Occ. Code 6689100

 

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 1, GRADE 22  

6689100

HEALTH PROGRAM INVESTIGATION SPECIALIST 2, GRADE 25     

6689200

HEALTH PROGRAM INVESTIGATION SPECIALIST 3, GRADE 27

6689300

 

 

New York State Department of Civil Service

 

Classification Standard

 

BRIEF DESCRIPTION OF CLASS SERIES

 

Health Program Investigation Specialists 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 on investigations.

 

These positions are classified at the Department of Health (DOH).

 

DISTINGUISHING CHARACTERISTICS

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 1:  full performance level; administer and coordinate systems development to advance fraud detection.

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 2: first supervisory level; administer and coordinate the activities within one of the geographical areas that comprise a statewide investigation bureau.

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 3: management level; under the direction of the Bureau/Program Director, coordinate the activities of a statewide or major geographic area investigation bureau; or provide statewide oversight for all steps in the investigative process.

 

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 of narcotics for unauthorized use.  They cooperate with federal narcotics agents and State and local law enforcement officials in cases involving illicit possession and sale of narcotics, and other types of narcotics law violations.  They are designated peace officers, 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.

 

 

 

 

 

 

 

 

Administer and coordinate systems development to advance fraud detection.

 

 

 

 

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

 

 

 

 

 

Implement and maintain guidelines and procedures for field staff operations. 

 

 

 

 

May supervise or direct the activities of subordinate staff or serve as a team leader.

 

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 2

 

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

 

Supervise subordinate Staff.

 

Provide guidance and oversight to subordinate staff

 

 

 

 

 

 

 

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

 

 

 

 

Report problem areas or potential areas for improvement, and make 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.

 

Develop and enforce investigative policies, procedures, and documentation.

 

 

 

 

 

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

 

 

 

 

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

 

 

 

Supervise professional staff.

 

MINIMUM QUALIFICATIONS

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 1

 

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

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 2

 

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

 

HEALTH PROGRAM INVESTIGATION SPECIALIST 3

 

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

 

 

 

Date:  6/13

 

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 that 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.