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Under direction of Chief, Medi-Cal Fraud Unit, to plan, organize and supervise the statewide investigation of fraud by providers of services in the Medi-Cal Program and in the administration of the Medi-Cal Program; to develop and implement innovative solutions to difficult administrative problems involving criminal violations connected with the California Medical Assistance Program; to evaluate investigations and related audits and to recommend criminal, civil, and administrative action; to do other related work.
Directs a multidisciplinary staff of investigators, auditors, and field representatives to investigate criminal violations in connection with the providing of services under Medi-Cal Program; in close coordination with the Department of Health Services, assists in developing and implementing a system of selective surveillance; coordinates closely with the Department of Health Services and with the fiscal intermediaries in analysis of program utilization patterns and practices with a view toward identifying areas of criminal violations; identifies computerized data maintained by the fiscal intermediary which indicates fraudulent practices on the part of a provider of Medi-Cal services, and arranges to obtain such data in the most useful possible form and at a minimum cost to the Unit; develops liaison with the United States Department of Health and Human Services and to Medicaid Fraud Units in other states to ensure coordination of investigative efforts; supervises the assignment of specific cases for follow-up criminal investigations which may lead to criminal prosecution or to civil or administrative action; develops support for the Units enforcement activities through contact with District Attorneys, U.S. Attorney's Office, and other governmental agencies; develops and recommends solutions to administrative problems involved in the field of Health Care Program investigations and implements changes to meet changing conditions; provides overall administrative guidance of auditors, investigators and field representatives to ensure uniform adherence to departmental policy and the overall attainment of the Unit's program objectives; recommends changes in existing legislation and proposes new legislation; analyzes budget and personnel needs; selects and trains staff members; evaluates the performance of staff members and takes appropriate action; represents the Unit at meetings and hearings; prepares reports and correspondence.
Experience: One year of experience in the California state service performing the duties of a supervisory investigative class such as Special Agent IV, Department of Justice, or a Supervising Special Investigator II.
1. Five years of progressively responsible experience in major white collar or medical investigations, such as fraud or conspiracy, at least two years of which have been supervising investigators in the preparation and formal presentation of the most complex cases in a major governmental-sponsored medical care program. or
2. Five years of progressively responsible investigative experience, at least two years of which shall have been in a supervising capacity with an agency such as the Federal Bureau of Investigation, the U.S. Treasury Department, the State Department of Justice, a District Attorney's Office, or similar governmental organization.
(Experience in the California state service applied toward this requirement must have included two years performing the duties of a class comparable to Supervising Special Investigator II.) and
Education: Equivalent to graduation from college. (Additional qualifying experience may be substituted for four years of the required education on a year-for-year basis.)
Knowledge of: Investigation techniques and procedures, rules of evidence and court procedures, principles of identification, preservation and presentation of evidence; sources of information used in locating persons; laws of arrest, search, and seizure, service of legal papers and the legal rights of citizens; State and local law enforcement agencies; accounting practices and procedures; business practices and medical care organizations and medical services firms; principles and techniques of personnel management and supervision; current trends in organization and management theory and practices; Department's Affirmative Action Program objectives; a manager's role in the Affirmative Action Program and the processes available to meet affirmative action objectives.
Ability to: Direct the work of multidisciplinary staff; develop innovative solutions to difficult administrative problems related in the field of health program, surveillance and to implement changes to meet changing conditions; interpret and apply to specific cases the provisions of the laws, rules, and regulations enforced or administered; establish and maintain close working relationships with persons and agencies such as those in the professional medical, legal, and investigative fields; analyze situations accurately; identify and take corrective administrative action on specific problems; speak and write effectively, prepare correspondence and prepare and review reports; effectively contribute to the Department's affirmative action objectives.
Demonstrated administrative ability and capacity for assuming progressively greater and broader responsibilities as evidenced by recent employment history and self-development efforts; willingness to travel throughout the State and work irregular hours; tact; good judgment; good memory for names, faces, and incidents; ability to qualify for a fiduciary bond.