Up Close and Personal with a Health Care Fraud Analyst

Considered a Career as an FBI Intelligence Analyst?
Here’s What It’s Like: Up Close and Personal

04/01/05

$100 billion—with a “b.” That’s how much health care fraud costs our country every year, according to conservative estimates. Who picks up the tab? Our government (a major victim), our nation’s businesses (especially insurance companies), and you and I, every time we get medical care. And sometimes, the culprits behind these scams are those you’d least expect: doctors, nurses, pharmacists, and other trusted medical professionals. So it’s no wonder Paula, a health care fraud intelligence analyst at the FBI for nearly six years, finds special joy in helping to unravel crooks’ elaborate schemes.

Q. Paula, can you tell us about some of the interesting cases you’ve worked on?
Paula: Sure, one of the more interesting cases involved a nationwide scheme in which outpatient surgery centers recruited well-insured people to undergo elective surgeries covered by their policies in exchange for kickbacks. The surgeries were unwarranted and unnecessary and generated bogus insurance claims that turned a tidy profit for the providers. We’ve since worked with private industry to develop a national database of suspicious outpatient centers. The surgery scheme was highlighted on national television with a lot of input from the FBI.

Q. What’s a typical workday like?
Paula: I write intelligence assessments to determine whether cases may be regional or national in scope and support field investigations with several types of specialized data analysis. And I’m often asked to speak at national conferences for FBI managers and private insurers and health care programs on fraud intelligence matters. I’m never bored and I can never predict what’s next.

Q. Have you traveled overseas on cases?
Paula: Yes. I taught a health care fraud data mining class at Scotland Yard in England last year. They were a great audience and London is my new favorite city.

Q. What do you like most about the job?
Paula: Each project I work on is more exciting than the last. It’s very rewarding to use my health care background in exercise physiology in my position as a health care fraud intelligence analyst. I love to get up for work every day and I can see myself working here the rest of my life. I know I’m working for the right side.

Q. Do you have any advice for prospective FBI recruits?
Paula: Follow your heart. If you are motivated by a desire to do what is right, then the Bureau is a wonderful home. We’re all about putting the bad guys in jail. Everything I do here is reduced to that, so I sleep well at night!

Interested in applying? Go to fbijobs.gov. And read more about the FBI’s Directorate of Intelligence.