Office of Inspector General

Mary Beth Sheffield, Inspector General
2727 Mahan Drive, MS4
Tallahassee, FL 32308
(850) 412-3990
(850) 921-6009 Fax

The Office of the Inspector General is an integral part of the Agency for Health Care Administration (Agency). The purpose of the Office of the Inspector General is to provide a central point for coordination of and responsibility for activities that promote accountability, integrity, and efficiency in the Agency. Section 20.055, Florida Statutes, mandates the duties and responsibilities of each inspector general, with respect to the state agency/department in which the office is established.

The primary mission of the Office of the Inspector General is:

To assist the Secretary and other Agency management in championing accessible, affordable, quality health care for all Floridians by assessing the efficiency and effectiveness of health care administration resource management.

This is accomplished by providing an independent examination and evaluation of Agency programs, activities, and resources and by conducting internal investigations of alleged violations of Agency policies, procedures, rules or laws. Additionally, the Inspector General's mission is accomplished by investigating Medicaid providers suspected of fraud or abuse in the Medicaid program.

For an itemization of the specific duties and responsibilities of the Inspector General, and a summary of the Inspector General's activities for the latest complete fiscal year, please view the Office of the Inspector General Annual Report. [3MB, PDF]

Organization and Staff

The Inspector General is appointed by and reports to the Secretary. The Inspector General oversees four sections: Internal Audit, Investigations, HIPAA Compliance Office and Medicaid Program Integrity.

Internal Audit - Performs management consultation, management reviews, special projects, and independent audits. Internal Audit provides Agency management with an independent analysis of operations and controls within the Agency and recommends methods by which these functions may be improved in accordance with Sections 20.055(2)(d) and 20.055(5), Florida Statutes.

Investigations - Provides for the receiving, processing, investigation, and documentation of complaints of alleged violations of Agency policies, procedures, rules, or laws by the Agency or its employees. Conducts investigations pursuant to the Whistle-blower Act in accordance with Sections 112.3187 through 112.31895, Florida Statutes. Other investigations are conducted in accordance with the procedures and standards adopted by the Governor's Council on Integrity and Efficiency.

HIPAA Compliance Office - Advises and assists the agency in its HIPAA compliance efforts and in safeguarding the privacy of all Protected Health Information (PHI) in the Agency's custody. Assists Medicaid recipients in exercising their rights as provided by HIPAA.

Medicaid Program Integrity - Pursuant to Section 409.913, Florida Statutes, investigates providers suspected of fraud or abuse in the Medicaid program. Medicaid Program Integrity also recovers overpayments, issues administrative sanctions, and refers cases of suspected fraud for criminal investigation to the Office of the Attorney General. For more detailed information on MPI and their successes, please reference The State's Efforts to Combat Medicaid Fraud and Abuse FY 2015-16.

Other Inspector General Reports and Resources

Other Links of Interest

Pursuant to Florida Statutes 20.055