Hawaii Medicaid Fraud Control Unit: 2019 onsite review
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- 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, June 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Forms and Records Control -- standards Fraud -- legislation & jurisprudence Government Regulation Medicaid -- legislation & jurisprudence Hawaii United States United States. Department of Health and Human Services
- Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. The purpose of this review was to identify and address factors that contributed to the Hawaii MFCU’s low case outcomes during FYs 2016–18 and to assess Unit operations. In 2015, OIG issued a report from its 2014 onsite review of the MFCU that raised concerns about the Unit’s ability to carry out its statutory functions and meet program requirements. To address the deficiencies identified during OIG’s previous onsite review, the MFCU developed and implemented a corrective action plan. Despite this effort, we found that the Hawaii MFCU’s case outcomes were low during FYs 2016–18, compared to other similarly sized MFCUs. What OIG Found. We identified several contributing factors in three areas that affected the Hawaii Medicaid Fraud Control Unit’s (MFCU’s or Unit’s) low case outcomes during Federal fiscal years (FYs) 2016–18. We found that the MFCU received few fraud referrals from the Medicaid Program Integrity Unit and other stakeholders, which limited the number of cases available for the Unit to investigate and prosecute. The Unit also experienced significant turnover of investigators and lacked sufficient Medicaid fraud cases to adequately train new and inexperienced investigators. Additionally, we found that the MFCU’s agreement with Adult Protective and Community Services Branch (referred to as Adult Protective Services or APS) for processing patient abuse and neglect complaints was structured in such a way that it led to the Unit screening thousands of complaints unsuitable for investigation, which diverted the Unit’s time and resources from working viable cases with substantial potential for criminal prosecution. What OIG Recommends and How the Unit Responded. To address these issues and improve case outcomes, we recommend that the Unit: 1. develop and implement a plan to increase Medicaid fraud referrals from the Medicaid agency and other stakeholders; 2. develop and expedite an in-house Medicaid fraud training program for Unit investigators; and 3. revise the Unit’s agreement with APS to establish minimum criteria for a complaint to be sent to the MFCU. The Unit concurred with all three 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:
- 9918282077706676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918282077706676