Missouri Medicaid Fraud Control Unit: 2018 onsite inspection
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Reports-in-brief (Promoting Women in Development (Project))
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, January 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Fraud -- prevention & control Medicaid -- organization & administration Missouri United States United States. Department of Health and Human Services
- Genre(s):
- Technical Report
- Abstract:
- What OIG Found. The Missouri Medicaid Fraud Control Unit (MFCU or Unit) reported 48 indictments; 45 convictions; 43 civil settlements and judgments; and $42.1 million in recoveries for fiscal years (FYs) 2016–18. From the information we reviewed, we found that the Unit generally operated in accordance with applicable laws, regulations, and policy transmittals. However, we made four findings involving the Unit's adherence to the MFCU performance standards, one of which also involved compliance with Federal regulations: (1) Unit case files did not include all relevant facts, information, and significant documents. (2) The Unit lacked a policy requiring a specific frequency for periodic supervisory reviews. (3) The Unit did not report all convictions and adverse actions to Federal partners. (4) The Unit's training plan did not include an annual minimum number of training hours for Unit investigators. In addition to the findings, we made a number of observations regarding beneficial practice that may be of interest to other MFCUs, as follows: (1) The Unit experienced significant turnover among management and staff. (2) The Unit created in-house training videos to assist staff in Unit investigations and trials. What OIG Recommends. To address the four findings, we recommend that the Unit take steps to (1) ensure that Unit case files include all relevant facts, information, and significant documents; (2) revise the Unit's policies and procedures manual to include a specific frequency for conducting periodic supervisory review of Unit case files, and take steps to ensure that case files include documentation of periodic supervisory reviews; (3) ensure that the Unit consistently reports convictions and adverse actions to Federal partners; and (4) establish training-hour requirements for Unit investigators and ensure that all investigators receive annual training. The Unit concurred with all four recommendations.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (30 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918266298406676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918266298406676