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Code of Federal Regulations (Last Updated: July 5, 2024) |
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Title 42 - Public Health |
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Chapter V - Office of Inspector General-Health Care, Department of Health and Human Services |
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SubChapter B - OIG Authorities |
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Part 1007 - State Medicaid Fraud Control Units |
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Subpart B - Requirements for Certification |
§ 1007.15 - Establishment and certification of Unit.
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§ 1007.15 Establishment and certification of Unit.
(a) Initial application. In order to demonstrate that it meets the requirements for certification, the State or territory must submit to OIG an application approved by the Governor or chief executive, containing the following:
(1) A description of the applicant's organization, structure, and location within State government, and a statement of whether it seeks certification under § 1007.7(a), (b), or (c);
(2) A statement from the State Attorney General that the applicant has authority to carry out the functions and responsibilities set forth in Subpart B. If the applicant seeks certification under § 1007.7(b), the statement must also specify either that:
(i) There is no State agency with the authority to exercise statewide prosecuting authority for the violations with which the Unit is concerned, or
(ii) Although the State Attorney General may have common law authority for statewide criminal prosecutions, he or she has not exercised that authority;
(3) A copy of whatever memorandum of agreement, regulation, or other document sets forth the formal procedures required under § 1007.7(b), or the formal working relationship and procedures required under § 1007.7(c);
(5) A statement of the procedures to be followed in carrying out the functions and responsibilities of this part;
(6) A proposed budget for the 12-month period for which certification is sought; and
(7) Current and projected staffing, including the names, education, and experience of all senior professional employees already employed and job descriptions, with minimum qualifications, for all professional positions.
(b) Basis for, and notification of, certification.
(1) OIG will make a determination as to whether the initial application under paragraph (a) of this section meets the requirements of §§ 1007.5 through 1007.13 and whether a Unit will be effective in using its resources in investigating Medicaid fraud and patient or resident abuse and neglect.
(2) OIG will certify a Unit only if OIG specifically approves the applicant's formal written procedures under § 1007.7(b) or (c), if either of those provisions is applicable.
(3) If the application is not approved, the applicant may submit a revised application at any time.
(4) OIG will certify a Unit that meets the requirements of this Subpart B for 12 months.