Mich. Comp. Laws Ann. § 333.26368 - Creation of office of health services inspector general; transfer of powers and duties necessary for office to perform duties from department of community health

Michigan established the Office of Health Services Inspector General (OHSIG) for the purpose of combating fraud, waste, and abuse in Michigan’s health services programs. The OHSIG’s powers and duties include:

• “Solicit[ing], receiv[ing], and investigat[ing] complaints related to fraud, waste, and abuse in Health Services Programs.”
• Performing Michigan’s health services federally mandated fraud and abuse activities.
• Investigating fraudulent billing practices and improving the means of investigating these practices.
• Garnering testimony from witnesses and compelling production of documents in relation to investigations.
• Examining and copying documents and records held by a state or local government entity or contractor as necessary. OHSIG must keep these documents and records confidential in compliance with any relevant state and federal laws.
• “Pursu[ing] administrative and civil enforcement actions” and other “formal or informal enforcement action[s]…under state or federal law” against perpetrators of fraud and abuse.
• Settling administrative and civil actions.
• Submitting information to the Medicaid Fraud Control Unit and the Department of Human Services Office of Inspector General.
• Reviewing and monitoring contracts for managed care, health plans, and other service arrangements in order to reduce the risk of fraud.
• Monitoring arrangements between Medicaid managed care companies and providers, billing, and encounter data for instances of fraud and abuse.
• Serving as a clearinghouse for fraud and abuse activities by Department of Community Health contractors.
• Ensuring that entities participating in Medicaid programs comply with their obligation to educate their employees, contractors, and agents about the federal and state false claims act.