How to Become a Medicare Fraud Investigator
- Get a bachelor's degree in a field related to fraud, such as accounting and auditing, criminal justice, criminology or pre-law.
- Work two to three years in a fraud-related field. You'll need to get some basic fraud investigation experience before you'll be hired as a Medicare fraud investigator.
- Become a member of the Association of Certified Fraud Examiners or the National Health Care Anti-Fraud Association.
- Become certified as a fraud examiner or investigator. The ACFE offers certification as a Certified Fraud Examiner that requires passing a CFE exam and submitting an application, proof of ...
- Apply for Medicare fraud jobs with private organizations or with the federal government. ...
How do I get a job as a Medicare auditor?
You can apply directly for a government job through the Centers for Medicare and Medicaid Services (CMS) or you might find a job through a private company. If you advertise yourself as a ethical worker with strong computer skills, you may just get your perfect job as a Medicare auditor. Get an associate's or bachelor's degree.
How do I become a Medicare fraud investigator?
You'll need to get some basic fraud investigation experience before you'll be hired as a Medicare fraud investigator. This can include working as an accountant who specializes in fraud detection, an insurance adjuster, a criminologist in white-collar-crime detection, a lawyer who specializes in fraud or a fraud investigator for the police.
What is a Medicare fraud?
A provider that charges Medicare twice for a service or item that you only got once. A person who steals your Medicare number or card and uses it to submit fraudulent claims in your name. A company that offers you a Medicare drug plan that Medicare hasn’t approved.
How much money does a health care fraud investigator make?
There's plenty of work for health care fraud investigators to do. The employment website ZipRecruiter reports salaries that range from $22,000 to $115,500 , with a typical pay range for Medicare Fraud investigators of $32,000 to $56,000 . As with most jobs, various factors can affect earnings, including geographic location.
How do I get AHFI certification?
Professional Experience A minimum of two (2) years working in health care fraud detection and investigation as an employee of an organization eligible for NHCAA membership or a government agency PLUS a minimum of five (5) years of non-health care fraud investigative experience.
Who monitors Medicare fraud?
Government agencies, including the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), enforce these laws.
How do you start a fraud investigation?
7 Steps for Conducting a Fraud InvestigationStep 1: Receive and react to an allegation. ... Step 2: Establish an investigative team. ... Step 3: Conduct a preliminary assessment. ... Step 4: Preserve and collect evidence. ... Step 5: Analyze financial, business, and electronic records. ... Step 6: Conduct interviews. ... Step 7: Report the findings.
What does a healthcare investigator do?
Your duties include researching evidence and documents, interviewing the provider and patient, gathering information to review, analyzing claims, and producing reports with your final recommendations.
What is AKS in healthcare?
The federal Anti-Kickback Statute (AKS) (See 42 U.S.C. § 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs.
Who investigates false claims?
The Attorney General works to protect the state against fraud and other financial misconduct through the enforcement of the California False Claims Act.
What do fraud investigators look at?
A fraud investigation determines whether a scam has taken place and gathers evidence to protect the victims involved. Fraud is misrepresentation with the intent to deceive. For example, if a company makes a specific claim about a product and knows that the product won't work as promised, they are guilty of fraud.
How long does a fraud investigation take?
A fraud investigation can take up to 90 days and we will notify you once it's complete. In the meantime, we may contact you for additional information.
How long does it take to investigate a case of fraud?
Typically bank fraud investigations take up to 45 days.
What is the role of forensic investigators?
Forensic investigators help to solve crimes, working in close collaboration with law enforcement officials and other forensics professionals. They collect evidence such as fingerprints, bodily fluids and human tissue, detail crime scenes using photographs or drawings, and analyze evidence in laboratories.
What is a field investigator?
Field investigators, also known as private investigators, perform surveillance for law enforcement agencies or private clients. They are hired to observe a given situation, investigate a case, and provide physical evidence to validate the nature of happenings for a client.
What is health investigation?
healthcare investigation : healthcare activity element with the intention to clarify one or more health conditions of a subject of care.
What Does a Medicare Auditor Do?
As a Medicare auditor, you review health insurance information and documentation to ensure accuracy and locate errors or discrepancies. Your duties include reviewing billing and claims processes to ensure healthcare and medical service providers abide by Medicare regulations.
How to to Become a Medicare Auditor
The qualifications you need to become a Medicare auditor include a degree or equivalent experience and knowledge of Medicare rules and regulations. This career involves analyzing large amounts of information, so you need organizational and analytical skills.
How long does it take to become a Medicare fraud investigator?
Work two to three years in a fraud-related field. You'll need to get some basic fraud investigation experience before you'll be hired as a Medicare fraud investigator. This can include working as an accountant who specializes in fraud detection, an insurance adjuster, a criminologist in white-collar-crime detection, ...
What is Medicare fraud?
Medicare fraud occurs when physicians or organizations misrepresent themselves to get money from Medicare for services they didn't provide. For example, a doctor might bill for a service that he didn't perform so that he can get extra reimbursement money.
Who hires Medicare fraud investigators?
Private organizations also hire Medicare fraud investigators. One of them, Catapult Consultants, has a Healthcare Solutions division that offers Medicare and Medicaid compliance services and also works to identify, investigate, pursue and recover dollars for fraud and abuse.
How many years of school do I need to become a fraud investigator?
The NHCAA offers an accreditation as a Health Care Fraud Investigator that requires at least a high school degree, three years of professional experience, letters of reference, and passing the accreditation exam.
What Does a Medicare Fraud Investigator Do?
A Medicare fraud investigator studies cases related to the misuse of health care insurance. Your duties focus on collecting information on instances of suspected fraud. You review health care data and records to look for evidence of fraudulent activity.
How to to Become a Medicare Fraud Investigator
The qualifications you need to become a Medicare fraud investigator include a degree, investigative skills, and knowledge of Medicare rules and regulations. You can start on this career path in several different ways.
What does a Recovery Audit Contractor (RAC) do?
RAC's review claims on a post-payment basis. The RAC's detect and correct past improper payments so that CMS and Carriers, FIs, and MACs can implement actions that will prevent future improper payments.
What Topics do RAC's Review?
Stay in the know on proposed and approved topics that RAC's are able to review. These topics will be updated monthly on the RAC reviews topic page and include:
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