Senior Healthcare Fraud Investigator

Zachary Piper Solutions is seeking a Senior Healthcare Fraud Investigator to support a Government Consulting company supporting the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Integrity and Compliance (OIC). This position is 100% remote and focused on healthcare fraud lead development, case analysis, referral package development, and program integrity support for the VHA Fraud Rapid Response Center ("VA War Room").

Location(s): Remote (Local to Washington, DC)

Responsibilities of the Senior Healthcare Fraud Investigator:

• Review and validate fraud, waste, and abuse (FWA) leads generated through analytics platforms, including anomaly detection and network analysis tools
• Develop investigative case packages related to community care provider fraud, coordinated billing schemes, and healthcare program integrity concerns
• Build decision-ready referral packages supporting potential administrative actions, including provider removals, referral holds, recoupments, and oversight referrals
• Prepare claim review workpapers, determination packages, and quality assurance documentation
• Support case management workflow development, intake and triage procedures, case tracking, and status reporting
• Maintain overpayment recovery, referral tracking, and oversight reporting logs
• Provide subject matter expertise on healthcare fraud schemes, provider risk scoring, and case prioritization methodologies
• Collaborate with VA stakeholders, OIG personnel, and program leadership to support briefings, white papers, and operational reporting
• Assist with training materials, process improvement initiatives, and knowledge transfer activities

Qualifications for the Senior Healthcare Fraud Investigator:

• Bachelor's degree in a relevant field
• 8+ years of experience supporting federal healthcare program integrity, fraud investigations, healthcare fraud referrals, and case development
• Experience with Medicare, Medicaid, VHA healthcare programs, or related federal healthcare systems
• Working knowledge of the False Claims Act, Anti-Kickback Statute, Stark Law, Civil Monetary Penalties Law, and HHS OIG exclusion authorities
• Strong written and verbal communication skills for executive and senior leadership audiences
• Ability to pass or maintain a Tier 2 / Moderate Background Investigation (MBI)
• Experience supporting healthcare fraud referrals involving HHS OIG, VA OIG, or other federal oversight organizations preferred
• Familiarity with VA Community Care claims, provider exclusion screening, CMS program integrity data, or similar healthcare claims environments preferred
• Experience with Palantir or similar analytics, investigative, or case management platforms preferred
• Certified Fraud Examiner (CFE) certification preferred
• Knowledge of CIRTS, GAO Green Book, OMB A-123, or Payment Integrity Act fraud risk frameworks preferred

Compensation for the Senior Healthcare Fraud Investigator:

• Salary Range: ($105,000 - $115,000)
• Comprehensive Benefits: Medical, Dental, Vision, 401(k), Paid Time Off, Holidays, and additional company-sponsored benefits

This job opens for applications on October 9, 2026. Applications for this job will be accepted for at least 30 days from the posting date.

Keywords: Healthcare Fraud Investigator, Senior Healthcare Fraud Investigator, Fraud Waste and Abuse (FWA), Program Integrity, Healthcare Compliance, Government Healthcare Programs, Federal Healthcare Fraud, Healthcare Investigations, Administrative Investigations, Claims Analysis, Claims Review, Medical Claims Auditing, Provider Fraud, Provider Abuse, Provider Misconduct, Billing Fraud, Coordinated Billing Schemes, Upcoding, Unbundling, Phantom Billing, False Claims, Improper Payments, Payment Integrity, Overpayment Recovery, Recovery Audits, Recoupments, Fraud Detection, Fraud Analytics, Risk Analytics, Data Analytics, Anomaly Detection, Network Analysis, Predictive Analytics, Case Development, Investigative Case Management, Referral Development, Referral Packages, Decision Memorandums, Evidence Documentation, Investigative Workpapers, Determination Packages, Risk Assessments, Fraud Risk Management, Provider Risk Scoring, Case Prioritization, Healthcare Program Oversight, Internal Controls, Compliance Monitoring, Compliance Audits, Regulatory Compliance, Healthcare Regulations, Federal Regulations, Healthcare Law, False Claims Act (FCA), Anti-Kickback Statute (AKS), Stark Law, Civil Monetary Penalties Law (CMPL), Exclusion Screening, Sanction Screening, HHS OIG, Office of Inspector General, VA OIG, Inspector General Investigations, Administrative Referrals, Program Audits, VA Community Care, Veterans Affairs, VA, VHA, Veterans Health Administration, Office of Integrity and Compliance, Healthcare Operations

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