Medicaid Fraud Control -Deputy Director

MFCU Deputy Director: The West Virginia Attorney General’s Office seeks a Deputy Director for the Medicaid Fraud Control Unit (“MFCU”). The MFCU is charged with investigating, prosecuting and obtaining criminal and civil remedies against individuals and corporate entities responsible for improper or fraudulent Medicaid billing schemes as well as investigating and prosecuting allegations of abuse and neglect of residents in nursing homes and other residential healthcare facilities.

To fulfill these obligations, the MFCU works to identify and investigate fraud committed by hospitals, nursing homes, pharmacies, home health agencies, transportation providers, clinics, hospitals, doctors, dentists, nurses, and other Medicaid providers – as well as individuals, who, for their own financial benefit, interfere with quality healthcare or exploit Medicaid beneficiaries.

Applicants must be licensed to practice law, possess good judgement, and have a minimum of three (3) years of management experience, with at least five (5) years of management experience preferred. Candidates with prior experience handling healthcare fraud and/or healthcare regulatory matters may substitute such specialized experience for management experience on a year-for-year basis. Ideal applicants will have substantial grand jury and trial experience that preferably includes the investigation, prosecution or defense of financial crimes, as well as experience in state and federal courts in West Virginia.

Responsibilities will include, but not be limited to:

• Assisting the MFCU Director in overseeing and managing the MFCU’s operations;
• Applying generally accepted investigative techniques to advance the MFCU’s investigations toward completion, including but not limited to the use of administrative subpoenas, interviews, grand jury subpoenas, surveillance, cell phone record preservation requests, consensual telephone and non-telephone monitoring, wiretaps, pen registers, mail covers, undercover operations, confidential informants and witnesses, document examination, review of financial records, claims data analysis, search warrants, arrest warrants, and indictments;
• Providing legal guidance, direction and assistance to MFCU staff to ensure consistent forward momentum in the MFCU’s investigations;
• Employing broad management skills in administration, budgeting, personnel, and technical matters, including planning, organization, defining and sequencing investigative tasks, and human resource development;
• Assisting the MFCU Director in establishing objectives and performance goals, and assessing investigative output and case progress;
  Utilizing feedback systems, performance measures and benchmarks to assure adequate performance and successful goal achievement;
• Planning, directing, overseeing, coordinating and conducting investigations related to alleged Medicaid fraud by health care providers, as well as patient abuse, neglect and financial exploitation allegations;
• Supervising subordinate staff, providing technical direction and guidance when problems of high complexity and sensitivity arise during investigations, and implementing generally accepted project management techniques as needed;
• Meeting with other West Virginia and federal law enforcement agencies involved in the investigation, litigation and prosecution of matters falling within the MFCU’s jurisdiction;
• Establishing and maintaining liaison with other MFCU partners, such as Managed Care Organizations (MCOs) and private sector health insurance companies;
• Assisting the MFCU Director in maintaining and reviewing the Unit’s statistical data, and in preparing annual reports and recertification applications for submission to the Inspector General for the U.S. Department of Health and Human Services (HHS);
• Planning, attending and participating in training programs designed to increase, advance, and update advocacy skills, legal knowledge, project management skills, personnel management performance, knowledge of emerging issues in digital evidence, and the investigation and prosecution of health care fraud, abuse and neglect cases;
• Reviewing and assessing investigative output and case progress; and
• Instructing subordinate staff on office policies, procedures, work processes and methods as needed to maximize the MFCU’s effectiveness, and recommending modifications to the same, in accordance with the Attorney General’s directives and instructions;

Candidates must have an active WV law license or be eligible for admission.

Please send your resume and preferred salary range to jobs@wvago.gov with “MFCU Deputy Director” in the subject line.