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Idaho Code Ann. § 56-226, Medicaid Fraud Control Unit

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Establishes a Medicaid Fraud Control Unit (“MFCU”) within Idaho’s Office of the Attorney General. Grants the MFCU authority to investigate and prosecute violations of Idaho’s medical assistance laws and, subject to federal approval, violations of federal health care program law that relate substantially to Idaho’s state plan. Clarifies that the MFCU is independent of the Department of Health and Welfare (“Department”) and that Department officials have no authority to review or intervene in MFCU prosecutorial decisions. Tasks the MFCU with reviewing complaints about the abuse or neglect of Medicaid recipients that receive care in a health care facility or reside in a board and care facility. Permits the MFCU to access provider records while carrying out their duties. Prohibits persons from withholding records from the MFCU on the grounds that permitting access would violate a Medicaid recipient’s right to privacy or privilege. Requires the MFCU to safeguard Medicaid recipients’ privacy, but permits disclosure of appropriate information to the Department or other agencies with licensing authority over providers or facilities.

Current as of March 2020