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

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