Creation of Office; duties; report to Legislature

1. The Office of the Medicaid Inspector General is hereby created within the Authority. 2. The Office shall: (a) Establish policies and protocols to ensure the integrity of reimbursement under Medicaid and the participation of providers in Medicaid and the Children’s Health Insurance Program; (b) Review providers of services under Medicaid and the Children’s Health Insurance Program, the enrollment of such providers and the revalidation of such providers; (c) Review, audit and investigate providers of services under Medicaid and the Children’s Health Insurance Program: (1) To ensure compliance with applicable state and federal requirements; and (2) Upon an allegation of waste, fraud or abuse against a provider; (d) Make recommendations to the Authority regarding the prevention and detection of fraud, waste and abuse in Medicaid and the Children’s Health Insurance Program; (e) Take such actions as are necessary to maximize the ability of the Authority to prevent and recover improper reimbursements and other improper payments to providers; and (f) Perform such other duties as delegated by the Director. 3. On or before October 1 of each year, the Office shall: (a) Compile a report on the activities of the Office during the immediately preceding fiscal year which must include, without limitation: (1) The number of investigations and administrative actions initiated pursuant to this chapter during the immediately preceding fiscal year, the subject of each such investigation or administrative action and a description of each such investigation or administrative action; (2) A summary of the outcome and type of each completed investigation or administrative action; and (3) The number of referrals for prosecution to the Medicaid Fraud Control Unit established within the Office of the Attorney General pursuant to NRS 228.410 and other law enforcement agencies, the subject of each such referral and a description of each such referral; and (b) Submit the report to the Director, the Governor and the Director of the Legislative Counsel Bureau for transmittal to: (1) In odd-numbered years, the Joint Interim Standing Committee on Health and Human Services and the Joint Interim Standing Committee on the Judiciary; and (2) In even-numbered years, the next regular session of the Legislature.