§ 50-24.8-10 — Powers and duties of Medicaid fraud control unit

North Dakota § 50-24.8-10

• Jurisdiction: North Dakota
• Title 50: Public Welfare
• Ch. 50-24.8: Medicaid Fraud Control Unit

Text

1. The Medicaid fraud control unit shall:

a. Investigate and prosecute under applicable criminal or civil laws fraud and patient
abuse or neglect by providers or any other person, including cases referred by
the department;
b. Review complaints of patient abuse, patient neglect, and misappropriation of
patient property and, if appropriate, investigate and initiate criminal or civil
proceedings or refer the complaint to another federal, state, or local agency for
action;
c. Refer to the department for collection and, if appropriate, imposition of
appropriate provider administrative actions involving provider overpayments and
abuse;
d. Communicate and cooperate with and, subject to applicable confidentiality laws,
provide information to other federal, state, and local agencies involved in the
investigation and prosecution of health care fraud, patient abuse, and other
improper activities related to the Medicaid program;
e. Transmit to other state and federal agencies, in accordance with law, reports of
convictions, copies of judgments and sentences imposed and other information
and documents for purposes of program exclusions or other sanctions or
penalties under Medicaid, Medicare, or other state or federal benefit or
assistance programs;
f. Recommend to state agencies appropriate or necessary adoption or revision of
laws, rules, policies, and procedures to prevent fraud, abuse, and other improper
activities under the Medicaid program and to aid in the investigation and
prosecution of fraud, abuse, and other improper activities under the Medicaid
program; and
g. Enter an agreement with the Medicaid agency regarding referrals, information
sharing, and improper payment recoveries as provided in title 42, Code of
Federal Regulations, part 455, section 23.
2. The Medicaid fraud control unit may:
a. Initiate criminal prosecutions and civil actions pursuant to subsection 1 in any
court of competent jurisdiction in the state;
b. Upon request, obtain information and records from applicants, recipients, and
providers;
c. Subject to applicable federal confidentiality laws and rules and for purposes
related to any investigation or prosecution under subsection 1, obtain from the
department, local offices of public assistance, and other local, county, or state
government departments or agencies records and other information, including
applications, provider enrollment forms, claims and reports, individual or entity tax
returns, or other information provided to or in the possession of the tax
commissioner or the state auditor;
d. Refer appropriate cases to federal, other state, or local agencies for investigation,
prosecution, or imposition of penalties, restrictions, or sanctions;
e. Work cooperatively with federal agencies; and
f. Enter agreements with the department and other federal, state, and local
agencies in furtherance of the unit's mission.