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Forensic Sciences, Digital, and Financial Crime

Criminal Enforcement Attorney, Medicaid Investigations, Attorney III (60010505)

US Government, Dept of Justice

Wake County, North Carolina, USA
  • Full Time
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As of June 1, 2023 the salary range for this position will be $84,878 to $148,547.
This position is reposted Current applicants are still under consideration and do not need to reapply.
THE STARTING SALARY FOR A NEW HIRE TO THIS POSITION IS LIMITED TO THE RECRUITMENT RANGE OF $82,808 to $96,326. Salary offers for the selected candidate are based on the candidate’s education and experience related to the position, as well as our agency budget and equity.
Note to Current State Employees:
The salary grade for this position is LG08.  State employees are encouraged to apply for positions of interest even if the salary grade is the same as, or lower than, their current position.  Please detail ALL work history including non-state service experience.  If selected for this position, a new salary will be recalculated taking into consideration the quantity of relevant education and experience, funding availability, and internal equity. Based upon these factors, a pay increase MAY or MAY NOT result.  
This position is not-subject to the Fair Labor Standards Act.
This position is located in the Medicaid Investigations Division of the Department of Justice.  The Attorney General’s Medicaid Investigations Division investigates and prosecutes health care fraud committed by Medicaid providers and the physical abuse of patients and embezzlement of patient funds in Medicaid-funded facilities. These cases protect and recover taxpayers dollars that can be used to provide needed medical services to Medicaid enrollees.  These cases also protect our most vulnerable elderly and disabled citizens.
MID receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,106,236 for Federal fiscal year (FY) 2022. The remaining 25 percent, totaling $2,035,412 for FY 2022, is funded by the State of North Carolina.
The primary purpose of the Criminal Enforcement Attorney position is to prosecute criminal cases and assist with criminal investigations. The criminal cases involve Medicaid fraud, patient abuse, and/or misappropriation of patient funds. The Criminal Section will bring state and federal actions against Medicaid providers alleged to have committed complex health care fraud schemes. 
The Criminal Enforcement Attorney position is also one of the attorney positions that fulfills the staff requirements of a MFCU contained in Title 42 of the Code of Federal Regulations, Section 1007.13(a)(1), which mandates that the MFCU staff must include “one or more attorneys experienced in the investigation or prosecution of civil fraud or criminal cases, who are capable of giving informed advice in applicable law and procedures and providing effective prosecution or liaison with other prosecutors.”

The allegations investigated include the submission of fraudulent claims to the Medicaid Program for services or supplies not rendered, billing for a higher level of service than was actually provided, double billing, soliciting or paying kickbacks, billing for a service the provider knows is not medically necessary, and cost report fraud. Allegations investigated also include patient abuse and neglect and the misappropriation of patient funds.

Medicaid Investigations Division (MID) is staffed by Department of Justice attorneys, investigators, auditors, analysts, and a nurse investigator, paralegals, and administrative staff.  MID provides state and national training opportunities to aid employees in understanding the complexities of health care fraud investigations.  Cases are tried in state and federal court in partnership with law enforcement agents with federal and state agencies such the Office of Inspector General, FBI, IRS, NC SBI, Sheriffs’ Offices, and Police Departments.

Over the past decade, the NC MID has recovered more than $20 million per year for the past three years and helped win more than 450 criminal convictions in health care fraud and abuse cases.

The Criminal Section conducts investigations and brings state and federal actions against Medicaid providers alleged to have committed complex health care fraud schemes.

Duties include:

  • Thoroughly review all pertinent information relating to cases referred to the Division or generated by the Division.
  • Ensure investigations are conducted within the parameters and in accordance with current state and federal laws and court rulings which are often complicated and technical in nature.
  • Determine whether there is a criminal violation of the law by thorough and precise analysis, research of documentary evidence, and interviews.
  • Analyze, review and prepare state and federal arrest warrants, indictments, and other pleadings necessary to the successful prosecution of charges initiated by the Division.
  • Supervise the preparation of cases being presented in state or federal court.
  • Work with investigators to investigate cases and gather sufficient evidence to support the filing of a state or federal indictment or warrant,
  • Prepare discovery and analyze and respond to discovery requests, and ensure that all discovery is provided as required by law.
  • Perform legal research in the field of health care fraud and investigations including precedent setting arguments.
  • Organize trial documents to insure their admissibility and to make them understandable to the court and jury.
  • Pursue cases in state court as a Special Prosecutor or in federal court as a SAUSA or may pursue the case jointly in state or federal court with Assistant District Attorneys or Assistant United States Attorneys.
  • Negotiate criminal pleas in complex criminal actions, prepare agreements for criminal restitution, and analyze financial settlements proposed by opposing counsel.
  • Pursue and assist in the recovery of damages and penalties from Medicaid providers who have committed fraud by bringing and supporting state and federal forfeiture proceedings.
  • Lead parallel criminal actions and provide direction to the investigators on the criminal aspects of the matter.
  • Provide consultation and advice to the Criminal Chief and Director; keep the Director and Criminal Chief apprised of important developments in criminal cases.

This position requires travel which may include overnight stays.
This position requires some overtime.The North Carolina Department of Justice provides excellent representation and support to law enforcement, consumers, the State, and its people through teamwork, innovation, and a commitment to public service.

The State of North Carolina offers employer paid health insurance plus twelve paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at Employee Benefits.  

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