.
• Conducting financial investigations to assess the ability of individuals and organizations to satisfy settlements and judgments, including detailed analysis of assets, liabilities, debt covenants, borrowing capacity, earnings, financial ratios, aging schedules, tax considerations, and collectability.
• Examining personal and business financial records to identify payments, kickbacks, money flows, sources and uses of cash, related‑party transactions, and potential damages.
• Performing asset valuations, records reconstruction, and creation of computerized financial models for use in presentations of financial evidence.
• Preparing clear, accurate reports summarizing financial analyses, data findings, and evidentiary conclusions.
• Communicating investigative findings to attorneys, investigators, and other team members, and providing recommendations to client regarding investigative plans, areas of focus, and potential courses of action.
• Reviewing defense presentations, expert reports, and related materials, and collaborating with independent experts as needed.
• Preparing expert reports for litigation and participating in negotiations upon request.
• Professionally engaging with witnesses, persons of interest, and representatives of local, state, and federal agencies to obtain statements, clarify facts, and establish sequences of events in support of investigative objectives.
• Participate in the Suspicious Activity Report (SAR) Review Team, reviewing FINCEN reports to generate investigative leads for law enforcement and assisting in de‑conflicting pending investigations.

• Must be Certified Public Accountant.
• MBA or equivalent in accounting or directly related field.
• Thorough knowledge of generally accepted accounting principles and generally accepted auditing standards.
• Minimum of three years’ experience as an auditor.
• Minimum two years specialized experience in the specific subject matter area involved - for example, Medicare billing and claims systems, or DoD inventory systems.
• Working knowledge of appropriate accounting and financial analysis ADP systems and applications.
• Thorough knowledge of generally accepted accounting principles and generally accepted auditing standards.
• Working knowledge of appropriate accounting and financial analysis ADP systems and applications.
• Excellent oral and written communication skills.
• Experience in litigation environment, experience working with automated litigation support helpful.

Contact Government Services (CGS) strives to simplify and enhance government bureaucracy through the optimization of human, technical, and financial resources. We combine cutting‑edge technology with world‑class personnel to deliver customized solutions that fit our client’s specific needs. We are committed to solving the most challenging and dynamic problems.

For the past seven years, we’ve been growing our government‐contracting portfolio, and along the way, we’ve created valuable partnerships by demonstrating a commitment to honesty, professionalism, and quality work.

Here at CGS we value honesty through hard work and self‑awareness, professionalism in all we do, and to deliver the best quality to our consumers mending those relations for years to come.

We care about our employees. Therefore, we offer a comprehensive benefits package:

• Health, Dental, and Vision
• Life Insurance
• 401k
• Flexible Spending Account (Health, Dependent Care, and Commuter)
• Paid Time Off and Observance of State/Federal Holidays

Contact Government Services, LLC is an Equal Opportunity Employer. Applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.