Medical Fraud Investigators play a key role in preventing the occurrence of financial fraud and the unlawful receipt of funds in health care sector. They are responsible to review and analyze suspicious medical claims filed by patients, medical personnel and insurance agencies.
Medical Fraud Investigators use a variety of tools to initiate investigations, identify suspects, collect the accurate data, secure evidences and develop cases for future action including referral to law enforcement, education, over payment recovery and other administrative actions in case of any medical fraud . They also serve as a witness in criminal and civil proceedings in connection to this malpractice.
Medical Fraud Investigators work at FBI, federal government and various private organizations.
Educational Requirements:
To become a Medical Fraud Investigator, the aspiring candidates need to hold a Bachelor’s degree related to criminal justice or health care.
The course work of Bachelor’s degree programs in health care administration includes health facilities operations, budgeting, medical billing and health care records while Criminal justice covers the area of policing strategies, judicial process, investigative techniques, crime prevention and crisis management.
Students can also go for a Master’s degree in related field or a Law degree to get better job opportunities in this field.
Certification and Licensure
Since most states of USA require a Medical Fraud Investigator to be licensed, the aspiring candidates need to pass a licensing exam and complete a state-approved training program. The Association of Certified Fraud Examiners (ACFE) or the National Health Care Anti-Fraud offers certification which also requires passing an examination.
Skill set
Medical Fraud Investigators possess wide range of knowledge in various fields such as health laws finance, governing regulations and medical terminology. In addition they hold various traits such as analytical and problem solving capacity, expertise in investigation, effective communication and interpersonal skills, ability to remain calm under pressure, work without supervision, interpret laws and regulations, conduct interviews, computer skills etc.
Job Outlook and Salary
The job outlook for a Medical Fraud Investigator remains excellent across the USA. According to U.S. Bureau of Labor Statistics (BLS), the growth rate for job opportunities in this profession may rise 3 percent from 2012 to 2022. The average annual salary of a Medical Fraud Investigator was $59,850 in 2012.