Medicaid Inspector General

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Medicaid Inspector General
Responsibilities: Reporting directly to the Attorney General, the Medicaid Inspector General provides the highest level of direction and oversight of the Office of the Medicaid Inspector General (OMIG) to include strategic planning, organization, procedures and policies in support of the OMIG’s mission to provide increased accountability, integrity and oversight of the state Medicaid program, MediKan program and Children’s Health Insurance Program (CHIP) or their successor programs. Detection and investigation of fraud, waste, abuse and illegal acts relating directly to such programs. Conduct performance reviews and supervise activities to detect and investigate fraud, waste, abuse and illegal acts; Solicit, receive and investigate complaints; Audit state programs, contractors, vendors, and health care providers related to ensuring appropriate payments are made for services rendered and to the recovery of overpayments; Investigate fraud, waste, abuse, or illegal acts committed by clients of the programs or by consumers of services of such programs. Monitor the adherence to the terms of any contract between a state agency and any organization with which the state agency has entered into a contract to make claims payments. Keep the Attorney General apprised of efforts relative to OMIG’s mission. Report findings of credible evidence of fraud, waste, abuse, or illegal acts found to the Attorney General. Referral of appropriate cases for administrative action, civil action, or criminal prosecution. Refer to the appropriate authority or entity matters for civil and administrative enforcement actions against any individual or entity that engages in improper practices relative to such programs; Make information and evidence obtained available to the appropriate officials and consult with the deputy attorney general for Medicaid Fraud and Abuse Division and other state and federal law enforcement officials for coordination of criminal investigations and prosecutions; Ensure the preparation of cases, preservation of evidence, provision of testimony and support administrative hearings and other legal or administrative proceedings. Performing other functions necessary or appropriate to fulfill the duties and responsibilities of the OMIG in accordance with federal and state law. Participate in the appointment of agents, investigators, assistants, and other officers and employees as may be needed for the performance of duties; Represent the OMIG with federal, state, and county entities and other stakeholders regarding Medicaid program integrity issues, including multi-agency investigations and prosecutions, resources, and strategic direction; Oversee and direct the analysis and reporting of current organizational structure, and methods and protocols in use; consider recommendations for changes or improvements; ensure implementation of adopted ideas and monitor progress. Prepare annual reports, findings and recommendations regarding the office’s investigations into reports of fraud, waste, abuse and illegal acts relating to any such programs.

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