Job Description

Executive Service

Asst. Attorney General - Civil Medicaid Fraud Division

Office of the TN Attorney General and Reporter

Civil Medicaid Fraud Division

Nashville, TN

Closing Date: 01/06/2025

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Our employees can have 2 remote workdays each week after they have completed six months of employment.

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Who we are and what we do:

The Tennessee Attorney General and Reporter represents all State officials, employees, agencies, departments, boards, and commissions in matters arising from their public duties. Such representation includes litigation, transactional assistance, and general legal advice to a wide variety of State entities. The Attorney General's Office employs approximately 200 attorneys organized into 21 legal divisions within 6 sections.

How you make a difference in this role:

The Civil Medicaid Fraud Division (CMF) is part of the Public Protection Section of the Attorney General's Office. CMF investigates and prosecutes civil cases of Medicaid fraud against health providers and related parties under the Tennessee Medicaid False Claims Act (TMFCA) and on behalf of other state payers under the Tennessee False Claims Act (TFCA). Most of CMF's cases result from qui tam actions brought pursuant to the TMFCA or referrals from TennCare's Managed Care Organizations (MCOs).

CMF's practice areas give attorneys exciting opportunities to work on complex cases in federal and state courts. These cases prosecute and deter fraud, waste and abuse committed against TennCare, other state healthcare payers, their members, and the taxpayers whose dollars fund these important state programs. The division strives to offer the best culture for litigators in public service: excellent work-product on interesting issues in a collegial and collaborative environment, while also protecting a high-quality of life outside of work.

Please note that the position requires in-person work at least three days per week.

Key Responsibilities:

The duties and responsibilities of the CMF AAG include, but are not limited to, the following:

1. Case Investigation and Development

• Conduct investigations of healthcare providers, pharmaceutical companies, laboratories, manufacturers and other entities suspected of submitting false claims to TennCare and other state payers.
• Gather and examine billing records, medical documentation, contracts, and other relevant documents.
• Interview witnesses, whistleblowers (qui tam relators), and State personnel.

2. Legal Analysis and Case Preparation

• Research and apply federal and state Medicaid laws, including the federal False Claims Act, TMFCA and TFCA.
• Analyze complex billing schemes and healthcare regulations to determine violations.
• Assist in developing litigation strategy and evaluating potential settlements.
• Draft legal memoranda, civil complaints, civil investigative demands (CIDs) and subpoenas.

3. Litigation and Case Management

• Participate in civil litigation from initial investigation through resolution, judgment or appeal as necessary.
• Prepare and file pleadings, motions, and legal briefs.
• Conduct discovery, including depositions and document review.
• Coordinate with the U.S. Department of Justice, state Medicaid agencies, and multi-state working groups.
• Oversee settlement negotiations.

4. Collaboration and Coordination

• Work with internal divisions to ensure consistent enforcement across overlapping areas of authority.
• Liaise with TennCare, Medicaid program integrity units, and external stakeholders.
• Assist in compliance monitoring and post-settlement enforcement.

Minimum Qualifications:

Educational / Background Preferences

• Juris Doctor with at least three years of complex civil litigation experience.
• Prior experience in healthcare regulation preferred.

Professional Skills

• Strong knowledge of healthcare law and complex civil litigation in federal and state courts.
• Experience litigating cases under the False Claims Act, TMFCA and TFCA.
• Analytical skills for reviewing large datasets and complex financial/billing records.
• Excellent legal writing and research skills.
• Familiarity with governmental litigation procedures, including CIDs and e-discovery.

Cognitive and Interpersonal Traits

• Analytical thinker with attention to detail.
• Integrity and discretion, especially when handling sensitive health and financial information.
• Collaborative mindset, able to work effectively with investigators, nurse coders, data analysts and other attorneys.
• Persistence and initiative, willing to pursue multi-year, complex investigations and lawsuits.
• Communication skills, able to explain technical or legal findings clearly to non-legal audiences.

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.

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