An Act To Establish the Office of the Inspector General in the Department of Health and Human Services
Maine Legislature, Session 127, LD 1349
Committee: Health and Human Services
Sponsors: DION, LIBBY, ALLEY, BLUME, DAVITT, GILBERT, POWERS, SAUCIER, BREEN
Amends: 5 MRSA §200-C, 22 MRSA §13

Legislative Document 
No. 1349 
H.P. 918 
House of Representatives, April 16, 2015 
An Act To Establish the Office of the Inspector General in the 
Department of Health and Human Services 
Reference to the Committee on Health and Human Services suggested and ordered printed. 
ROBERT B. HUNT 
Clerk 
Presented by Representative DION of Portland. 
Cosponsored by Senator LIBBY of Androscoggin and 
Representatives: ALLEY of Beals, BLUME of York, DAVITT of Hampden, GILBERT of Jay, 
POWERS of Naples, SAUCIER of Presque Isle, Senator: BREEN of Cumberland. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  5 MRSA §200-C, sub-§2, as enacted by PL 1975, c. 715, §1, is amended 
to read: 
2.  Purpose. The purpose of the division shall be is to investigate and prosecute, 
including actions for civil recovery, any act of fraud or attempted fraud perpetrated 
against the State or any department, agency or commission thereof. The division shall 
may not have primary responsibility for the investigation of any act of fraud or attempted 
fraud or incident of commingling or misapplication of funds pursuant to Title 22, section 
13, subsection 2 chapter 3. 
Sec. 2.  5 MRSA §200-C, sub-§3, as enacted by PL 1975, c. 715, §1 and amended 
by PL 2003, c. 689, Pt. B, §6, is further amended to read: 
3.  Cooperation, information. All agencies of the State and municipal governments 
shall cooperate fully with the division, rendering any assistance requested by the division. 
Every head of a department, bureau, division, commission or any other unit of State 
Government shall report in writing to the division any suspected act of fraud or attempted 
fraud or violation of any law in connection with funds of the State. Any such act or 
violation involving funds administered by the Department of Health and Human Services 
shall must be reported pursuant to Title 22, section 13, subsection 3 106. 
Sec. 3.  22 MRSA §13, as corrected by RR 2011, c. 2, §22, is repealed. 
Sec. 4.  22 MRSA c. 3 is enacted to read: 
CHAPTER 3 
INSPECTOR GENERAL 
§101.  Definitions 
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings. 
1.  Agency.  "Agency" means a bureau, division, office, agency or program operated, 
licensed or certified by the department. 
2.  Employee.  "Employee" means a person who provides services on site at a facility 
or agency or off site directly to an individual or with a facility or agency, including an 
employee or contractual agent of the department or agency involved in providing, 
monitoring or administering mental health or intellectual disabilities services, including 
but not limited to a payroll processor, contractor, subcontractor or volunteer. 
3.  Facility.  "Facility" means a facility operated by the department. 
4.  Financial exploitation.  "Financial exploitation" means an employee's, facility's 
or agency's taking unjust advantage of an individual's assets, property or financial 
resources through deception, intimidation or conversion for the employee's, facility's or 
agency's advantage or benefit. 
5.  Individual.  "Individual" means a person receiving on-site or off-site mental 
health, autism or intellectual disabilities services from a facility or agency. For purposes 
of this subsection, "intellectual disabilities" has the same meaning as in Title 34-B, 
section 5001, subsection 3. 
6.  Mental abuse.  "Mental abuse" means the use of demeaning, intimidating or 
threatening words, signs, gestures or other actions by an employee about an individual 
that results or could result in mental distress or maladaptive behavior. 
7.  Neglect.  "Neglect" means an employee's, agency's or facility's failure to provide 
adequate medical care, personal care or maintenance that, as a consequence: 
A.  Causes an individual pain, injury or emotional distress; 
B.  Results in either an individual's maladaptive behavior or the deterioration of an 
individual's physical or mental condition; or 
C.  Places an individual's health or safety at substantial risk. 
8.  Physical abuse.  "Physical abuse" means an employee's nonaccidental and 
inappropriate contact with an individual that causes bodily harm, including directing 
another individual or person to engage in such contact. 
