Page 395

MEDICAL SERVICES POLICY MANUAL,SECTION N N-100 Fraud Investigation N 160 Disposition of Investigations

2. The investigator assigned to the case will: a. Examine the electronic record and/or any other records on file within or outside DHS for suspected false statements of clients or other persons; b. Conduct a systematic inquiry to determine validity of allegations of criminal conduct; such investigation may entail interviewing caseworkers with knowledge of the case, division staff, and the suspect for any accounts of alleged conduct; c. After determination of a period of total ineligibility for Medicaid, request a Medicaid profile for purposes of establishing the Medicaid overpayment; d. Prepare a written, documented report at the completion of the investigation for referral to the Prosecutor; e. Administratively close the investigation if, at any stage of the inquiry, the investigative staff determines that the case is not suitable for prosecution; f. Notify the DHS referral source of the disposition of the investigation and return copies of the case record to the County Administrator.

N-160 Disposition of Investigations MS Manual 01/01/14 The Fraud Investigations Unit will notify the County Administrator of the initial disposition of each referral. For cases referred for prosecution, the Fraud Investigations Unit will: • Request the Prosecuting Attorney to file charges and send a copy of the request to the County Office. • Advise the Overpayment Unit of the factual basis for the overpayment as well as overpayment calculation documents. For cases administratively closed, the Fraud Investigations Unit will: • Forward a memo to the County Office and the Overpayment Unit explaining the reason for the closure. If an overpayment has been calculated, these documents will be forwarded to the Overpayment Unit.