​Fraud Investigator, Department of Health Care Services Series

California State Personnel Board Specification

Series established February 23, 2000

Scope

This series specification describes two Fraud Investigator classes used by the Department of Health Care Services, Audits and Investigations, Investigations Branch. This series is used for positions that conduct and supervise criminal/civil investigations into allegations of fraud perpetrated against the California Medical Assistance Program (Medi-Cal) and other programs under the purview of the Department of Health Care Services. Subordinates may be assigned to provide technical assistance and training to local, State, and Federal law enforcement and social services agencies. Investigators perform the full range of peace officer duties and responsibilities in the accomplishment of their assignments.

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Definition of Series

Supervisors supervise criminal/civil investigations into violations of fraud against the Medi-Cal Program and various other Departmental programs. This includes the following: investigations into organized criminal activity and assist in the prosecution of cases involving organized criminal activity by Medi-Cal beneficiaries; investigate violations of laws and regulations pertaining to Medi-Cal; conduct preliminary criminal fraud investigations of Medi-Cal providers; investigate cases involving the diversion of legally manufactured controlled substances for illicit use and sale by beneficiaries; investigate the illegal use of Medi-Cal documents to fraudulently obtain controlled substances; investigate criminal fraud in the Vital Statistics Program which involves illegal trafficking of vital statistic documents; investigate illegal use of Medi-Cal documents to obtain medical services; conduct internal investigations; confer with Deputy District Attorneys, City District Attorneys, and Attorney Generals in preparing cases for court; plan and coordinate Medi-Cal enforcement activity involving State, Federal, and local enforcement and regulatory personnel; confer with local, State, and Federal law enforcement officers and allied health agency officials on the conduct of Medi-Cal investigations; provide training and technical assistance on the latest techniques of enforcement and investigation of criminal fraud to State, Federal, and local enforcement and regulatory agencies; conduct background investigations on peace officer candidates; effect arrests of law violators; and gather intelligence data.

Definition of Leve​​ls

Supervising Fraud Investigator I, De​​​partment of Health Care Services

Incumbents in this class function as a working supervisor directing a team of three or more investigators working in the field and/or representatives of other law enforcement agencies; or assisting the Supervising Fraud Investigator II, Department of Health Care Services, in planning the regional Medi-Cal investigation program and to act for the Supervising Fraud Investigator II, Department of Health Care Services, in his/her absence. Incumbents can work closely with other law enforcement and regulatory agencies both to coordinate their respective investigative efforts on given cases and to provide high-level technical advice and training in investigation and enforcement activities.

Supervising Fraud Investigator II, Department of Health Car​​​e Services

Incumbents in this class function as the manager responsible for planning, organizing, and directing the law enforcement programs in a designated geographical area of the State; and have full fiscal responsibility relative to the budget. Incumbents oversee the implementation of a training program for local and Federal law enforcement agencies in their region. Incumbents may assist in administering a specialized program or project within the Investigations Branch.

Minimum Qualific​​ations

Supervising Fraud Investigator I, Department of He​​alth Care Services

All Levels​​

Applicants may be admitted into the examination without meeting all of the requirements in this section, but the applicant must meet those requirements prior to appointment.

Must meet the peace officer selection standards developed by the Commission on Peace Officer Standards and Training per Penal Code section 13510(a) and in accordance with existing law; and

Firearm Conviction Disqualification: Anyone who is restricted for employment-related purposes from accessing, possessing, carrying, receiving, or having under their control a firearm or ammunition under all applicable State or Federal laws is ineligible for appointment to any position in these classifications; and

POST Training Requirements: Under Penal Code Section 832, successful completion of a training course in laws of arrest, search and seizure, and in firearms and chemical agents is a requirement for permanent status in these classifications; and

Either I​

​Experience: Two years of experience performing investigative duties in the California state service in a class with a level of responsibility not less than that of an Investigator, Range B.

Or ​II

​Experience: Three years of experience as a peace officer in an investigative assignment performing criminal investigations including or supplemented by one year of supervisory experience. and

Education: Equivalent to two years of college with a major in criminal justice, law enforcement, or criminology. Evidence of satisfactory completion of courses in the following subject areas: introduction to criminal justice, introduction to criminal law, basic investigation, evidence, criminal procedure, and philosophy of law.

Supervising Fraud​​​ Investigator II, Department of Health Care Services

Either I​

​Experience: Two years of experience performing investigative duties in the California state service in a class with a level of responsibility not less than that of a Supervising Fraud Investigator I, Department of Health Care Services.

Or ​​II

​Experience: Five years of increasingly responsible experience as a peace officer in an investigative assignment performing criminal investigations, at least two years of which must have been in a supervisory capacity. (Experience in the California state service applied toward this requirement must include at least two years performing the duties of a class at a level of responsibility not less than that of a Supervising Fraud Investigator I, Department of Health Care Services.) and

Education: Equivalent to two years of college with a major in criminal justice, law enforcement, or criminology. Evidence of satisfactory completion of courses in the following subject areas: introduction to criminal justice, introduction to criminal law, basic investigation, evidence, criminal procedure, and philosophy of law.