9.  Provider.  "Provider" means a person other than an agency that provides services 
to a recipient on behalf of or under contract with the department. 
10.  Recipient.  "Recipient" means a person who receives assistance or services from 
the department. 
11.  Recommendation.  "Recommendation" means an admonition, separate from a 
finding, that requires action by a facility, agency or department to correct a systemic 
issue, problem or deficiency identified during an investigation. 
12.  Sexual abuse.  "Sexual abuse" means any sexual contact or intimate physical 
contact between an employee and an individual, including an employee's coercion or 
encouragement of an individual to engage in sexual behavior that results in sexual 
contact, intimate physical contact, sexual behavior or intimate physical behavior.  For 
purposes of this subsection, "sexual contact" has the same meaning as in Title 17-A, 
section 251, subsection 1, paragraph D. 
13.  Vendor.  "Vendor" means a person who provides goods or services to the 
department, including administrative services such as payroll processing, bookkeeping or 
facilities maintenance. 
§102.  Office of the Inspector General 
1.  Inspector General; office; salary.  The Inspector General is the executive head 
of the Office of the Inspector General, established within the department by this chapter.  
The Inspector General is entitled to receive an annual salary for all services.  The 
Inspector General is entitled to receive actual expenses incurred in the performance of 
official duties. 
2.  Appointment; term of office; removal.  The Inspector General is appointed by 
the Governor and subject to review by the joint standing committee of the Legislature 
having jurisdiction over health and human services matters and to confirmation by the 
Legislature. The Inspector General serves a term of office for 7 years or until a successor 
has been appointed and qualified. Any vacancy occurring must be filled by appointment 
for the unexpired portion of the term. The Inspector General is removable for cause by 
impeachment or by address of the Governor to both branches of the Legislature. 
3.  Operation; appropriation.  The Inspector General operates independently within 
the department, including in the performance of investigations and issuance of reports, 
findings and recommendations.  The appropriation for the Office of the Inspector General 
must be separate from the overall appropriation for the department. 
4.  Duties.  The duties of the Inspector General include: 
A.  Investigating reported acts of fraud or attempted fraud or incidents of 
commingling or misapplication of funds in connection with, but not limited to, the 
requesting, obtaining, receiving, withholding, recording, reporting, expending or 
handling of funds administered by the department; 
B.  Conducting quality assurance audits and program reviews to ensure that public 
funds are well managed and dispensed for the purposes for which the funds are 
appropriated and deliver the best value for the intended recipients of the funds or 
department services; 
C.  Investigating reports of suspected mental abuse, physical abuse, sexual abuse, 
neglect or financial exploitation of a recipient of mental health or intellectual 
disabilities services by an employee, agency or facility or any death of an individual 
under section 105; 
D.  Maintaining a process by which an employee, recipient or member of the public 
may file a report or complaint concerning the department or an agency or facility, 
including any fraud, attempted fraud or commingling or misapplication of funds 
under section 103 or any abuse, neglect or financial exploitation or death under 
section 105; and 
E.  Issuing reports and recommendations as required by this chapter. 
5.  Cooperation; information.  All agencies of the State and municipal governments 
shall cooperate fully with the Inspector General, rendering any assistance requested by 
the Inspector General. Every head of a department, bureau, division, commission or any 
other unit of State Government shall report in writing to the Inspector General all 
information concerning any suspected incident of fraud or attempted fraud or violation of 
any law in connection with funds administered by the department, abuse or neglect of a 
recipient of department services or death of an individual. The Inspector General may 
access any program of the department, agency or facility and any records of any program 
of the department, agency or facility for any purpose under subsection 4. 
