Text of section effective on April 01, 2025
Sec. 544.0102.  COMMISSION POWERS AND DUTIES RELATED TO OFFICE OF INSPECTOR GENERAL.  (a)  The executive commissioner shall work in consultation with the office of inspector general when the executive commissioner is required by law to adopt a rule or policy necessary to implement a power or duty of the office of inspector general, including a rule necessary to carry out a responsibility of the office of inspector general under Section 544.0103(a).
(b)  The executive commissioner is responsible for performing all administrative support services functions necessary to operate the office of inspector general in the same manner that the executive commissioner is responsible for providing administrative support services functions for the health and human services system, including office functions related to:
(1)  procurement processes;
(2)  contracting policies;
(3)  information technology services;
(4)  legal services, but only those related to:
(A)  open records;
(B)  procurement;
(C)  contracting;
(D)  human resources;
(E)  privacy;
(F)  litigation support by the attorney general;
(G)  bankruptcy; and
(H)  other legal services as detailed in the memorandum of understanding or other written agreement required under Subchapter E, Chapter 524;
(5)  budgeting; and
(6)  personnel and employment policies.
(c)  The commission's internal audit division shall:
(1)  regularly audit the office of inspector general as part of the commission's internal audit program; and
(2)  include the office of inspector general in the commission's risk assessments.
(d)  The commission's chief counsel is the final authority for all legal interpretations related to statutes, rules, and commission policies on programs the commission administers.
(e)  The commission shall:
(1)  in consultation with the inspector general, set clear objectives, priorities, and performance standards for the office of inspector general that emphasize:
(A)  coordinating investigative efforts to aggressively recover money;
(B)  allocating resources to cases that have the strongest supportive evidence and greatest potential to recover money; and
(C)  maximizing opportunities for referral of cases to the office of the attorney general in accordance with Section 544.0051; and
(2)  train office of inspector general staff to enable the staff to pursue priority Medicaid and other health and human services fraud and abuse cases as necessary.
(f)  The commission may require employees of health and human services agencies to provide assistance to the office of inspector general in connection with its duties relating to the investigation of fraud and abuse in the provision of health and human services.  The office of inspector general is entitled to access to any information a health and human services agency maintains that is relevant to the office of inspector general's functions, including internal records.
(g)  To the extent permitted by federal law, the executive commissioner, on the office of inspector general's behalf, shall adopt rules establishing:
(1)  criteria for:
(A)  initiating a full-scale fraud or abuse investigation;
(B)  conducting the investigation;
(C)  collecting evidence; and
(D)  accepting and approving a provider's request to post a surety bond to secure potential recoupments in lieu of a payment hold or other asset or payment guarantee; and
(2)  minimum training requirements for Medicaid provider fraud or abuse investigators.
(h)  The executive commissioner, in consultation with the office of inspector general, shall adopt rules establishing criteria:
(1)  for opening a case;
(2)  for prioritizing cases for the efficient management of the office of inspector general's workload, including rules that direct the office to prioritize:
(A)  provider cases according to the highest potential for recovery or risk to this state as indicated through:
(i)  the provider's volume of billings;
(ii)  the provider's history of noncompliance with the law; and
(iii)  identified fraud trends;
(B)  recipient cases according to the highest potential for recovery and federal timeliness requirements; and
(C)  internal affairs investigations according to the seriousness of the threat to recipient safety and the risk to program integrity in terms of the amount or scope of fraud, waste, and abuse the allegation that is the subject of the investigation poses; and
(3)  to guide field investigators in closing a case that is not worth pursuing through a full investigation.
Added by Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 1.01, eff. April 1, 2025.