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Regulatory Compliance and Fraud Investigator

Recruitment #19-004373-0003




MDH/Office of the Inspector General, Baltimore, Maryland

Main Purpose of Job

This position will function at a full performance level, under general supervision to a second-line managerial position within the Office of the Inspector General (OIG). This position will be responsible for investigating, overseeing and coordinating cases of fraud, waste and abuse of health care providers, contractors and grantees who deliver Medicaid services.

This position will also ensure that non-compliance and violations of Medicaid resources expended through Medicaid programs and services are investigated, in accordance with state and federal laws, regulations and policies. Such policies include the Code of Maryland Regulations (COMAR), with approximately 59 program areas, as well as the Affordable Care Act and Amendments; the Health Insurance Portability and Accountability Act of 1996, and multiple other statutes, policies and procedures which govern and regulate physicians and allied health care providers who administer services to Medicaid recipients, under the Medicaid/Medical Assistance program for the entire State of Maryland.

Finally, this position will analyze and report findings, as well as make recommendations to the appropriate internal and external entities and authorities for fiscal assessment, subsequent monetary recovery and/or civil/criminal prosecution. This position will lead and perform a wide variety of complex Medicaid provider investigations and inspections initiated by multiple referral sources, which include questionable or compromising scenarios of fraud, waste and abuse.


Education: Possession of a Bachelor's degree in Accounting from an accredited college or university or a Bachelor's degree from an accredited college or university, with 30 credit hours in Accounting and related courses, including or supplemented by 3 credit hours in Auditing.

Experience: Three years of experience conducting financial and operational internal audits which include elements for finance and compliance; economy and efficiency, and program results.


1. Applicants who have met the requirements for admission to the CPA examination prior to July 1, 1974 will be considered to have met the educational requirement referenced above.

2. Possession of a certificate as a Certified Public Accountant or Certified Internal Auditor, or a Master’s degree in Accounting from an accredited college or university, may be substituted for one year of the required experience.

3. Applicants may substitute one year of professional accounting experience for one year of auditing experience.

4. Candidates may substitute U.S. Armed Forces military service experience as a Commissioned Officer in Internal Review classifications or Auditing specialty codes in the Financial or Auditing fields of work, on a year-for-year basis, for the required experience.


The desired candidate should have experience with submitting or auditing insurance claims for healthcare providers. He/she should also have the ability to work on team-oriented projects, as well as the ability to write formal audit reports.  

In addition, the desired candidate should have good oral and written communication skills, and the willingness to pursue issues in the face of opposition.  

Finally, the desired candidate should be a Certified Fraud Examiner, Certified Internal Auditor, or contain related certification.


Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties may be required to possess a motor vehicle operator's license valid in the State of Maryland.


Applicants who meet the minimum (and selective) qualifications will be included in further evaluation. The evaluation may be a rating of your application based on your education, training and experience as they relate to the requirements of the position. Therefore, it is essential that you provide complete and accurate information on your application. Please report all related education, experience, dates and hours of work. Clearly indicate your college degree and major on your application, if applicable. For education obtained outside the U.S., any job offer will be contingent on the candidate providing an evaluation for equivalency by a foreign credential evaluation service prior to starting employment (and may be requested prior to interview). 

Complete applications must be submitted by the closing date. Information submitted after this date will not be added. 

Incorrect application forms will not be accepted. Resumes will not be accepted in lieu of a completed application.

Candidates may remain on the certified eligible list for a period of at least one year. The resulting certified eligible list for this recruitment may be used for similar positions in this or other State agencies.



Online applications are highly recommended. However, if you are unable to apply online, the paper application (and supplemental questionnaire) may be submitted to MDH, Recruitment and Selection Division, 201 W. Preston St., Room 114-B, Baltimore, MD 21201. Paper application materials must be received by 5 pm, close of business, on the closing date for the recruitment, no postmarks will be accepted.

If additional information is required, the preferred method is to upload.  If you are unable to upload, please fax the requested information to 410-333-5689. Only additional materials that are required will be accepted for this recruitment. All additional information must be received by the closing date and time.

For questions regarding this recruitment, please contact the MDH Recruitment and Selection Division at 410-767-1251.

If you are having difficulty with your user account or have general questions about the online application system, please contact the MD Department of Budget and Management, Recruitment and Examination Division at 410-767-4850 or

Appropriate accommodations for individuals with disabilities are available upon request by calling: 410-767-1251 or MD TTY Relay Service 1-800-735-2258.

We thank our Veterans for their service to our country.

People with disabilities and bilingual candidates are encouraged to apply.

As an equal opportunity employer, Maryland is committed to recruitment, retaining and promoting employees who are reflective of the State's diversity.