6.  Violation of law; action.  Whenever the Inspector General determines that fraud, 
attempted fraud or any other violation of law may have occurred, the Inspector General 
shall report in writing all information concerning the fraud, attempted fraud or violation 
to the Attorney General, the Chief of the State Police or another law enforcement agency 
as the Inspector General determines appropriate.  Upon referral from the Inspector 
General under this subsection, the Attorney General may take any action the Attorney 
General determines appropriate, including civil action for recovery of funds, injunctive 
relief or criminal prosecution. The Inspector General shall, upon request of the Attorney 
General and in such a manner as the Attorney General determines appropriate, assist in 
the recovery of funds, investigation or other actions required by the Attorney General in 
investigating or prosecuting a matter under this subsection. The Inspector General shall 
conduct any investigation in a manner to ensure the preservation of evidence for possible 
use in a civil or criminal proceeding. 
7.  Audit methods.  When conducting audits pursuant to this chapter, the Inspector 
General may not engage a private vendor to conduct the audit or base any auditor's 
compensation on a percentage of the alleged overpayment amount, except that the 
department may engage a private vendor to conduct an audit of a provider located outside 
this State and may base that vendor's compensation on a percentage of the amount of 
overpayment received by the department. The department shall disclose to the public any 
mathematical algorithm used in performance of an audit. The Inspector General may 
request the services of the State Auditor to carry out the purposes of this chapter. 
8.  Subpoena power.  The Inspector General may issue a subpoena to a witness and 
compel the production of a document or physical evidence related to an investigation 
under this chapter.  The Inspector General may not issue a subpoena under this subsection 
for the production of a document of a labor organization or to a labor organization or a 
representative of a labor organization acting in a representative capacity to an employee 
whose conduct is the subject of an investigation or the document relates to the 
representation of the employee.  A person who fails to respond to a subpoena under this 
subsection or knowingly provides false information to the Inspector General commits a 
Class E crime. 
9.  Audit by Office of Program Evaluation and Government Accountability.  The 
Office of Program Evaluation and Government Accountability shall conduct a program 
audit of the Inspector General upon complaint or on an as-needed basis as determined by 
the Office of Program Evaluation and Government Accountability.  An audit conducted 
under this subsection must include a review of the Inspector General's compliance with 
this chapter and effectiveness in performing the duties under subsection 4.  The findings 
of an audit conducted under this subsection must be reported to the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
and the joint standing committee of the Legislature having jurisdiction over financial 
affairs within 60 days of the conclusion of the audit. 
10.  Rules.  The Inspector General may adopt routine technical rules as defined by 
Title 5, chapter 375, subchapter 2-A to carry out the provisions of this chapter. 
§103.  Human Services Fraud Investigation Unit 
1.  Establishment; composition.  The Human Services Fraud Investigation Unit, 
referred to in this section as "the unit," is established within and is responsible to the 
Office of the Inspector General. The Inspector General may employ and assign to the unit 
such employees as the Inspector General determines appropriate. 
2.  Purpose.  The purpose of the unit is to investigate reported acts of fraud or 
attempted fraud or incidents of commingling or misapplication of funds in connection 
with, but not limited to, the requesting, obtaining, receiving, withholding, recording, 
reporting, expending or handling of funds administered by the department pursuant to 
section 102, subsection 4, paragraph A. The Inspector General shall investigate such 
reported acts or incidents involving, but not limited to, employees, recipients, providers 
or vendors administering, receiving or applying for services or funds administered by the 
department. 
3.  Limitation on actions to recover overpayments.  Based upon a report or 
recommendation by the Inspector General, the department may impose a sanction or 
withhold payment from a MaineCare provider in order to recover or impose penalties for 
an overpayment for services rendered or goods delivered under the MaineCare program 
as provided in this subsection. 
A.  The department may impose a sanction or withhold payment when the department 
has obtained an order from the Superior Court allowing interim sanctions upon 
showing a substantial likelihood that overpayment or fraud has occurred and that 
substantial harm to the department will result from further delay or when the 
department has taken final agency action and the provider has waived or exhausted its 
right to judicial review. 
