Fraud Investigator (Medicare & Medicaid) for Catapult Consultants

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Medicare and Medicaid Fraud Investigator at Catapult Consultants

Introduction: Catapult Consultants, a leader in the field of program integrity, is currently seeking a meticulous and experienced Fraud Investigator specializing in Medicare and Medicaid billing. This challenging position involves working collaboratively within a multidisciplinary team to uncover instances of fraud, waste, and abuse in billing by healthcare providers. The individual will play a crucial role in developing complex cases that may involve high financial stakes, sensitive issues, or necessitate referral to law enforcement.

Position Details:

  1. Location and Schedule:
    • Full-time position with comprehensive benefits
    • Office locations in Brookfield, WI; Lisle, IL; Bingham Farms, MI; Grove City, OH; or Omaha, NE
    • Qualified candidates with health care program integrity experience may be eligible for remote work in specified states
  2. Qualifications:
    • High School diploma required
    • Minimum of 1 year of experience in program integrity investigation or a related field
    • Valid driver’s license required
    • Intermediate knowledge of Microsoft Word, Excel, Outlook, and PowerPoint
    • Highly-motivated, detail-oriented professional with excellent analytical, organizational, verbal & written communication, and follow-up skills
  3. Preferred Qualifications:
    • Bachelor’s or Master’s degree in Criminal Justice, Statistics, Data Analysis, Accounting, Finance, Healthcare, or Business-related field
    • Certified Fraud Examiner (CFE) certification
    • Knowledge of statistics, data analysis techniques, and advanced computer skills
    • Experience in fraud detection and investigation within the Medicare program
    • Experience working with a Medicaid program in specified states


  1. Independent Investigations:
    • Conducts thorough investigations in response to potential fraud, waste, or abuse situations.
  2. Data Analysis:
    • Utilizes data analysis techniques to detect aberrancies in Medicare claims data and proactively develops leads from various sources.
  3. Referral and Recoupment:
    • Completes written referrals to law enforcement and initiates recoupment of overpaid monies.
  4. Coordination:
    • Refers instances of unethical or improper practices to appropriate entities and coordinates with state programs for Medicaid-related issues.
  5. Information Sharing:
    • Responds to requests for information from law enforcement and maintains cases referred to them.
  6. Fraud Determinations:
    • Makes potential fraud determinations using internal guidelines and relevant regulations.
  7. Alerts and Vulnerabilities:
    • Develops and prepares Fraud Alerts and Program Vulnerabilities for submission to CMS.
  8. Stakeholder Engagement:
    • Collaborates with Medicare contractors, law enforcement, and other stakeholders, sharing information on ongoing investigations.
  9. Administrative Actions:
    • Pursues applicable administrative actions during investigation/case development.
  10. Documentation and Reporting:
    • Maintains chain of custody on all documents, follows confidentiality guidelines, and compiles necessary documentation.
  11. Support and Other Duties:
    • Provides support for cases at hearing/appeal and ALJ level and performs additional duties contributing to UPIC goals and objectives as assigned by PI Management.

Catapult Consultants is offering an exciting opportunity for a motivated and skilled individual to contribute to the crucial task of ensuring program integrity in Medicare and Medicaid billing. If you meet the qualifications and seek a challenging yet rewarding role, apply now through Catapult Consultants. Remember, jobs fill quickly!

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