OFFICE OF THE INSPECTOR GENERAL

Frequently Asked Questions (FAQs)

1. What is the Kansas Health Policy Authority Office of Inspector General?
2. What programs and operations does KHPA administer that could be subject to OIG oversight?
3. Who is the Inspector General?
4. What is the mission of the OIG?
5. How does the OIG perform its work?
6. What happens to the results of OIG audits and investigations?
7. How is the KHPA OIG able to provide increased accountability in KHPA’s programs and operations?
8. How isthe KHPA OIG able to provide increased integrity in KHPA’s programs and operations important?
9. Does the OIG have access to confidential records, including medical records, in performing its work?
10. How can the public be assured that theOIG’s review KHPA programs and operations is objective?
11. Are there any protections for whistleblowers who wish to report illegal or otherwise questionable acts to the OIG?
12. What is fraud?
13. What is waste?
14. What is abuse?
15. What happens if the OIG finds evidence of fraud, waste, abuse or other illegal acts?
16. How do I contact the OIG with my concerns?
17. Are there other places thatI can contact with questions about KHPA programs, including Medicaid, MediKan, HealthWave and the State Employees Health Benefits Plan?
18. What if I have an issue with Medicare?
19. What other websites would be helpful to learn more?

1.  What is the Kansas Health Policy Authority Office of Inspector General?

The Kansas Health Policy Authority (KHPA) Office of Inspector General (OIG) was created in 2007 by the Kansas Legislature as an independent oversight body.  The KHPA OIG is the first statutorily-created Office of Inspector General in the state of Kansas. The OIG enabling legislation can be found in Kansas Statutes Annotated (K.S.A.) 75-7427.

In general, the OIG’s function is to review and help improve KHPA programs and operations and to investigate, identify and deter fraud, waste, abuse and other illegal acts in the State Medicaid Program, the State MediKan Program and the State Children’s Health Insurance Program (HealthWave). 

2.  What programs and operations does KHPA administer that could be subject to OIG oversight?

As indicated in KSA 2005 Supp.75-7401, et seq., the mission of Kansas Health Policy Authority (KHPA) is to develop and maintain a coordinated health policy agenda which combines the effective purchasing and administration of health care while promoting effective public health strategies.  The powers, duties and functions of the Kansas Health Policy Authority are intended to be exercised to improve the health of the people of Kansas by increasing the quality, efficiency and effectiveness of health services and public health programs.  To fulfill its mission, KHPA manages the State Medicaid Program, the State MediKan Program and the State Children’s Health Insurance Program, as well as the State Employees Health Benefit Plan and the State Self-Insurance Fund for Workers’ Compensation under the authority of an independent Board. 

3.  Who is the Inspector General?

Robin J. Kempf serves as the Inspector General.  She was appointed as the entities first Inspector General by the KHPA Board in September 2007, and was subsequently approved for confirmation by the Senate Confirmation Oversight Committee in October of the same year.  Ms. Kempf is an attorney with over 10 years experience in state government, including legal representation of the Kansas Board of Regents and auditing work with the Kansas Legislative Division of Post Audit. 

4.  What is the mission of the OIG?

The mission of the Office of Inspector General is:

• To provide increased accountability and integrity in the Kansas Health Policy Authority’s programs and operations;
• To help improve those programs and operations; and
• To identify and deter fraud, waste, abuse and other illegal acts in the State Medicaid Program, the State MediKan Program and the State Children’s Health Insurance Program. 

The Office will accomplish its mission through performance reviews, audits, and investigations.

5.  How does the OIG perform its work?

The OIG pursues three different types of activities to meet its mission:  performance reviews (also known as performance audits), financial audits and investigations. 

• Audits (including performance reviews and financial audits)
  In general, audits are formal evaluations of an organization, its systems, processes, projects or products.  Performance reviews, or performance audits, examine the effectiveness or efficiency of a program or operation.  Financial audits review either financial documents to verify their accuracy, or internal processes, usually related to handling money, to review their strength.  The overarching goal of all OIG audits is to review the quality of KHPA programs and processes and make recommendations for improving them.
  
  The OIG conducts its audits in a manner consistent with generally accepted government auditing standards developed by the U.S. General Accountability Office (GAO).  These standards are also commonly known as The Yellow Book.
  
  Audit topics are identified through an annual risk assessment resulting in the development of an annual audit plan, which is reviewed and approved by the KHPA Board. 
  
  
• Investigations
  Investigations are inquiries into specific circumstances surrounding an allegation or incident of fraud, waste, abuse or other illegal act.  They attempt to determine the extent of the incident, the amount of loss, and what weaknesses may have existed that lead to the allegation/incident.  Investigative reports may make corrective action recommendations intended to avoid similar problems in the future.
  
