(a) The commission shall develop and implement a program to provide annual training to contractors who process Medicaid claims and to appropriate staff of the health and human services agencies in identifying potential cases of fraud, waste, or abuse under Medicaid. The training provided to the contractors and staff must include clear criteria that specify:
(1) the circumstances under which a person should refer a potential case to the commission; and
(2) the time by which a referral should be made.
(b) The health and human services agencies, in cooperation with the commission, shall periodically set a goal of the number of potential cases of fraud, waste, or abuse under Medicaid that each agency will attempt to identify and refer to the commission. The commission shall include information on the agencies’ goals and the success of each agency in meeting the agency’s goal in the report required by § 531.103(c).

Text of section effective until April 01, 2025