NY Pub Health L § 32 (2021)
2021 New York Laws PBH - Public Health Article 1 - Short Title and Definitions: General Provisions 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; and27. 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.