Criminal Justice Division Medicaid Fraud Control Unit – Hauppauge (Suffolk County)Medical Analyst, Opportunity for Registered NursesReference No. MFCU_HAU_ MA_6369Salary is $80,537 + $3,400 in location pay To be considered for this opportunity, submit a complete application online at ag.ny.gov/job-postings/other

The Office of the New York State Attorney General’s (OAG) Medicaid Fraud Control Unit (MFCU) is seeking an experienced Registered Nurse to serve as a Medical Analyst in its Hauppauge office. Medical Analysts support the unit by working in partnership with its attorneys, auditors, detectives, data analysts, and legal support analysts to conduct complex, long-term healthcare fraud investigations.

Possessing both civil and criminal enforcement powers, MFCU uses various state laws to bring civil actions and criminal proceedings, including asset forfeiture actions. Many of the unit’s investigations are conducted in coordination with other federal, state, or local government and prosecutorial agencies, and have resulted in large-scale criminal convictions and the recovery of millions of dollars of taxpayer money.

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Several matters that highlight MFCU’s important work include OAG’s report concerning neglect of nursing home residents across New York state during the COVID-19 pandemic, and the recent filing of four major lawsuits against nursing homes, including Centers Health Care, Cold Spring Hills Center for Nursing and Rehabilitation, The Villages of Orleans Health and Rehabilitation Center, and Fulton Commons Care Center, Inc.

Additional recent significant cases include the: indictment of a Long Island physician for defrauding Medicaid and subjecting patients to invasive and unnecessary testing, conviction of former fugitive dentist for Medicaid Fraud, and prosecution and convictions of persons involved in a homicide and cover up at a nursing home in Suffolk County.

Duties:
• Assisting with screening and evaluating complaints of abuse and neglect for initial follow-up, identifying aberrant diagnoses and treatments, and aiding staff in understanding medical terminology and billing codes;
• Identifying and reviewing medical records and analyzing medical documentation to identify potential fraud, abuse, mistreatment and neglect, including testifying as to such analyses in grand jury proceedings and trials;
• Assisting detectives in field interviews of medical personnel and experts;
• Aiding attorneys in recruiting and preparing health care witnesses (pharmacists, nurses, aides, administrators, physicians, dentists, etc.) for legal proceedings, including grand jury or trial;
• Supporting attorneys in preparing for legal proceedings and reviewing legal documents for proper medical terminology;
• Monitoring the development and revision of professional standards within nursing and other medical fields of relevance to the unit’s mission and advising attorneys and others on such developments and revisions; and
• Interacting with professional boards and regulatory groups as directed by attorneys in furtherance of the unit’s mission.

Preferred Skills and Experience:
• Nursing administration (e.g., Director of Nursing, Administrator, Risk Manager, In-Service Coordinator), including current or past employment within a long-term care facility;
• Conducting investigations related to resident abuse, mistreatment, or neglect, as well as quality assurance issues;
• Case management, MDS 3.0 Resident Assessment, and/or managed care;
• Prior experience as a legal nurse consultant; and
• Knowledge of state and federal rules and regulations related to health care, particularly the Medicaid program.

Candidates from diverse backgrounds are encouraged to apply. The OAG is an equal opportunity employer and is committed to workplace diversity.