B.  Notwithstanding paragraph A, the department may terminate or suspend the 
participation of a provider in the MaineCare program pursuant to federal regulation 
and state rule. This authority includes, but is not limited to, provider payment 
suspensions required under section 1714-E. 
C.  For the purposes of this subsection, "overpayment" does not include an 
overestimate made as part of a prospective interim payment, a 3rd-party liability 
recovery, a departmental administrative error or receivership fees or debt. In addition, 
this subsection does not apply to routine adjustments of $2,500 or less that result 
from claims editing or processing. 
§104.  Quality assurance audits and program reviews 
1.  Quality assurance audits and program reviews.  The Inspector General shall 
design a comprehensive and well-coordinated system of quality assurance audits and 
program reviews of agencies, facilities and department administration to ensure that 
public funds are well managed and dispensed for the purposes for which the funds are 
appropriated and deliver the best value for the intended recipients of the funds or 
department services pursuant to section 102, subsection 4, paragraph B. 
2.  Facility, agency and department.  In conducting a quality assurance audit or 
program review of an agency, facility or department administration under subsection 1, 
the Inspector General may review all relevant records, policies, procedures or other 
information to determine the effectiveness, efficiency and economical use of resources 
and compliance with laws, regulations, rules, policies and procedures of the program, 
agency, facility or department administration. 
3.  Program baseline information.  In conducting a quality assurance audit or 
program review of a department program under subsection 1, if applicable, the Inspector 
General must use the following baseline information for the prior year for the program 
under audit or review: 
A.  The total unduplicated number of households, children, persons with disabilities 
and seniors receiving assistance under the program; 
B.  The average monthly benefit for each program in general funds, federal 
allocations and any special revenue funds; and 
C.  The total program expenditure in general funds, federal allocations and any 
special revenue funds for each program. 
4.  Components of a quality assurance audit and program review.  A quality 
assurance audit or program review of a department program under subsection 1 must 
include review of the department's program integrity efforts for that program, including: 
A.  A description of the department's efforts under this section and under chapters 
851, 855, 1053-B and 1054-A, including any efforts made in cooperation with federal 
agency partners in investigating and prosecuting fraudulent claims, misuse of public 
benefits instruments investigated pursuant to Title 17-A, section 905-C and 
overpayments to providers, vendors and retailers, including: 
(1)  The number of staff investigating cases; 
(2)  The number of cases opened, investigated and disposed of; 
(3)  The sources of the cases opened; 
(4)  The dispositions of the cases closed; 
(5)  The number and amount of fraudulent overpayments recovered and fines or 
penalties actually imposed, expressed in absolute dollar values and as 
percentages of all funds spent in each program; 
(6)  The amount of recoveries of fraudulent claims reclaimed by the Federal 
Government; 
(7)  All costs associated with all activities related to discovering, investigating 
and prosecuting cases in which fraud was alleged, whether or not fraud was 
determined to exist, for each program, both in absolute dollar values and as 
percentages of each program; 
(8)  The average length of time to recover fraudulent overpayments and fines or 
penalties imposed from the time cases are opened until the time overpayments 
and fines or penalties are repaid in full; 
(9)  The amount of fraudulent overpayments determined as uncollectible; 
(10)  The amount of fraudulent overpayments recovered by type of offender; 
(11)  The amount of fraudulent overpayments recovered by a business unit within 
the department's audits and program integrity activities group; 
(12)  The number of program providers, retailers or vendors, by type, that are 
terminated from participation or otherwise sanctioned from participation in 
public programs as a result of program integrity activities; 
(13)  The amount of all recoveries of fraudulent overpayments received as a 
result of multistate litigation against pharmaceutical companies or other 
providers; and 
(14)  The dollar amount, by provider type, of any overpayment recoveries; 
B.  A description of the status of cases referred to the Attorney General's health care 
crimes or other unit or other law enforcement entities under section 102, subsection 6 
and the number and disposition of those cases and the amount of overpayments 