  The OIG will conduct investigations that are consistent with the principles and quality standards set out for investigations by the Association of Inspectors General (AIG). 
  
  Topics for OIG investigations will be identified by audit work performed by OIG staff and referrals from KHPA staff, legislators, and the general public. 

6.  What happens to the results of OIG audits and investigations?

Generally, results of OIG audits and investigations are provided to the KHPA Board.  (See also FAQ #15: What happens if the OIG finds evidence of fraud, waste, abuse or other illegal acts?) The Board may recess for a closed, executive meeting under the Kansas Open Meetings Act to discuss such information, at the Board’s discretion.

The Inspector General will produce an annual report that summarizes the OIG’s activities during the past year to the KHPA Board, the Governor, several legislative committees, and the Legislative Post Auditor. 

7.  How is the KHPA OIG able to provide increased accountability in KHPA’s programs and operations?

Accountability is an ethical concept that relates to decision-makers being held responsible for their “actions, products, decisions, and policies, including the administration, governance and implementation within the scope of the role or employment position and encompassing the obligation to report, explain and be answerable for resulting consequences."

The KHPA OIG provides increased accountability by examining KHPA’s decision-making processes, and reporting subsequent findings to the public.  Furthermore, based on its review, the KHPA OIG will make recommendations for improving KHPA programs and operations to help KHPA meet its mission. 

8.  How is the KHPA OIG able to provide increased integrity in KHPA’s programs and operations important?

Program integrity is the concept of using public funds appropriately.  Methods for promoting program integrity include implementing procedures to ensure that public funds are spent efficiently for program needs and reducing fraud, waste and abuse.  The KHPA OIG will provide increased program integrity by performing objective reviews to ensure public funds are spent appropriately and that procedures have been put in place to support agency integrity.  Furthermore, based on its review, the KHPA OIG will be able to make suggestions for improving integrity in KHPA programs and operations and helping KHPA to meet its mission.   

9.  Does the OIG have access to confidential records, including medical records, in performing its work?

The controlling statute states that staff may have access to all pertinent information necessary, confidential or otherwise, to carry out the duties of the OIG.  This includes information maintained by KHPA staff, vendors, contractors, health care providers and federal, state and local government agencies. 

However, there are some limits on the OIG’s access to confidential records.  Access is limited to those files maintained by providers or contractors only to the point necessary to verify the accuracy of invoices, compliance with contract provisions, or compliance with program requirements.  Furthermore, the OIG may not access any medical records related to individuals who are not enrolled in Medicaid or other KHPA programs.

In addition, OIG staff is subject of a strict code of confidentiality and consequences for violation of that public trust.  To maintain record confidentiality, the OIG statute makes OIG staff subject to the same duty of confidentiality imposed by law on any other person or agency from whom it receives the information.  For example, if OIG staff obtains medical records deemed confidential under the federal Health Insurance Portability and Accountability Act (HIPAA), staff are required to maintain that confidentiality. 

There is an exception to the confidentiality clause when OIG staff identifies evidence of fraud, waste, abuse, or other illegal acts.  In that case, the OIG has the additional responsibility of preserving the evidence and immediately notifying the Office of the Kansas Attorney General for possible criminal or administrative action.  At that point, the OIG turns the case over to the Attorney General. 

For more information, see FAQ #15: What happens if the OIG finds evidence of fraud, waste, abuse or other illegal acts?

10.  How can the public be assured that the OIG’s review of KHPA programs and operations is objective?

Even though the Inspector General and her employees are part of the KHPA staff, several statutory provisions promote objectivity in the OIG’s oversight of KHPA programs and operations.  Those provisions include:

• The Inspector General reports directly to the KHPA Board, which is a statutorily created governing body whose members are independently appointed and come from outside the organization.
• The Inspector General is selected by the KHPA Board, but the appointment must be confirmed by the Kansas Senate.
• The position of Inspector General is a classified position, and therefore, the person in that position has all the job protections offered by the Kansas Civil Service Act, including that he or she can only be removed for cause.
• The OIG receives a line item appropriation directly from the Kansas Legislature, as opposed to from the KHPA itself. 
• The OIG provides an annual report of its activities to entities outside of the KHPA, including the Governor, several legislative committees, and the Legislative Post Auditor.

All of these provisions serve to provide checks and balances and help to ensure organizational independence and promote objectivity on the part of the OIG.

