TITLE
8 SOCIAL SERVICES
CHAPTER
1 SOCIAL SERVICES GENERAL
PROVISIONS
PART
2 GENERAL OPERATING PROCEDURE
FOR THE OFFICE OF INSPECTOR GENERAL
8.1.2.1 ISSUING
AGENCY:
New Mexico Human Services Department
(HSD).
[8.1.2.1 NMAC - N, 11/01/2018]
8.1.2.2 SCOPE: The rule applies to the general public.
[8.1.2.2 NMAC - N, 11/01/2018]
8.1.2.3 STATUTORY AUTHORITY:
A. Sections
27-1-2 and 27-1-3 NMSA 1978 provides for the department to “adopt, amend and
repeal bylaws, rules and regulations.” It
also provides for administration of public assistance programs.
B. The
Office of Inspector General (OIG) of the Human Services Department (HSD) was
created by the secretary under authority granted by Paragraph (3) of Subsection
B of Section 9-8-6 NMSA 1978.
[8.1.2.3 NMAC - N, 11/01/2018]
8.1.2.4 DURATION:
Permanent.
[8.1.2.4 NMAC - N, 11/01/2018]
8.1.2.5 EFFECTIVE DATE: November 1, 2018, unless a later date is
cited at the end of a section.
[8.1.2.5 NMAC - N, 11/01/2018]
8.1.2.6 OBJECTIVE:
The
objective of these regulations is to provide general operating policy for the Office
of Inspector General (OIG).
[8.1.2.6 NMAC - N, 11/01/2018]
8.1.2.7 DEFINITIONS:
The following words and terms, when used in this section, shall have the
following meanings, unless the text clearly indicates otherwise:
A. “Abuse” means to make
excessive or improper use of a thing, or to employ it in a manner contrary to
the material or legal rules for its use; to make an extravagant or excessive
use, as to abuse one's authority. Abuse
may also occur through expressive carelessness in following written
instructions or policy or in failing to take proper action that results in
improper payments for public assistance, food benefits, vendor payments, or
claims processing. Abuse through
expressive carelessness may occur in eligibility determination, supervision
review, data processing, claims processing, or program interpretation.
B. “Fraud” is an
intentional misappropriation, deception or misrepresentation made by a
person(s) or entities with knowledge that the deception could result in some
unauthorized benefit to the person(s), entity, other entity or some other
person(s). The term includes any act
that constitutes fraud under applicable federal or state laws, regulations, or
rules.
C. “Waste” means not receiving reasonable value for money in connection with any government
funded activities due to an inappropriate act or omission by person(s) or
entities with control over or access to government resources (e.g., executive,
judicial or legislative branch employees, grantees or other recipients). Waste goes beyond fraud and abuse and does not
involve a violation of law. Waste
relates primarily to mismanagement, inappropriate actions and inadequate
oversight.
[8.1.2.7 NMAC - N, 11/01/2018]
8.1.2.8 MISSION STATEMENT: [RESERVED]
[8.1.2.8 NMAC - N, 11/01/2018]
8.1.2.9 RESPONSIBILITIES: Generally, the OIG, is responsible for conducting
independent audits, reviews, and investigations of HSD programs and operations,
while detecting and preventing fraud, waste, and abuse. Through audits and reviews, the OIG promotes
accountability, efficiency, economy, and integrity through research and
analysis, and by providing recommendations for improvement to HSD’s secretary, leadership
and management. The OIG conducts
investigations into public assistance, i.e. medicaid, supplemental nutrition
assistance program (SNAP), temporary assistance for needy families (TANF),
etc., fraud, and HSD contractor and internal employee fraud. If potential fraud is identified, the OIG,
when appropriate, will pursue prosecutive remedies and, in coordination with
HSD, administrative remedies. Nothing in
this section shall prohibit law enforcement agencies from pursuing claims for
alleged violations of criminal conduct or other governmental entities from seeking
all rights and remedies as permitted by law and regulations.
