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Report (OEI-06-14-00190)

11-21-2014
Iowa State Medicaid Fraud Control Unit: 2014 Onsite Review

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Summary

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 conducted the onsite review in April 2014. We based our review on an analysis 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 management and selected staff; (6) a review of a sample of cases worked by the Unit; and (7) an onsite observation of Unit operations.

WHAT WE FOUND

For fiscal years 2011 through 2013, the Iowa Unit reported 94 criminal convictions, 38 civil judgments and settlements, and recoveries of nearly $44 million. Our review found no evidence of significant noncompliance with applicable laws, regulations, or policy transmittals. However, we found that the 47 percent of the Unit's case files lacked documentation indicating periodic supervisory reviews. Further, the Unit's memorandum of understanding (MOU) with the State Medicaid agency did not reflect all current requirements. Subsequent to our onsite review, the Unit revised the MOU to include these requirements.

WHAT WE RECOMMEND

We recommend that the Iowa Unit implement processes to ensure that supervisors conduct and document case reviews periodically, consistent with the Unit's revised practice. The Unit concurred with our recommendation.

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Exclusions Database Report Fraud

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