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Minnesota State Medicaid Fraud Control Unit: 2013 Onsite Review

WHY WE DID THIS STUDY

OIG oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The 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, 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 Director and supervisors; (6) an onsite review of case files; and (7) an onsite review of Unit operations conducted in April 2013.

WHAT WE FOUND

For fiscal years (FYs) 2010 through 2012, the Minnesota Unit obtained 62 criminal convictions and 59 civil settlements, and reported recoveries of over $64 million. Our review of compliance issues found no evidence of significant noncompliance with applicable laws, regulations, or policy transmittals. However, we found that the Unit's memorandum of understanding (MOU) with the State Medicaid agency did not reflect all current processes. In addition, the Unit's training plan did not include a minimum number of training hours. We also found that some Unit case files lacked documentation of supervisory approval and periodic review. Finally, the Unit stored some case files in a location accessible to non-Unit staff.

WHAT WE RECOMMEND

We recommend that the Minnesota Unit (1) update its MOU with the State Medicaid agency; (2) establish training hour requirements for each professional discipline; (3) include notation of supervisory approval and periodic supervisory review in all case files; and (4) secure case files. The Unit concurred with all four of our recommendations.