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Report (OEI-07-12-00510)

06-12-2013
Illinois State Medicaid Fraud Control Unit: 2012 Onsite Review

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Summary

WHY WE DID THIS STUDY

OIG oversees all Medicaid Fraud Control Units (MFCU or Unit) with respect to Federal grant compliance. As part of this oversight, OIG reviews all Units. These reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements.

HOW WE DID THIS STUDY

We based our review on an analysis of data from seven sources: (1) a review of policies and procedures and documentation of the Unit's operations, staffing, and caseload; (2) a review of financial documentation; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with the Unit's management; (6) an onsite review of case files; and (7) an onsite review of Unit operations.

WHAT WE FOUND

Our review of the Illinois Unit identified instances of noncompliance with Federal regulations and instances where the Unit could better adhere to performance standards. The Unit's organizational structure with regard to the Unit's attorneys conflicts with certification requirements and attorneys assigned to the Unit are ineligible for Federal reimbursement. Opportunities for improvement in the Unit's adherence to the performance standards include, but are not limited to, reporting all convicted individuals for exclusion purposes, updating the Unit's Memorandum of Understanding with the State Medicaid agency, improving communication and collaboration efforts with external stakeholders, and establishing a minimum number of training hours required for each professional discipline.

WHAT WE RECOMMEND

We recommend that the Illinois Unit submit a corrective action plan within 30 calendar days from the date of the final report to resolve the Unit's noncompliance with the certification requirements and the full-time employment rule for attorneys. The Unit should also work with OIG's MFCU oversight division to ensure full compliance with each of the 12 performance standards. The Illinois Unit concurred with six recommendations and concurred in part with four recommendations.

Copies can also be obtained by contacting the Office of Public Affairs at Public.Affairs@oig.hhs.gov.

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