New York Codes, Rules and Regulations › Title 9 - EXECUTIVE DEPARTMENT › Subtitle A - Governor's Office › Chapter I - Executive Orders › Part 5 - Executive Orders (George E. Pataki) › Section 5.140 - Executive order no. 140: establishing the position of medicaid inspector general

Current through Register Vol. 46, No. 28, July 10, 2024
WHEREAS, the State has a continuing responsibility to
					 ensure that funds expended under the Medicaid program are used appropriately
					 and efficiently to promote public health;
WHEREAS, fraud, waste and abuse by providers and recipients
					 in the Medicaid program reduces the ability of the State to properly fund the
					 program and results in harm to the health of the State's citizens;
WHEREAS, controlling fraud, waste and abuse in the Medicaid
					 program includes preventing, detecting, and investigating such fraud, waste and
					 abuse, and referring such fraud, waste and abuse for civil or criminal action
					 where appropriate;
WHEREAS, the system by which New York State currently
					 controls Medicaid fraud, waste and abuse was created in response to the
					 exposure of widespread and shocking abuses in the State's nursing home industry
					 by the Temporary State Commission on Living Costs and the Economy in late
					 1974;
WHEREAS, the current system is based largely on formal and
					 informal agreements among the State Department of Health, the Medicaid Fraud
					 Control Unit of the State Department of Law, the Office of the State
					 Comptroller and other local, State, and federal agencies whose clients are
					 served by the Medicaid program, or who are otherwise responsible for the
					 control of Medicaid fraud, waste and abuse;
WHEREAS, New York State's current efforts to control
					 Medicaid fraud, waste and abuse range from investigating providers before they
					 enroll in the Medicaid program, to removing providers from the program when it
					 is determined that there are clear patient safety issues, and to identifying
					 fraud, waste and abuse on the part of both providers and recipients;
WHEREAS, as a result of these activities, and due to
					 tremendous investments in detection systems upgrades and improvements, the
					 Department of Health has recouped, withheld or avoided the unnecessary spending
					 of approximately $9.3 billion in the Medicaid program from 1999 through
					 2004;
WHEREAS, we must nonetheless continue to expand and build
					 upon current efforts to control fraud, waste and abuse in the Medicaid
					 program;
WHEREAS, changes in federal and state laws, as well as in
					 the health care industry and in available technology, suggest that it is time
					 for a comprehensive review of the State's fraud, waste and abuse control
					 infrastructure;
WHEREAS, toward that end, I have appointed an outside
					 expert to conduct such a review and recommend any fundamental, long-term
					 structural changes necessary to further improve the State's Medicaid fraud,
					 waste and abuse control efforts;
WHEREAS, while we examine and prepare to implement such
					 fundamental, long-term structural changes, the immediate coordination of the
					 State's efforts to control Medicaid fraud, waste and abuse at all levels of
					 government is essential;
NOW, THEREFORE, I, GEORGE E. PATAKI, Governor of the State
					 of New York, by virtue of the authority vested in me by the Constitution and
					 the Laws of the State of New York, do hereby direct by Executive Order, the
					 following:
1. There is hereby
				  established in the Executive Department the position of Medicaid Inspector
				  General of the State of New York, who shall be appointed by, and serve at the
				  pleasure of, the Governor. The responsibilities of the Medicaid Inspector
				  General shall include:
a. Coordinating the
				  Medicaid fraud, waste and abuse control activities of State executive agencies
				  whose clients are served by Medicaid, including the Department of Health, the
				  Office of Mental Health, the Office of Mental Retardation and Developmental
				  Disabilities, the Office of Alcoholism and Substance Abuse Services, the Office
				  of Children and Family Services and the State Education Department;
b. Developing multi-agency investigation
				  teams to work in concert with the Office of the Attorney General, the Office of
				  the State Comptroller, the Office of the Welfare Inspector General and county
				  law enforcement officials;
c.
				  Reporting directly to the Secretary to the Governor on progress and
				  accomplishments;
d. Recommending
				  legislative, policy and structural changes needed to strengthen the integrity
				  of the Medicaid program;
e.
				  Focusing attention and State resources on efforts to control Medicaid fraud,
				  waste and abuse;
f. Ensuring
				  continual improvement in the coordination and effectiveness of agency
				  performance;
g. Periodically
				  consulting with the Medicaid Fraud Control Advisory Council established herein
				  concerning its recommendations regarding Medicaid fraud, waste and abuse
				  control;
h. Jointly developing,
				  implementing and integrating new technologies for assisting in the control of
				  Medicaid fraud, waste and abuse; and
i. Identifying the staff in each
				  participating agency who are primarily accountable for specific Medicaid fraud,
				  waste and abuse control outcomes, and recommending the structural changes and
				  logistical support necessary to ensure such accountability.