New York Laws
Title 3 - Office of the Medicaid Inspector General
32 - Functions, Duties and Responsibilities.

§ 32. Functions, duties and responsibilities. The inspector shall have
the following functions, duties and responsibilities:

1. to appoint such deputies, directors, assistants and other officers
and employees as may be needed for the performance of his or her duties
and may prescribe their duties and fix their compensation within the
amounts appropriated therefor;

2. to conduct and supervise activities to prevent, detect and
investigate medical assistance program fraud and abuse amongst the
following: the department; the offices of mental health, alcoholism and
substance abuse services, temporary disability assistance, and children
and family services and the office for people with developmental
disabilities;

3. to coordinate, to the greatest extent possible, activities to
prevent, detect and investigate medical assistance program fraud and
abuse amongst the following: the department; the offices of mental
health, alcoholism and substance abuse services, temporary disability
assistance, and children and family services and the office for people
with developmental disabilities; the commission on quality of care and
advocacy for persons with disabilities; the department of education; the
fiscal agent employed to operate the medical assistance information and
payment system; local governments and entities; and to work in a
coordinated and cooperative manner with, to the greatest extent
possible, the deputy attorney general for Medicaid fraud control; the
welfare inspector general, federal prosecutors, district attorneys
within the state, the special investigative unit maintained by each
health insurer operating within the state, and the state comptroller;

4. to solicit, receive and investigate complaints related to fraud and
abuse within the medical assistance program;

5. to keep the governor, attorney general, state comptroller,
temporary president and minority leader of the senate, the speaker and
the minority leader of the assembly, and the heads of agencies with
responsibility for the administration of the medical assistance program
apprised of efforts to prevent, detect, investigate, and prosecute fraud
and abuse within the medical assistance program, and to provide a
quarterly briefing to the legislature on activities of the office;

6. to pursue civil and administrative enforcement actions against any
individual or entity that engages in fraud, abuse, or illegal or
improper acts or unacceptable practices perpetrated within the medical
assistance program, including but not limited to: (a) referral of
information and evidence to regulatory agencies and licensure boards;
(b) withholding payment of medical assistance funds in accordance with
state and federal laws and regulations; (c) imposition of administrative
sanctions and penalties in accordance with state and federal laws and
regulations; (d) exclusion of providers, vendors and contractors from
participation in the program; (e) initiating and maintaining actions for
civil recovery and, where authorized by law, seizure of property or
other assets connected with improper payments; and entering into civil
settlements; and (f) recovery of improperly expended medical assistance
program funds from those who engage in fraud or abuse, or illegal or
improper acts perpetrated within the medical assistance program. In the
pursuit of such civil and administrative enforcement actions under this
subdivision, the inspector shall consider the quality and availability
of medical care and services and the best interest of both the medical
assistance program and recipients;

6-a. to post on the department's internet website, within reasonably
prompt fashion, all final administrative determinations issued by
administrative law judges in connection with any actions taken by the
office pursuant to this title;

7. to make information and evidence relating to suspected criminal
acts which he or she may obtain in carrying out his or her duties
available to appropriate law enforcement officials and to consult with
the deputy attorney general for Medicaid fraud control, the welfare
inspector general, and other state and federal law enforcement officials
for coordination of criminal investigations and prosecutions.

The inspector shall refer suspected fraud or criminality to the deputy
attorney general for Medicaid fraud control and make any other referrals
to such deputy attorney general as required or contemplated by federal
law. At any time after such referral, with ten days written notice to
the deputy attorney general for Medicaid fraud control or such shorter
time as such deputy attorney general consents to, the inspector may
additionally provide relevant information about suspected fraud or
criminality to any other federal or state law enforcement agency that
the inspector deems appropriate under the circumstances;

8. to subpoena and enforce the attendance of witnesses, administer
oaths or affirmations, examine witnesses under oath, and take testimony;

9. to require and compel the production of such books, papers, records
and documents as he or she may deem to be relevant or material to an
investigation, examination or review undertaken pursuant to this
section;

