| (a) The OIG is responsible for preventing, detecting,
auditing, inspecting, reviewing, and investigating fraud, waste, and
abuse in the provision of HHS in Medicaid and other HHS programs.
As part of its authority, the OIG may impose sanctions upon a finding
by the OIG of fraud, waste, or abuse in Medicaid. The OIG is also
responsible for enforcing state law relating to the provision of HHS
in Medicaid and other HHS programs. As a result, the OIG may also
investigate a suspected regulatory violation in a non-Medicaid, HHS
program and, upon a finding of a violation, may recommend the HHS
program take appropriate enforcement action to the extent of the HHS
program's regulatory authority. The OIG administers program integrity
and enforces program violations to the extent of applicable law governing
Medicaid and the provision of other HHS. This includes pursuing Medicaid
and other HHS fraud, abuse, overpayment, or waste. To accomplish the
objectives of this chapter, the OIG implements review processes to
distinguish payment discrepancies that can be corrected through routine
payment adjustments from those suspected to result from program violations
requiring investigation and possible administrative enforcement or
judicial action.
(b) The Inspector General establishes objectives and
priorities for the OIG that emphasize:
(1) coordinating investigative efforts to aggressively
recover funds;
(2) allocating resources to cases that have the strongest
supportive evidence and the greatest potential for recovery of money;
and
(3) maximizing opportunities for referral of cases
to the OAG.
(c) In addition to performing functions and duties
otherwise provided by law, the OIG may:
(1) assess administrative penalties otherwise authorized
by law on behalf of HHSC;
(2) request that the OAG obtain an injunction to prevent
a person from disposing of an asset identified by the OIG as potentially
subject to recovery by the OIG due to the person's fraud, waste, or
abuse;
(3) provide for coordination between the OIG and SIUs
or entities with which managed care organizations contract to identify
and investigate fraudulent claims and other types of program abuse
by recipients and providers, and approve the plan of the SIUs to prevent
and reduce fraud, waste, or abuse;
(4) audit the use and effectiveness of state or federal
funds, including contract and grant funds, administered by a person
or state agency receiving the funds from an HHS agency;
(5) conduct investigations relating to the funds described
in paragraph (4) of this subsection; and
(6) recommend policies promoting economical and efficient
administration of the funds described in paragraph (4) of this subsection
and the prevention and detection of fraud, waste, or abuse in the
administration of those funds.
(d) The OIG may require employees of HHS agencies to
provide assistance to the OIG in connection with its duties relating
to the review, inspection, investigation, or audit of fraud, waste,
abuse, or overpayment in the provision of HHS.
(e) The OIG is entitled to access to any information
maintained by an HHS agency, including internal records, relevant
to the functions of the OIG. This chapter sets forth the types of
activities performed by the OIG to ensure program integrity.
(f) HHSC may obtain any information or technology necessary
to enable the OIG to meet its responsibilities as mandated by state
statute or other law.
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