recovered, all detailed on a per case basis, as long as the information disclosed 
conforms to the requirements of Title 16, section 804 and does not compromise the 
investigation or prosecution of a case; 
C.  If the department uses a vendor, contractor or other program integrity unit to 
assist in the identification and recovery of overpayments, a description of the 
performance and activities of the vendor, contractor or other program integrity unit 
used by the department.  The report must include what the scope of the vendor's, 
contractor's or other program integrity unit's activity is, what payments have been 
made to the vendor, contractor or other program integrity unit, how many cases have 
been opened, how many overpayments have been recovered and any other benefits 
from the vendor's, contractor's or other program integrity unit's involvement; 
D.  A description of the department's participation in federally mandated program 
integrity efforts, including the federal Department of Health and Human Services, 
Centers for Medicare and Medicaid Services recovery audit program and payment 
error rate measurement program, and the effect of this participation on department 
resources and money recovered and the number of providers sanctioned and referrals 
made as a result of this participation; 
E.  The results of any federal audits of the department's program integrity activities, 
including weaknesses identified and best practices identified; 
F.  A description of any known defects, deficiencies or weaknesses in any systems 
managed or used by the department that resulted in the improper or inaccurate 
payment of claims or benefits, including but not limited to the Medicaid information 
system, provider enrollment system and eligibility determination system.  The report 
must include an estimate of the financial effect of these issues and a timeline for 
remediation and a description of any known defects, deficiencies or weaknesses in 
any systems managed or used by the department that have been corrected and an 
estimate of the cost of and any savings from these corrections; 
G.  A description of any investments in technology planned by the department to 
improve efforts to prevent improper payments; and 
H.  A description of any policy changes or improvements implemented by the 
department to improve the accurate payment of claims and benefits. 
5.  Report.  Upon completion of a quality assurance audit or program review under 
this section, the Inspector General shall report the findings and any recommendations to 
the commissioner and the joint standing committee of the Legislature having jurisdiction 
over health and human services matters and the joint standing committee of the 
Legislature having jurisdiction over financial affairs. 
§105.  Investigation of mental abuse, physical abuse, sexual abuse, neglect or 
financial exploitation or death of an individual 
1.  Mental abuse, physical abuse, sexual abuse, neglect or financial exploitation 
of an individual.  Upon receipt of a report or a complaint or upon the Inspector General's 
own initiative, the Inspector General shall investigate instances of possible mental abuse, 
physical abuse, sexual abuse, neglect or financial exploitation of an individual.  The 
Inspector General may take immediate action to prevent mental abuse, physical abuse, 
sexual abuse, neglect or financial exploitation of an individual or, if the Inspector General 
determines a crime was or is being committed, report the matter immediately to the Chief 
of the State Police or other appropriate law enforcement agency under section 102, 
subsection 6. If the Inspector General takes immediate action or reports a matter to a law 
enforcement agency under this subsection, the Inspector General shall immediately notify 
the Attorney General, the commissioner and the director of the agency or facility where 
the incident occurred. 
2.  Death of individual.  The Inspector General shall investigate the death of an 
individual that occurs: 
A.  At an agency, facility or site funded by the department; 
B.  Within 24 hours after the individual was refused services at an agency, facility or 
site funded by the department; or 
C.  Within 14 days after the individual was discharged or transferred from an agency, 
facility or site funded by the department. 
Upon written request of a department or agency of the State, the Inspector General shall 
assist that department or agency in investigating a report of the death, abuse or neglect of 
a person with mental illness, autism or intellectual disabilities. 
3.  Site visits.  The Inspector General shall conduct an unannounced site visit to each 
facility at least once annually to review and make recommendations on systemic issues 
relative to preventing, reporting, investigating and responding to mental abuse, physical 
abuse, sexual abuse, neglect or financial exploitation of individuals in the facility's care. 
