The Investigations Division's mission is to ensure the protection of the health, safety and welfare of Iowans by: 1) maintaining public assistance program integrity and accountability through the prevention, detection and investigation or public assistance fraud, waste and abuse by Medicaid providers and public assistance recipients; 2) auditing health care facilities and local DHS offices to ensure compliance with state and federal funding requirements; 3) initiating the recovery of any misallocated taxpayer funds; 4) detecting, investigating and prosecuting dependent adult abuse that occurs in health care facilities; and 5) investigating regulated professionals for the health professional boards.
What We Do
The Investigations Division audits health care facilities and conducts criminal, civil and administrative investigations of fraud and misconduct. Staff within the division work closely with other state and local partners in identifying fraud, waste and abuse, and where appropriate, forward cases to federal, state and local officials for prosecution.
Abuse Coordinating Unit
Assists with the detection, investigation and prosecution of civil, administrative dependent adult abuse investigations in health care facilities.
- Audits health care facilities to determine whether Medicaid reimbursement procedures meet all participation requirements and conducts expenditure audits of local Department of Human Services (DHS) offices to determine eligibility for federal fund reimbursement for operating expenses.
Economic Fraud Control Unit (EFCU)
- Investigates recipient public assistance fraud and food assistance trafficking.
- Investigates the transfer or assignment of a legal or equitable interest in property from a Medicaid transferor to a transferee for less than fair market value.
Medicaid Fraud Control Unit (MFCU)
- Investigates allegations of fraud committed by providers against the Medicaid program as well as fraud in the administration of the Medicaid program; and
- Investigates abuse/neglect and other crimes committed upon residents in care facilities or related programs that receive funding from the Medicaid program.
Professional Standards Unit
- Investigates licensed professionals for the Iowa Department of Public Health, Professional Licensure Bureau.
Public Assistance Debt Recovery Unit (PADRU)
Investigates and initiates collections of overpayment debts owed to DHS.