Thursday, November 7, 2013

OIG Releases Reports Highlighting State MFCUs

By Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG), has recently released 3 separate reports on the Medicaid Fraud Control Units (MFCUs) in West Virginia, Montana and Nevada.  OIG oversees all MFCUs with respect to  applicable performance standards and it also monitors compliance with Federal grant requirements.

In West Virginia, OIG found that in Fiscal Years (FYs) 2010-1012, the MFCU reported combined civil and criminal recoveries of nearly $46 million and 20 convictions.  The OIG found, however, instances where the MFCU did not fully meet federal regulations or the twelve performance standards, and identified opportunities for improvements.  OIG made recommendations to ensure compliance with each of those required standards.

In Montana, OIG found that in FYs 2010-2012, the MFCU reported recoveries of $9.8 million, 6 convictions and 31 civil judgments and settlements.  Ninety-five percent of the MFCU’s case files contained documentation of supervisory approval to open cases; however, 40 percent of closed case files lacked documentation of supervisory approval to close the cases.  In addition, 65 percent of the MFCU case files lacked documentation of periodic supervisory reviews.  The MFCU also failed to refer sentenced providers to OIG for program exclusion within the appropriate timeframe. 

Lastly, the MFCU memorandum of understanding (MOU) with the Montana Medicaid agency did not reflect current law and practice as required, and the MFCU did not always adhere to the MOU stipulations.  OIG made recommendations for the MFCU to improve in all these aforementioned areas.  In Nevada, OIG found that in FYs 2009-2011, the MFCU reported recoveries of $13.4 million, convictions increased and the MFCU opened 262 cases. 

All of the MFCU case files contained documentation indicating supervisory approval to open and close cases, and most case files contained documentation indicating periodic supervisory reviews.  Unit professional staff, however, occasionally performed non-MFCU duties and the MFCU policies and procedures manual and MOU with Nevada’s State Medicaid agency were not updated and complied with regularly.  The MFCU maintained proper fiscal control of its resources; but incorrectly claimed indirect costs.

OIG made recommendations for the MFCU to improve in all of these aforementioned areas.  To obtain a copy of the West Virginia report click here; the Montana report click here; and the Nevada report click here.

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