The Investigations Division investigates alleged fraud in the state's public assistance programs including the theft of warrants, investigates Medicaid fraud by health care providers, and conducts professional practice investigations on behalf of state licensing boards. Through a review of applications for public assistance, the Division can prevent the issuance of funds to ineligible individuals. In addition, when individuals fraudulently receive public assistance, the Division initiates recovery actions to recoup the overpayments.
Division employees, too, perform expenditure audits of local Department of Human Services (DHS) offices to determine eligibility for federal fund reimbursement for operating expenses. These DHS audits also ensure compliance with applicable state and federal funding requirements. When conducting health care audits at residential care facilities, nursing facilities, and residential and intermediate care facilities for the mentally retarded, DIA auditors protect residents by assuring them that their personal funds are being properly maintained. Audit findings, too, are used to determine whether Medicaid reimbursement procedures meet all participation requirements.
Staff in the Medicaid Fraud Control Unit conducts investigations of alleged abuse and neglect of residents in long-term care facilities that receive Medicaid reimbursements from the federal government. Investigators also look into allegations that residents have been defrauded of personal funds or possessions.
When abuse or fraud is substantiated, the Division works with local law enforcement officials to bring the offenders to trial. When Medicaid fraud is suspected, the DIA often works side-by-side with investigators from the Federal Bureau of Investigation, the U.S. Postal Service, as well as other state and federal law enforcement agencies.
Jim Smith, Acting