23/07/2024 | Press release | Archived content
The Office of Inspector General (OIG) administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies each Unit, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic inspections of Units and issues public reports of its findings and observations.
For the review period fiscal years (FYs) 2020-2022, the Unit reported obtaining 37 indictments, 34 convictions, 41 civil settlements, and $75.3 million in recoveries. We observed that the Unit maintained strong working relationships with stakeholders, took steps to ensure continuous case flow, and provided ample training to its staff. We identified several areas in which the Unit should improve its adherence to performance standards or program requirements:
Some of the Unit's case files were accessible by unauthorized Unit staff.
Although the Unit's case management system allowed managers to effectively monitor cases, it did not allow for the accurate reporting of Unit performance data to OIG.
The Unit did not report adverse actions to the National Practitioner Data Bank (NPDB) from 2017 through 2022 and did not consistently report its convictions to OIG for exclusion within the required timeframe.
Although the Unit reported that it made program recommendations to the State Medicaid agency, it did not adequately monitor the State's response to the Unit's program recommendations.
The Unit reported retaining certain settlement proceeds rather than working with the Medicaid agency to ensure the appropriate return of the Federal Government's share of those recoveries.
To address the findings, we recommend that the Unit:
The Unit concurred with five recommendations and non-concurred with one recommendation.
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.