11.  Are there any protections for whistleblowers who wish to report illegal or otherwise questionable acts to the OIG?

There are several types of protections for people reporting information to the OIG on fraud, waste, abuse or other illegal acts in the programs administered by KHPA.  First, the OIG may not make public the identity of a whistleblower, unless that person consents to the disclosure in writing. 

Second, the information provided remains confidential and may only be made public if one of following four conditions exists:

• the release of information is required to protect the public health;
• the whistleblower consents to the release of information;
• the whistleblower’s identity will continue to remain confidential even with the release of information; or
• the information is required to be disclosed in an administrative proceeding or court proceeding, and the identity of the whistleblower can continue to be protected. 

Third, the OIG statute prevents any person from prohibiting their agents, employees, contractors or subcontractors from making a report to the OIG.  Additionally, the statute prevents any person from requiring their agents, employees, contractors, or subcontractors to give notice prior to reporting to the OIG.

Fourth, if a whistleblower believes he or she has been retaliated against by his or her employer for reporting to the OIG, he or she may bring an action in court to collect damages for the retaliation.

Finally, if the whistleblower is a state employee, he or she gains all the protections found in the Kansas Whistleblower Act, K.S.A. 75-2973.

12.  What is fraud?

Fraud is an illegal act that involves obtaining something of value through willful misrepresentation. 

Some examples of fraud that have the potential to occur in KHPA programs are:

• A beneficiary misrepresenting his or her income and assets in order to qualify for Medicaid;
• A provider billing for services that were not provided; or
• An employee using state-owned phones, vehicles or equipment for personal use. 

13.  What is waste?

Waste is the intentional or unintentional, thoughtless or careless expenditure, consumption, mismanagement, use, or squandering of state resources.  Waste also includes incurring unnecessary costs as a result of inefficient or ineffective practices, systems, or controls.

Examples of waste that have the potential to occur in KHPA programs include:

• A beneficiary goes to his or her doctor for check-ups excessively;
• A provider recommends and bills Medicaid extra medical tests beyond what is truly necessary; or
• An employee allows overpayments to a contractor by not checking that services were actually performed.

14.  What is abuse?

Abuse is an excessive or improper use of authority in a manner contrary to the natural or legal or ethical rules for the use of that authority.

Examples of abuse that have the potential to occur in KHPA programs include: 

• A beneficiary applies to participate in the Medicaid programs in both Kansas and Missouri and proceeds to get medical attention in both states;
• A provider prescribes and bills Medicaid for medicines that a beneficiary really doesn’t need; or
• An employee suggests that KHPA award a contract to a business that is owned by the employee’s friend.

15.  What happens if the OIG finds evidence of fraud, waste, abuse or other illegal acts?

By statute, the Inspector General is required to report any findings of credible evidence of fraud, waste, abuse or other illegal acts to the Kansas Attorney General.  The Inspector General will also provide a report to the KHPA Board.  Furthermore, the OIG will work closely with the Attorney General to ensure that appropriate law enforcement agencies are able to take over the case from the OIG.    

If the OIG determines that reasonable suspicion exists that a licensed or otherwise regulated entity, such as a nurse or physician, may have violated their licensure or other regulatory standards, the Inspector General is required to report such suspicions to the appropriate regulatory agency.

16.  How do I contact the OIG with my concerns?

The OIG can be reached by phone at 785-296-1076 or by e-mail at OIG@khpa.ks.gov.

17.  Are there other places that I can contact with concerns about KHPA programs, including Medicaid, MediKan and HealthWave? 

The KHPA has set up the following phone numbers for questions about their programs.

• For questions about Medicaid, MediKan and HealthWave, call 785-296-3981
• For questions about the State Employee Health Benefits Plan, call 785-368-6361
• For questions about the State Self Insurance Fund for Workers’ Compensation, call 785-296-6995

For concerns about fraud perpetrated by a Medicaid provider, contact the Kansas Attorney General’s Office, Medicaid Fraud and Abuse Division at (toll free) 1-866-551-6220 or 785-368-6220.  This office will also investigate concerns about abuse and neglect of a patient in any health care facilityreceiving Medicaid funds.

18.  What if I have an issue with Medicare?

Medicare is a federal health insurance program that covers individuals 65 and older, individuals under 65 with disabilities, and individuals with End Stage Renal Disease (ESRD).  Neither the KHPA nor the OIG have any authority over the Medicare program; however, for concerns or questions about the Medicare program, call Senior Health Insurance Counseling for Kansas (SHICK) at 1-800-860-5260 or the federal Medicare program at 1-800-MEDICARE (1-800-633-4227).  Additional information can also be found at SHICK’s website and Medicare’s website.

19.  What other websites would be helpful to learn more?

State agency sites:

Federal agency sites: