(a) The office of inspector general may review the records of a managed care organization to which this subchapter applies to determine compliance with this subchapter.
(b) The office of inspector general, in consultation with the commission, shall:
(1) investigate, including by means of regular audits, possible fraud, waste, and abuse by managed care organizations to which this subchapter applies;
(2) establish requirements for providing training to and regular oversight of special investigative units established by managed care organizations under § 544.0352(a)(1) and entities with which managed care organizations contract under § 544.0352(a)(2);
(3) establish requirements for approving plans to prevent and reduce fraud and abuse that managed care organizations adopt under § 544.0353;
(4) evaluate statewide Medicaid fraud, waste, and abuse trends and communicate those trends to special investigative units and contracted entities to determine the prevalence of those trends;
(5) as needed, assist managed care organizations in discovering or investigating fraud, waste, and abuse; and
(6) provide ongoing, regular training to appropriate commission and office staff concerning fraud, waste, and abuse in a managed care setting, including training relating to fraud, waste, and abuse by service providers, recipients, and enrollees.

Text of section effective on April 01, 2025