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Connecticut Medicaid Fraud Control Unit: 2021 Inspection

WHY WE DID THIS STUDY

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of Units and prepares public reports based on these reviews.

HOW WE DID THIS STUDY

OIG conducted an onsite inspection of the Connecticut MFCU in November 2021. Our review period covered Federal fiscal years 2019-2021. We based the inspection on an analysis of data and information from 7 sources: (1) Unit documentation; (2) financial documentation; (3) structured interviews with key stakeholders; (4) structured interviews with Unit management and selected staff; (5) a random sample of 62 case files from the Unit's 121 nonglobal case files that were open at any point during the review period; (6) a review of convictions submitted to OIG for program exclusion and adverse actions submitted to the National Practitioner Data Bank during the review period; and (7) an onsite review of Unit operations.

WHAT WE FOUND

From the information we reviewed, we found that the Unit generally operated in accordance with applicable laws, regulations, policy transmittals, and MFCU performance standards. However, we found that, during our 3-year review period, the Unit did not receive referrals of patient abuse or neglect and was unable to take sufficient steps to ensure that it received such referrals. We also found that the Unit lacked a central repository for case information, making access to case data and pertinent case documents inefficient. Finally, we found that the Unit did not adhere to its policy of documenting supervisory reviews monthly and that the Unit did not consistently report convictions or adverse actions to Federal partners within the appropriate timeframes.

WHAT WE RECOMMEND

To address the four findings, we recommend that the Unit (1) develop and implement outreach efforts to ensure that the Unit regularly receives referrals of patient abuse and neglect; (2) seek approval from the Office of the Chief State's Attorney to implement a new case management system; (3) conduct and document supervisory reviews of case files in accordance with Unit policy; and (4) ensure that all convictions and adverse actions are reported to Federal partners within the appropriate timeframes. The Unit concurred with all four recommendations.