4.  Reports and recommendations.  Upon the conclusion of an investigation under 
subsection 1 or 2, the Inspector General shall report its findings to the commissioner and 
to the director of the agency or facility where the incident occurred and include any 
recommendations the Inspector General determines appropriate. 
§106.  Employees 
1.  Mandatory reporting.  In addition to the reporting requirements under Title 34-B 
or department rules, if an employee witnesses, suspects, is told of or has reason to believe 
an instance of fraud or attempted fraud or an incident of commingling or misapplication 
of funds under section 103 or of abuse, neglect, financial exploitation or death of an 
individual under section 105 has occurred or is occurring, the employee shall report the 
allegation to the Inspector General within 4 hours after initial discovery of the 
information pursuant to the process under section 102, subsection 4, paragraph D.  A 
violation of this subsection is a Class D crime. 
2.  Cooperation with Inspector General.  An employee shall cooperate with the 
Inspector General in the performance of the Inspector General's duties.  Failure to 
cooperate under this subsection includes: 
A.  Creating and transmitting a false report to the Inspector General; 
B.  Providing false information to an investigator of the Inspector General during an 
investigation, site visit, quality assurance audit or program review; 
C.  Colluding with other employees to cover up evidence; 
D.  Colluding with other employees to provide false information to an investigator of 
the Inspector General during an investigation, site visit, quality assurance audit or 
program review; 
E.  Knowingly destroying or not properly preserving evidence; 
F.  Withholding evidence; 
G.  Failing to provide information upon request of the Inspector General during an 
investigation, site visit, quality assurance audit or program review; or 
H.  Obstructing an Inspector General investigation, site visit, quality assurance audit 
or program review. 
3.  Retaliation.  An employee who complies with the provisions of this section may 
not be retaliated against if the employee acted in good faith in conformance with the 
employee's duties. 
§107.  Reports and recommendations 
1.  Annual report.  No later than January 1st of each year, the Inspector General 
shall provide to the Governor, the joint standing committee of the Legislature having 
jurisdiction over health and human services matters, the joint standing committee of the 
Legislature having jurisdiction over financial affairs and the commissioner a summary of 
investigations, reports and recommendations made under this chapter for the prior 
calendar year.  The report shall detail any corrective or administrative action directed by 
the commissioner or final disposition of a matter as a result of an investigation, report or 
recommendation submitted by the Inspector General made under this chapter for the prior 
calendar year and a summary of the prior calendar year's program integrity efforts of the 
department, including efforts to investigate and prosecute fraudulent incidents or 
practices. The report must include objective data identifying trends in reported 
allegations, the timeliness of the Office of the Inspector General's investigations and the 
final dispositions of investigations for each agency and facility and of each 
departmentwide investigation for the most recent 3-year period. The report must include 
any detailed recommended administrative actions and matters for consideration by the 
Legislature.  The report may not contain any confidential or personally identifying 
information of a recipient. 
2.  Confidentiality.  Any raw data, finding or unsubstantiated report from an 
investigation or site visit conducted by the Inspector General is confidential except for the 
report under subsection 1 or as provided by this chapter, court order or other applicable 
law. 
3.  Disclosure of findings or report.  The Inspector General shall disclose the 
findings of an investigation or site visit, including whether any allegations were 
substantiated or unsubstantiated, to the following persons: 
A.  The Governor; 
B.  The commissioner; 
C.  The director of the agency or facility involved; 
D.  The alleged victim and a parent or guardian of the alleged victim, when 
applicable; 
E.  The complainant, when applicable; and 
F.  The accused, when applicable. 
4.  Agency or facility response.  Within 30 calendar days of receiving a report with 
recommendations from the Inspector General, the director of the agency or facility that is 
the subject of the report shall file a written response to the Inspector General and 
commissioner that addresses any corrective actions taken by the agency or facility to: 
A.  Protect an individual, when applicable; 
B.  Eliminate an identified problem; and 
C.  Prevent recurrences of an identified problem. 
A response under this subsection must include the implementation and completion dates 
of any corrective action taken.  If a written response is not made within the 30-day period, 
the commissioner shall determine the appropriate corrective action to be taken in 
response to the report. 
5.  Commissioner review.  Upon review of any report, finding or recommendation 
submitted by the Inspector General and any response under subsection 4, the 
commissioner may accept or reject a recommendation and may direct that further 
investigation be taken by the Inspector General or further corrective action be taken by 
the department or an agency or facility. 
Sec. 5.  Transition provisions.  The following provisions govern the transition of 
the Human Services Fraud Investigation Unit from the jurisdiction of the Department of 
Health and Human Services to the jurisdiction of the Office of the Inspector General. 
1.  The Human Services Fraud Investigation Unit under the jurisdiction of the Office 
of the Inspector General is the successor in every way to the powers, duties and functions 
of the former Human Services Fraud Investigation Unit under the jurisdiction of the 
Department of Health and Human Services. 
2.  All existing rules, regulations and procedures in effect, in operation or adopted in 
or by the Human Services Fraud Investigation Unit under the jurisdiction of the 
Department of Health and Human Services or any of its administrative units or officers 
are hereby declared in effect and continue in effect until rescinded, revised or amended 
by the proper authority. 
3.  All existing contracts, agreements and compacts currently in effect in the Human 
Services Fraud Investigation Unit under the jurisdiction of the Department of Health and 
Human Services continue in effect. 
4.  Any positions authorized and allocated subject to the personnel laws to the former 
Human Services Fraud Investigation Unit under the jurisdiction of the Department of 
Health and Human Services are transferred to the Human Services Fraud Investigation 
Unit under the jurisdiction of the Office of the Inspector General and may continue to be 
authorized. 
5.  All records, property and equipment previously belonging to or allocated for the 
use of the former Human Services Fraud Investigation Unit under the jurisdiction of the 
Department of Health and Human Services become, on the effective date of this Act, part 
of the property of the Human Services Fraud Investigation Unit under the jurisdiction of 
the Office of the Inspector General. 
6.  All existing forms, licenses, letterheads and similar items bearing the name of or 
referring to the Human Services Fraud Investigation Unit may be used by the Human 
Services Fraud Investigation Unit under the jurisdiction of the Office of the Inspector 
General until existing supplies of those items are exhausted. 
SUMMARY 
This bill creates the Office of the Inspector General within the Department of Health 
and Human Services to be operated and funded independently of the department.  The 
purpose of the Office of the Inspector General is to oversee the functions of the 
Department of Health and Human Services with 4 main duties: 
1.  Investigate instances of fraud, attempted fraud and commingling or misapplication 
of department funds; 
2.  Conduct quality assurance audits and program reviews of department programs, 
agencies and facilities; 
3.  Investigate instances of abuse, financial exploitation or death of mentally ill, 
autistic or intellectually disabled recipients of department assistance or services; and 
4.  Establish and maintain a process by which an employee, recipient of department 
assistance or services or a member of the public may report or complain about fraud, 
attempted fraud, commingling or misapplication of department funds or abuse, neglect, 
financial exploitation or death of a mentally ill, autistic or intellectually disabled recipient 
of department assistance or services. 
This bill requires the Inspector General to perform its duties through conducting 
investigations, audits and site visits and issuing findings, reports and recommendations 
that are reviewed by the Commissioner of Health and Human Services.  The bill moves 
the existing Human Services Fraud Investigation Unit from the jurisdiction of the 
Department of Health and Human Services to the Office of the Inspector General and 
directs the Inspector General to refer matters to the Attorney General or a law 
enforcement agency or enlist the assistance of the State Auditor when appropriate. This 
bill also requires the Inspector General to submit an annual report to the Governor, the 
Commissioner of Health and Human Services and the joint standing committees of the 
Legislature having jurisdiction over health and human services matters and financial 
affairs summarizing its activities for the prior calendar year. This bill provides for 
oversight of the Inspector General by the Office of Program Evaluation and Government 
Accountability on an as-needed basis.