10. to examine and copy or remove documents or records of any kind
related to the medical assistance program or necessary for the inspector
to perform its duties and responsibilities that are prepared, maintained
or held by or available to any state agency or local governmental entity
the patients or clients of which are served by the medical assistance
program, or which is otherwise responsible for the control of fraud and
abuse within the medical assistance program; provided, however, that any
such information be afforded confidentiality protection as provided for
under state and federal law. The removal of records shall be limited to
those circumstances in which a copy thereof is insufficient for an
appropriate legal or investigative purpose, provided that in such
instances the copying and return of such original, or copy where the
original is required for an appropriate legal or investigative purpose,
is expedited and such original or copy is readily accessible in
accordance with the care and treatment needs of the patient,

11. to recommend and implement policies relating to the prevention and
detection of fraud and abuse; provided however, that the consent of the
attorney general shall be obtained prior to the implementation of any
policy that shall affect the operations of the office of the attorney
general;

12. to monitor the implementation of any recommendations made by the
office to agencies or other entities with responsibility for
administration of the medical assistance program;

13. to prepare cases, provide testimony and support administrative
hearings and other legal proceedings;

14. to review and audit contracts, cost reports, claims, bills and all
other expenditures of medical assistance program funds to determine
compliance with applicable federal and state laws and regulations and
take such actions as are authorized by federal or state laws and
regulations;

15. to work with the fiscal agent employed to operate the Medicaid
management information system to optimize the system;

16. to work in a coordinated manner with relevant agencies in the
implementation of information technology relating to the prevention and
identification of fraud and abuse in the medical assistance program,
including the surveillance utilization review system and other automated

systems pursuant to paragraph (b) of subdivision eight of section three
hundred sixty-seven-b of the social services law;

17. to conduct educational programs for medical assistance program
providers, vendors, contractors and recipients designed to limit fraud
and abuse within the medical assistance program;

18. to, in conjunction with the commissioner, develop protocols to
facilitate the efficient self-disclosure and collection of overpayments
and monitor such collections, including those that are self-disclosed by
providers. The provider's good faith self-disclosure of overpayments may
be considered as a mitigating factor in the determination of an
administrative enforcement action;

19. to receive and to investigate complaints of alleged failures of
state and local officials to prevent, detect and prosecute fraud and
abuse in the medical assistance program;

20. to, consistent with provisions of this title, implement and amend,
as needed, rules and regulations relating to the prevention, detection,
investigation and referral of fraud and abuse within the medical
assistance program and the recovery of improperly expended medical
assistance program funds;

21. to conduct, in the context of the investigation of fraud and
abuse, on-site facility and office inspections;

22. to take appropriate actions to ensure that the medical assistance
program is the payor of last resort;

23. to annually submit a budget request, for the ensuing state fiscal
year, to the division of the budget, provided that the office's budget
request shall not be subject to review, alteration or modification by
the commissioner or any other entity or person prior to its submission
to the division of the budget;

24. to meet quarterly with representatives of social services
districts to discuss the status of ongoing cooperative efforts between
the office of Medicaid inspector general and districts, including
demonstration programs authorized pursuant to section five-a of part C
of chapter fifty-eight of the laws of two thousand five, the potential
for additional collaboration and/or for improved or innovative
techniques to be employed, and any issues of concern to such districts
with respect to the prevention and detection of fraud and abuse in the
medical assistance program;

25. to request submission of social services districts annual budget
and audit workplans for purposes of planning for and executing the
county demonstration program and for the creation of the office's annual
workplan and to include in the office's annual workplan a description of
activities that will be conducted in collaboration with social services
districts;

26. to develop training materials with respect to the office's audit
standards and criteria for identifying fraud or waste, for use by social
services districts who are engaged with the office in demonstration
programs or other collaborative efforts; and

27. to perform any other functions that are necessary or appropriate
to fulfill the duties and responsibilities of the office in accordance
with federal and state law.