TENTATIVE

Occ. Code 6689100

New York State Department of Civil Service

Classification Standard

BRIEF DESCRIPTION OF CLASS SERIES

Positions in this title series are classified at the Department of Health (DOH) to evaluate and implement policies, procedures and systems for the prevention, detection, investigation, and prosecution of fraud and abuse or violations of the Public Health Law in programs regulated by the Department of Health.  Incumbents of these positions develop and design new systems for eliminating potential fraud and abuse, develop uniform reporting systems that document program activity, and develop policies and procedures for conducting and reporting investigations.

DISTINGUISHING CHARACTERISTICS

HEALTH PROGRAM INVESTIGATION SPECIALIST 1:  first supervisory level; supervise subordinate investigators by assigning cases, reviewing reports, tracking the status of investigations, providing training and technical assistance and evaluating staff performance.  May be assigned to investigate complex and high profile cases.

HEALTH PROGRAM INVESTIGATION SPECIALIST 2: supervise, administer and coordinate the activities within one of the geographical areas that comprise a statewide investigation bureau, in charge of preventing, detecting, investigating, and prosecuting fraud and abuse or violations of the Public Health Law.

HEALTH PROGRAM INVESTIGATION SPECIALIST 3: management level; under the direction of the Bureau/Program Director, the Health Program Investigation Specialist 3 will coordinate the activities of a statewide OR major geographic area investigation bureau in charge of preventing, detecting, investigating and prosecuting fraud and abuse or violations of the Public Health Law OR provide statewide oversight responsibility for all steps in the investigative process regarding a broad range of complaints involving professional misconduct made against physicians and/or physician assistants as defined by State Education Law.

RELATED CLASSES

Medical Conduct Investigators investigate complaints and reports relating to the conduct of physicians and physician assistants.  They perform field or office-based investigations; assess complaints and verify jurisdiction; formulate investigative plans; interview complainants, patients, witnesses, physicians, and attorneys; obtain and evaluate documentary evidence including medical records, malpractice data, hospital quality assurance documentation, and prescribing information; engage the services of in-house physicians or independent medical specialty experts to review records and evidence; and prepare investigative reports.

Narcotic Investigators perform field investigation and law enforcement activities to prevent the diversion to unauthorized use of narcotics.  They cooperate with Federal narcotics agents and State and local law enforcement officers in cases involving illicit possession and sale of narcotics, and other types of narcotics law violations. They are designated peace officers and carry arms and make arrests.

            Investigators conduct interviews and obtain sworn statements from investigative targets and other witnesses, collect and process evidence, document investigative findings by writing narrative reports, and testify at administrative and criminal proceedings.

ILLUSTRATIVE DUTIES

HEALTH PROGRAM INVESTIGATION SPECIALIST 1

Perform investigations.

• Formulate investigative plans.

• Interview complainants. 

• Confer with legal and business representatives of persons of interest, suspects and targets of investigation and any other individuals whose input is necessary for an investigation.

• Compile various legal and technical background material in support of case investigations.

• Collect, process and properly maintain the chain of custody of all documentary, physical and photographic evidence.

• Document all investigative activity, interviews, and phone conversations.

• Analyze statistical and investigative data, quality assurance material, and criminal and malpractice information.

Administer and coordinate systems development to advance fraud detection Statewide.

• Disseminate technical information to industry and governmental agencies.

• Maintain systems for communicating changes in State and Federal policies and regulations.

• Review program areas and make changes that would result in greater accountability.

Manage and coordinate investigations with federal, State and local law enforcement agencies.

• Personally coordinate and conduct investigations.

• Prepare written reports on the status of assigned cases.

• Coordinate with the Division of Legal Affairs relative to the assessment of fines, preparation for hearings, referrals for criminal prosecution, etc.

• Testify before grand juries and trial juries.

Implement and maintain guidelines and procedures for field staff operations. 

• Develop criteria for prioritization and conduct of investigations.

• Develop guidelines for response to problems and inquiries for information.

• Develop, implement, and maintain a uniform case control and reporting system.

Supervise subordinate staff.

• Provide supervision, guidance, and oversight to subordinate staff, and intervene and resolve problems as necessary.

• Determine and oversee staff assignments. 

• Approve leave and track time and attendance.

• Review, monitor, and evaluate staff performance. 

• Complete performance evaluations.

• Identify training needs and arrange for provision of training.

• Manage and direct program activities by setting priorities and deadlines.

HEALTH PROGRAM INVESTIGATION SPECIALIST 2

May perform all of the same duties and functions as a Health Program Investigation Specialist 1.

Establish, review, and revise priorities of subordinate investigative staff to accomplish investigative goals and objectives.

• Utilize the automated systems for eliminating fraud and abuse through preventive and investigative activities.

• Coordinate investigation activities with other law enforcement units and personally coordinate difficult investigations.

• Assist with the development of policies and procedures for conducting and reporting investigations.

Report problem areas or potential areas for improvement, and make relevant recommendations for operational and procedural changes or enhancements.

• Distribute approved documents and provide appropriate training to investigative staff.

• Follow up after implementation to assess success and compliance.

HEALTH PROGRAM INVESTIGATION SPECIALIST 3

Function as Assistant Bureau/Program Director, assume control of the Bureau/Program in the absence of the Director and may perform all of the same duties and functions as a Health Program Investigation Specialist 1 or 2.

Develop and enforce investigative policies, procedures, and documentation.

• Develop uniform reporting systems to document activity.

• Develop policies and procedures for conducting and reporting on preventive and investigative activities.
• Ensure that all complaints are investigated within the established time frames.

• Ensure that all investigations are carried out in accordance with established laws, rules, and regulations.

• Provide direction, oversight, and coordination of investigations in Central and Regional offices.

• Provide consultation and direction to other investigative units within DOH.

Serve as a liaison to State, federal, and law enforcement agencies, and other interested parties.

• Maintain liaison with counsel concerning all cases referred to counsel for a hearing.

• Respond to the Public Affairs Group on inquiries from the press and consumer groups.

• Prepare presentations to the public and to professional groups.

Design, coordinate, and implement a complaint investigation system to ensure timely completion of all investigations.

• Maintain procedures to ensure all investigations are in compliance with established assignments.

• Identify critical system failures.

• Prepare and implement corrective measures.

MINIMUM QUALIFICATIONS

HEALTH PROGRAM INVESTIGATION SPECIALIST 1

Promotion:  one year of permanent competitive service as a Senior Investigator; or one year as a Senior Medical Conduct Investigator or a Narcotic Investigator 1.

HEALTH PROGRAM INVESTIGATION SPECIALIST 2

Promotion:  one year of permanent competitive service as a Health Program Investigation Specialist 1; or one year as a Supervising Medical Conduct Investigator or a Narcotic Investigator 2.

HEALTH PROGRAM INVESTIGATION SPECIALIST 3

Promotion:  one year of permanent competitive service as a Health Program Investigation Specialist 2 or a Principal Medical Conduct Investigator; or one year as a Health Program Investigation Specialist 1, Supervising Medical Conduct Investigator, or a Narcotic Investigator 2.

Date:  7/09

NOTE: Classification Standards illustrate the nature, extent and scope of duties and responsibilities of the classes they describe.  Standards cannot and do not include all of the work that might be appropriately performed by a class.  The minimum qualifications above are those which were required for appointment at the time the Classification Standard was written.  Please contact the Division of Staffing Services for current information on minimum qualification requirements for appointment or examination.