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How much do medicare fraud investigator jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for medicare fraud investigator in the United States is $30.83, according to ZipRecruiter salary data. Most workers in this role earn between $22.12 and $35.34 per hour, depending on experience, location, and employer.

What does a Medicare fraud investigator do?

A Medicare Fraud Investigator is responsible for detecting, investigating, and preventing fraudulent activities related to Medicare claims. They analyze billing patterns, review medical records, and conduct interviews to identify potential fraud or abuse. These professionals work closely with law enforcement agencies and may assist in prosecuting individuals or organizations that attempt to defraud the Medicare program. Their work helps ensure that Medicare funds are used appropriately and benefit those truly eligible.

What does a Medicare fraud investigator do?

A Medicare fraud investigator studies cases related to the misuse of health care insurance. Your duties focus on collecting information on instances of suspected fraud. You review health care data and records to look for evidence of fraudulent activity. Also, you interview people involved in the case, including witnesses, suspects, and healthcare providers. You document your findings and present a report to the relevant authorities. Your responsibilities can include helping prosecutors prepare cases and testifying about your investigations in court if necessary. Some investigators also look into non-criminal cases that involve Medicare waste or unnecessary spending.

What are the key skills and qualifications needed to thrive as a Medicare fraud investigator?

To thrive as a Medicare Fraud Investigator, you need a solid background in criminal justice, investigative techniques, and knowledge of healthcare regulations, typically supported by a relevant degree and experience in law enforcement or healthcare compliance. Familiarity with data analytics software, case management systems, and specialized fraud detection tools is essential. Strong analytical thinking, attention to detail, and effective communication skills help investigators identify suspicious patterns and work with multiple stakeholders. These skills are crucial for ensuring the integrity of Medicare programs and protecting public resources from fraudulent activity.

What are some of the most common challenges faced by Medicare fraud investigators, and how are these typically addressed?

Medicare Fraud Investigators often face challenges such as identifying sophisticated fraudulent schemes, keeping up with evolving regulations, and managing large volumes of complex data. To address these, investigators collaborate closely with legal teams, data analysts, and law enforcement agencies, leveraging advanced data analytics tools and ongoing training to stay current. Regular communication and teamwork are key, as many investigations require input from multiple disciplines to build strong cases and ensure compliance with industry standards.

What is the difference between Medicare Fraud Investigator vs Medicaid Fraud Investigator?

AspectMedicare Fraud InvestigatorMedicaid Fraud Investigator
Required CredentialsTypically requires a background in criminal justice, healthcare administration, or related certifications like CFESimilar credentials, often with additional state-specific Medicaid certifications
Work EnvironmentFederal or state government agencies investigating Medicare fraudState agencies focusing on Medicaid program fraud
Employer & IndustryFederal Centers for Medicare & Medicaid Services (CMS), law enforcementState Medicaid agencies, law enforcement
Search & Comparison IntentCommonly compared due to overlapping roles in healthcare fraud detectionOften compared with Medicare Fraud Investigator due to similar responsibilities

Medicare Fraud Investigators and Medicaid Fraud Investigators both focus on detecting healthcare fraud but differ mainly in the programs they oversee—federal Medicare versus state Medicaid. While their credentials and work environments are similar, their specific targets and agencies differ, making them distinct roles within healthcare fraud enforcement.

Are Medicare Fraud Investigators in demand?

Medicare Fraud Investigators are in demand due to the ongoing need to combat healthcare fraud and ensure program integrity. The role often requires knowledge of healthcare laws, investigative skills, and sometimes certification, with employment opportunities available in government agencies and private sectors.
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Medicare Fraud Investigator jobs near you
Infographic showing various Medicare Fraud Investigator job openings in the United States as of August 2026, with employment types broken down into 89% Full Time, and 11% Part Time. Highlights an 67% In-person, and 33% Remote job distribution, with an average salary of $64,132 per year, or $30.8 per hour.

Senior Healthcare Fraud Investigator / OSINT Analyst

Arlington, VA • Remote

Navanti Group
International Affairs • 11 - 50 employees
Learn more about Navanti Groupexternal

Part-time

Re-posted 15 days ago

Job description

Senior Healthcare Fraud Investigator / OSINT Analyst


Company: Navanti Group, LLC
Location: Remote
Employment Type: Part-Time / Consultant
Security Clearance: Active Top Secret clearance required at time of application
Estimated Level of Effort: Approximately 1015 hours per week on average, with workload varying based on investigative tasking. The position is anticipated to support approximately 550650 hours annually; no minimum number of hours is guaranteed.

