2023 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; 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.