What are the responsibilities and job description for the OAG - Medicaid Fraud Control Unit| Sergeant | 24-0867 position at CAPPS?

Job Description

REVISED 08 / 28 / 2024

GENERAL DESCRIPTION

Performs advanced criminal investigations of Medicaid provider fraud and nursing home related investigations for the Office of the Attorney General's Medicaid Fraud Control Unit (MFCU). Work involves conducting criminal investigations of violations of various state and federal statutes and prosecution assistance as needed. OAG employees enjoy excellent benefits along with tremendous opportunities to do important work and make a positive difference in the lives of all Texans.

The OAG is a dynamic state agency with over 4,000 employees throughout the State of Texas. As the State's law firm, the OAG provides exemplary legal representation in diverse areas of law. OAG employees enjoy excellent benefits (https : / / ers.texas.gov / Benefits-at-a-Glance) along with tremendous opportunities to do important work at a large, dynamic state agency making a positive difference in the lives of Texans.

JOB POSTING NOTICE

Applicants for this position should be prepared to pass a background investigation. Applicants will also be subject to a motor vehicle registration check. The MFCU works cases jointly with other law enforcement agencies including the FBI, U.S. Department of Health and Human Services - Inspector General and IRS. In certain cases, it is necessary for our staff to have a Top Secret security clearance in order to fully participate in joint investigations or in task force activities. Top Secret clearances are not required prior to employment but in certain cases may be required at a later date. Since most security clearance problems arise from criminal records or unresolved bad credit issues, full criminal and credit checks will be run on all applicants prior to employment.

ESSENTIAL POSITION FUNCTIONS

Conducts complex criminal investigations of Medicaid provider fraud, and / or assures that nursing home related investigations are addressed professionally and in a timely manner, utilizing a wide range of techniques, with the goal of accomplishing the primary mission of MFCU, bringing violators of state and federal law, over which MFCU has jurisdiction, to justice, and identifying Medicaid and Medicaid related overpayments to Medicaid providers
Plans, participates in and conducts undercover investigations, surveillance operations, raids, and searches; identifies, gathers, and examines evidence, including complex records of Medicaid providers; executes court orders, warrants, and subpoenas; and reports investigative findings
Establishes and maintains liaison with outside agencies, associations, groups, and the like whose assistance and cooperation can enhance the mission of MFCU, including but not limited to proactive generation of investigative targets; participates willingly in team investigative endeavors (intra-Team, inter-Team, inter-city, and inter-agency); and contributes to a positive work environment and high morale
May train, lead, and / or assist with the work of others.
Performs related work as assigned
Responds to emergency situations by serving on-call twenty-four hours per day / seven days per week
Maintains relevant knowledge necessary to perform essential job functions
Attends work regularly in compliance with agreed-upon work schedule
Ensures security and confidentiality of sensitive and / or protected information
Complies with all agency policies and procedures, including those pertaining to ethics and integrity

Qualifications :

MINIMUM QUALIFICATIONS

Education : Graduation from high school or equivalent

Education : Sixty credit hours from an accredited college or university; may substitute an associate's or bachelor's degree from an accredited college or university; or full-time investigations; law enforcement; auditing; accounting; compliance monitoring in Medicaid, Medicare, health care insurance, or closely related experience for the required education on a year-for-year basis

Experience : Four years full time criminal investigative experience as a licensed peace officer or comparable federal law enforcement officer

TCOLE certification

Knowledge of TCOLE training requirements and healthcare fraud investigation training needs

Knowledge of Microsoft Office products (i.e. Word, Excel, PowerPoint, Outlook)

Knowledge of criminal investigative principles, techniques, and methodologies

Knowledge of management and administrative principles, techniques, and methodologies

Knowledge of agency goals, objectives, rules, regulations, policies, and procedures

Knowledge of state and federal statutes, rules, and regulations pertaining to law enforcement activities

Knowledge of criminal and civil court proceedings and rules of evidence

Skill in effective oral and written communication (Writing sample will be required at time of interview, if selected)

Skill in researching and interpreting complex rules and regulations

Skill in applying investigative techniques and procedures

Skill in handling multiple tasks, prioritizing, and meeting deadlines

Skill in exercising sound judgment and effective decision making

Ability to develop and implement strategic plans and budgets

Ability to use and care for firearms

Ability to use intermediate impact weapons and Oleoresin Capsicum spray

Ability to use physical tactics

Ability to conduct complex criminal investigations of Medicaid provider fraud and nursing home related investigations

Ability to interpret and apply applicable provisions of the Texas Penal Code, the Texas Code of Criminal Procedure, and federal statutes pertaining to investigations

Ability to interpret and apply department policies and procedures

Ability to plan, assign, and supervise the work of others

Ability to handle stressful situations

Ability to receive and respond positively to constructive feedback

Ability to work cooperatively in a professional office environment

Ability to provide excellent customer service

Ability to work in person at assigned OAG work location, perform all assigned tasks at designated OAG work space within OAG work location, and perform in-person work with coworkers (e.g., collaborating, training, mentoring) for the entirety of every work week (unless on approved leave)

Ability to arrange for personal transportation for business-related travel, with reimbursement

Ability to work more than 40 hours as needed and in compliance with FLSA

Ability to lift and relocate 30 lbs.

Ability to travel (including overnight travel) up to 20%

Ability to achieve 64% or better of VO2 max on the 2000-meter row, or meet a minimum score of 64% on the 500-meter row test or 4-minute row test, utilizing a Concept 2 Rower

PREFERRED QUALIFICATIONS

Experience conducting white collar / economic crime investigations

Experience investigating healthcare provider fraud and working with state and federal prosecutors in criminal matters

Accomplished practitioner of the MFCU documentation and report writing system or a like system

Knowledge of healthcare fraud statutes (state and federal)

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