Current through Register Vol. 46, No. 19, March 20, 2024
The investigations division of the department conducts
criminal, civil, and administrative investigations of fraud and misconduct. The
division also conducts audits of health care facilities. Staff within the
division work closely with federal, state, and local partners in identifying
fraud, waste, and abuse and, where appropriate, presenting cases for criminal
prosecution.
(1)
Units of the
division. The division is comprised of the following units.
a.
Audit unit. The audit
unit audits health and human services health care facilities to review and
verify facility resident billing and personal allowance accounts and to
determine whether state billings accurately reflect the health care facility
census. The unit audits local department of human services offices to review
and verify whether administrative expense claims and official receipts are in
accordance with the criteria set forth in 2 CFR Part 200 and state
law.
b.
Economic fraud
control bureau (EFCB). The economic fraud control bureau investigates
recipient public assistance fraud and supplemental nutrition assistance program
(SNAP) trafficking. Division staff investigate suspected fraud and assist the
department of human services to determine eligibility for public assistance.
Division staff may conduct investigations relative to the administration of any
other state or federal benefit assistance program. Division staff may also
conduct investigations relative to the internal affairs and operations of
agencies and departments within the executive branch of state government,
except for institutions governed by the state board of regents.
c.
Medicaid fraud control unit
(MFCU). The Medicaid fraud control unit investigates allegations of
fraud committed by providers against the Medicaid program as well as fraud in
the administration of the Medicaid program. MFCU also investigates abuse,
neglect or other crimes committed upon residents in care facilities or related
programs that receive funding from the Medicaid program.
d.
Public assistance debt recovery
unit (PADRU). The public assistance debt recovery unit investigates
and initiates collections of overpayment debts owed to the department of human
services.
(2)
Peace officer status. Pursuant to Iowa Code section
10A.403, investigators assigned
to the division shall have the powers and authority of peace officers when
acting within the scope of their responsibilities to conduct investigations as
specified in Iowa Code section
10A.402(5). An
investigator shall not carry a weapon to perform responsibilities as described
in this subrule.
This rule is intended to implement Iowa Code sections
10A.401 to
10A.403.
