Minnesota Medicaid Fraud Control Unit: 2022 Inspection
- 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, September 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Fraud -- legislation & jurisprudence Fraud -- prevention & control Government Regulation Medicaid Minnesota
- Genre(s):
- Technical Report
- Abstract:
- What OIG Found. We found that the Minnesota MFCU operated in accordance with applicable laws, regulations, and policy transmittals, and reported strong case outcomes for FYs 2020–2022. From the data we reviewed, we found that the Unit maintained positive working relationships with Federal partners and investigated cases jointly. The Unit also reported nearly all convictions and adverse actions to Federal partners within the appropriate timeframes, including cases of patient abuse or neglect that were investigated and prosecuted by local authorities. However, we made four findings regarding the Unit’s adherence to the MFCU performance standards and compliance with Federal regulations. First, we found that the director was the only supervisor in the Unit, which limited the oversight of Unit operations. Second, we found that, although the Unit took steps to coordinate with other State agencies, it received few referrals of patient abuse or neglect. Third, we found that the Unit lacked a case management system that allowed efficient and secure access to case information and case outcomes data, which posed challenges for locating documents and tracking case statuses. Finally, we found that the Unit did not consistently conduct periodic supervisory reviews or document supervisory approvals in its case files. In addition to these findings, we made several observations regarding Unit operations and practices. What OIG Recommends and How the Unit Responded. To address the findings, we recommend that the Unit (1) continue efforts to hire a second-line supervisor and assess whether additional supervisors are warranted to meet the Unit’s oversight needs; (2) build upon its efforts to increase referrals of patient abuse or neglect; (3) implement a comprehensive case management system that allows for efficient access to case documents and information; and (4) take steps to ensure that periodic supervisory reviews are conducted on a consistent basis and that case files include documentation of supervisory approvals. 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 (31 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918716086106676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918716086106676