Knowledge and Ab​ilities

Supervising Fraud Investigator I, Department ​of Health Care Services

Knowledge of: Civil and criminal investigation techniques and interview and interrogation processes and procedures; provisions of the California Penal Code, Code of Civil Procedures; Evidence Code; the State Controlled Substances Act; Health and Safety Code, Welfare and Institutions Code, Code of Federal Regulations, the Federal Social Security Act, the Immigration and Naturalization Act, and other State and Federal laws pertaining to crimes committed against Medi-Cal and other related programs; the relative functions and duties of other Federal, State, and local law enforcement and regulatory agencies; the State and Federal criminal justice system; the securing and preservation of evidence; general training techniques and methods as applied to police officer training; laws of arrest, and search and seizure; principles and techniques of supervision; advanced peace officer training techniques and methods; applicable collective bargaining memorandum of understanding and related issues; State, Department, and Branch policies and procedures; disciplinary guidelines and personnel rules; and a manager's/supervisor's responsibility for promoting equal opportunity in hiring and employee development and promotion, and for maintaining a work environment that is free of discrimination and harassment; communication and active listening skills; behaviors indicative of potential hostility; techniques for effective interaction with diverse communities; how to approach problems with cultural awareness and sensitivity; cultural differences and similarities; implicit and explicit biases; community engagement and strategies and the benefits of effective community engagement; reporting obligations when biased behavior or misconduct is observed; characteristics protected under the Racial and Identity Profiling Act.

Ability to: Develop techniques, methods, and skills and apply applicable laws required to conduct civil and criminal investigations; effectively make use of the computerized data maintained by the State and fiscal intermediaries; read computerized data and discern patterns of fraud; apply laws to specific situations; gather and analyze facts and evidence and present such evidence as required; analyze situations accurately and take effective action; participate actively in extended surveillance, interviews, and interrogations; use sophisticated surveillance equipment; effect arrests; effectively control informants and paid operants; appear as an expert witness; proficiently use and maintain firearms; file complaints, and serve criminal subpoenas and subpoena duces tecums; write and execute search and arrest warrants; prepare factual reports; provide technical assistance to and conduct training for appropriate law enforcement and allied health agencies; communicate effectively before groups; establish and maintain cooperative working relationships; plan, direct, and conduct the most difficult and complex civil and criminal investigations; plan for and allocate resources to achieve program goals and objectives; effectively supervise the work of a group of Fraud Investigators, Department of Health Care Services, other law enforcement personnel, and support staff; review and monitor cases for efficient and effective progress; provide high-level technical advice and training to local, State, and Federal law enforcement personnel and social service agencies; initiate and review personnel matters; and effectively promote equal opportunity employment and maintain a work environment that is free of discrimination and harassment; be open-minded, flexible, and willing to learn and understand other cultures; social and cultural perceptiveness; seek clarifying questions to get a better understanding of the issue(s); maintain neutrality; identify effective ways to communicate and/or provide support; work cooperatively with various cultural backgrounds and others in the community; defuse, negotiate, and resolve conflicts; recognize and respect diversity through words and actions; effectively investigate allegations of misconduct pursuant to departmental policy; treat all people with respect and in an unbiased and unprejudiced manner; recruit qualified individuals who understand and demonstrate respect for diverse communities.

Supervising Fraud In​​vestigator II, Department of Health Care Services

Knowledge of: All of above, and techniques and methods involved in administering specialized investigative and enforcement programs; implementing training programs and intelligence exchange with multijurisdictional agencies; current management theories and methods of production evaluation; and organization and functions of the Department of Health Care Services, and other local, State, and Federal agencies.

Ability to: All of the above, and administer and manage a law enforcement program relative to Medi-Cal and other programs in a designated geographical area; implement training programs; assist in the formulation of Branch policy; assist in administering specialized investigator training programs statewide; address public and private groups regarding the Branch's mission and purpose; and utilize effective and contemporary methods of sound fiscal management.

Special Personal Cha​​racteristics

Both Levels:​

Willingness to work in various locations throughout the State and at odd and irregular hours; keenness of observation; good memory for names, faces, places, and incidents; emotional stability; tact; willingness to associate with criminally inclined persons and environments in performance of duties; satisfactory record as a law-abiding citizen; possession of a valid driver license issued by the Department of Motor Vehicles; willingness to use all appropriate means, including deadly force, to carry out peace officer duties; ability to work under stress and adverse conditions; exercise good judgment; demonstrate good work habits; and satisfactory completion, as a condition of probation, of all training prescribed by POST.

Special Physical Cha​​racteristics

Both Levels:​

Possession and maintenance of sufficient strength, endurance and agility necessary to perform the essential functions of the job with or without reasonable accommodation; hearing, vision and color vision sufficient to perform the essential functions of the job with or without reasonable accommodation.

Additional Desirable ​​Characteristics

Both Levels:​

In addition to the above knowledge and abilities, possession of the appropriate certificates as evidence of increased competency at each level and evidence of completed coursework in the following subjects: introduction to criminal justice, introduction to criminal law, basic investigation, evidence, criminal procedure, and philosophy of law.

Class His​tory​