Senior Healthcare Fraud Investigator

Zachary Piper Solutions is seeking a Senior Healthcare Fraud Investigator to support the DVA VHA in establishing and operating a high-visibility Fraud Rapid Response Center. This mission-driven initiative focuses on accelerating the identification and response to healthcare fraud, waste, and abuse (FWA) to protect Veterans and safeguard taxpayer dollars. The Senior Healthcare Fraud Investigator will lead fraud lead and case development by reviewing analytics-generated leads, developing supporting evidence and documentation, and preparing decision-ready referral packages for government review. This role offers the opportunity to apply extensive federal healthcare fraud investigation experience to a high-profile initiative with significant executive visibility.

Responsibilities of the Senior Healthcare Fraud Investigator include:

• Review and validate fraud, waste, and abuse leads generated by War Room analytics, including Provider 360 insights, anomaly detection, and network analysis.
• Develop potential healthcare fraud cases involving community care providers, suspicious billing patterns, coordinated schemes, and other program integrity vulnerabilities.
• Prepare comprehensive War Room referral packages with supporting evidence and documentation for potential administrative actions, including provider removals, referral holds, recoupments, and referrals to appropriate oversight bodies.
• Support weekly analytic runs and decision-ready case packages that clearly document facts, analysis, recommendations, and traceable supporting evidence.
• Prepare claim review workpapers and determination packages, applying case-file quality assurance checklists and sampling plans.
• Help design and refine end-to-end case management workflows, including intake, triage, handoffs, service-level agreements (SLAs), escalation paths, and case closure procedures.
• Contribute to intake and triage SOPs, case lifecycle definitions, status taxonomies, and standardized investigation templates aligned with CIRTS practices.
• Maintain accurate tracking registers for overpayments, recoveries, referrals, and case status, along with oversight and tracking logs.
• Provide investigative subject-matter expertise to inform fraud scheme typologies, analytical business rules, provider risk scoring, and case prioritization criteria.
• Perform case documentation and evidence-related work only under active direction from a federal investigator; investigative findings, case-opening decisions, and referral decisions remain with authorized government personnel.
• Collaborate with OIC, VA Office of Inspector General (OIG), and VHA stakeholders to support program integrity activities and case development.
• Prepare ad hoc white papers, outcome summaries, and leadership briefings for senior stakeholders.
• Support training materials, continuous improvement sessions, after-action reviews, and knowledge transfer to help VA personnel sustain War Room operations.

Qualifications of the Senior Healthcare Fraud Investigator include:

• Bachelor's degree in a relevant field.
• Active Public Trust Clearance
• 8+ years of federal healthcare program integrity and fraud investigations experience, including experience with Medicare, Medicaid, VHA healthcare fraud referrals, or related case development.
• Working knowledge of healthcare fraud laws and authorities, including the False Claims Act, Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law, and HHS OIG exclusion authorities.
• Experience reviewing fraud leads, developing case documentation, organizing supporting evidence, and preparing referrals or investigative packages.
• Strong written and verbal communication skills, including the ability to present findings and recommendations to executive-level audiences.
• Ability to pass or hold a Tier 2 / Moderate Background Investigation (MBI).

Desired Qualifications:

• Certified Fraud Examiner (CFE) certification.
• Current or prior VA/VHA system access or active VA contractor status.
• Experience working with HHS OIG, VA OIG, or other federal law enforcement agencies on healthcare fraud referrals.
• Experience with VA Community Care claims, CMS program integrity data, or provider exclusion screening.
• Familiarity with Palantir or comparable analytics and case management platforms.
• Experience with CIRTS or similar compliance and case-tracking systems.
• Knowledge of the GAO Green Book, OMB Circular A-123, and Payment Integrity Information Act fraud risk frameworks.

Compensation for the Senior Healthcare Fraud Investigator includes:

• Salary range of $105,000-$115,000 annually , depending on experience and qualifications.
• Remote work arrangement with on-site requirements as needed.
• Initial 9-month engagement, with potential follow-on opportunities that are not guaranteed.

Keywords: Senior Healthcare Fraud Investigator, Healthcare Fraud Investigations, Federal Healthcare, Fraud Waste and Abuse, FWA, Healthcare Program Integrity, Medicare Fraud, Medicaid Fraud, VHA, VA, VA Community Care, CMS, HHS OIG, VA OIG, Fraud Referrals, Case Development, Investigative Documentation, Claims Review, Provider Fraud, Coordinated Billing Schemes, False Claims Act, Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law, HHS OIG Exclusion Authorities, Palantir, Provider 360, Anomaly Detection, Network Analysis, CIRTS, Overpayment Recovery, Referral Packages, Quality Assurance, GAO Green Book, OMB Circular A-123, Payment Integrity, Public Trust, Tier 2 MBI.

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