Position Overview
Navanti Group is seeking a senior healthcare fraud investigator and Open-Source Intelligence analyst to support a sensitive federal law-enforcement customer. This individual will serve as the primary technical lead for healthcare fraud-related OSINT research, analysis, and reporting.
The selected candidate will support federal criminal, civil, administrative, and parallel healthcare fraud investigations by identifying publicly available information, relationships, assets, digital activity, business affiliations, and potential indicators of fraudulent conduct. The position requires an uncommon combination of direct healthcare fraud investigative experience, advanced OSINT expertise, federal investigative experience, and an active Top Secret clearance.
Primary Responsibilities

  • Conduct complex OSINT research concerning individuals, healthcare providers, businesses, affiliated entities, assets, ownership structures, and associated networks.
  • Identify and analyze online presence, business relationships, professional affiliations, financial indicators, and other publicly available information relevant to investigative objectives.
  • Conduct link, relationship, and network analysis to identify connections among subjects, providers, businesses, beneficiaries, and associated entities.
  • Apply healthcare fraud expertise to develop investigative leads involving:
    • Medicare and Medicaid fraud
    • Home health agency fraud
    • Durable medical equipment fraud
    • Hospice fraud
    • Provider enrollment and ownership-concealment schemes
    • Kickbacks and patient brokering
    • Billing irregularities and related fraud typologies
  • Translate OSINT findings into actionable healthcare fraud investigative value.
  • Monitor publicly available sources relevant to active and proactive investigations.
  • Prepare clearly sourced investigative summaries, intelligence products, link analyses, and rapid-turn responses.
  • Document research sources, methodologies, limitations, and analytical confidence.
  • Ensure findings are suitable for investigative, operational, administrative, and potential legal review.
  • Support authorized sensitive operational activities, including limited OSINT assistance related to undercover or covert investigative efforts.
  • Coordinate with Navantis Program Manager and Quality Manager to ensure deliverables meet customer requirements.


Mandatory Qualifications

  • Minimum of five years of specialized experience supporting civil or criminal healthcare fraud investigations.
  • Minimum of ten years of experience providing OSINT or investigative support to federal government agencies, the Intelligence Community, or law-enforcement organizations.
  • Demonstrated experience conducting advanced OSINT investigations and intelligence analysis.
  • Experience supporting sensitive or complex federal investigations.
  • Working knowledge of Medicare and Medicaid programs.
  • Familiarity with common and emerging healthcare fraud schemes across multiple provider types.
  • Experience supporting civil, criminal, administrative, or parallel investigative proceedings.
  • Familiarity with federal investigative standards, evidentiary considerations, documentation practices, and reporting requirements.
  • Ability to produce defensible, clearly sourced, and analytically sound investigative products.
  • Demonstrated discretion, sound professional judgment, and a security-conscious operational posture.


Preferred Qualifications

  • Prior experience supporting an Office of Inspector General, Department of Justice, federal healthcare law-enforcement organization, or federal investigative agency.
  • Experience with provider ownership research, corporate records, asset identification, public-record databases, social-media analysis, and digital-presence assessment.
  • Experience using network-analysis and social-media intelligence platforms.
  • Experience with link-analysis tools and preparation of visual network products.
  • Experience supporting protective intelligence, undercover operations, or sensitive online investigative activities.
  • Formal training in OSINT tradecraft, fraud investigations, financial investigations, intelligence analysis, criminal justice, or a related discipline.


Availability and Performance Requirements
The selected candidate must generally be available during federal business hours, Monday through Friday, between 8:00 a.m. and 6:00 p.m. Eastern Time. The individual must be able to acknowledge and begin assigned tasking within eight business hours and provide limited after-hours support for priority investigative requirements when necessary. The position is fully remote, and no routine travel is anticipated. Planned periods of unavailability must be communicated in advance to support continuity of operations.
Reporting Structure
The Senior Healthcare Fraud Investigator / OSINT Analyst will report administratively to Navantis Program Manager. Investigative priorities, technical direction, reporting standards, and task deadlines will be established by the authorized federal customer representative.

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