[8.1.2.9 NMAC - N, 11/01/2018]
8.1.2.10 Authority: In conjunction with federal and state law,
rules and regulations that apply to HSD programs, the OIG is authorized:
A. To
audit, review, inspect, evaluate, and investigate activities, records,
electronic media, and individuals affiliated with contracts and procurements
undertaken by HSD and any other official act or function of HSD.
B. To
have access to all records, reports, audits, reviews, documents, papers,
electronic media, recommendations, or other material available to the individual
or entity which relate to HSD’s programs and operations with respect to which
the OIG has responsibility.
C. To
conduct criminal, civil, and administrative investigations.
D. To
engage in prevention activities, including but not limited to; review of
legislation; review of rules, regulations, policies; procedures, and
transactions; training and education.
E. To
refer matters for further civil, criminal, and administrative action to
appropriate administrative and prosecutorial agencies.
F. To
refer matters to other law enforcement agencies, when appropriate.
G. To
conduct joint investigations and projects with other oversight or law enforcement
agencies.
H. To
establish guidelines and procedures to guide functions and processes conducted
by the OIG.
I. To
recoup the cost of investigations from nongovernmental entities as permitted by
law.
J. To
administer to or take from any person an oath, affirmation, affidavit or sworn
statement, whenever necessary in the performance of the OIG functions assigned
by this code.
K. To
request such information or assistance as may be necessary for carrying out the
duties and responsibilities provided by this code from any federal, state, or
local governmental agency or unit thereof.
L. Access
to HSD’s secretary, leadership and management when necessary for any purpose
pertaining to the OIG’s responsibilities.
[8.1.2.10 NMAC - N, 11/01/2018]
8.1.2.11 Powers: The OIG is granted the following powers:,
A. Access
to all records maintained by or available to any governmental entity relating
in any way to the OIG’s duties and responsibilities.
B. Access
to testimony or documents from any individual, firm, or nongovernmental entity
relating to the duties and responsibilities of the OIG.
C. Require
HSD employees to report to the OIG information regarding fraud, waste,
corruption, illegal acts, and abuse.
[8.1.2.11 NMAC - N, 11/01/2018]
8.1.2.12 Confidentiality: The OIG shall maintain confidentiality of
records and, to the extent practicable, the identities of individuals who provide
information to the OIG, except as authorized or required by law.
[8.1.2.12 NMAC - N, 11/01/2018]
8.1.2.13 Cooperation: In accordance with federal and state laws and
regulations and, if applicable, collective bargaining agreements, all HSD
employees shall cooperate fully and promptly with requests from the OIG for
information and data relating to HSD programs and operations. All HSD employees shall also comply with
requests for interviews and briefings and must provide affidavits or sworn
statements, if so requested by an employee of the OIG so designated to take
affidavits or sworn statements. The OIG
is not required to give advanced notice before conducting audits, reviews or
investigations. When possible,
supervisors will be informed in advance if their areas of responsibility that are
to be audited. Because some OIG
investigations may involve allegations of criminal misconduct, circumstances
will dictate whether, and what type of, notice will be given, if any. HSD employees must not impede or hinder other
employees’ cooperation with the OIG. In
accordance with Act 10-16C-1 through 10-16C-6 NMSA 1978, HSD managers shall
prohibit reprisals against employees who cooperate with or disclose information
to the OIG or other lawfully appropriate authority. HSD will also take administrative action
against employees who take reprisals against employees who have cooperated with
the OIG or other lawful appropriate authority to include, but is not limited
to, counsel, reprimand, suspension, or termination. 8.1.2.13 NMAC, must be applied to all HSD
contracts, replacing “HSD” with “contractor”, where applicable.
[8.1.2.13 NMAC - N, 11/01/2018]
HISTORY
OF 8.1.2 NMAC: [RESERVED]