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Nevada Medicaid Fraud Control Unit: 2018 Onsite Inspection

WHY WE DID THIS STUDY

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies each Unit, and oversees the Unit's 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

We conducted the onsite review of the Nevada MFCU in May 2018. Our review period covered Federal fiscal years (FYs) 2015-2017. We based our review on an analysis of data from eight sources: (1) Unit documentation; (2) financial documentation; (3) interviews with key stakeholders; (4) interviews with Unit managers and selected staff; (5) a survey of Unit staff; (6) a simple random sample of case files opened at any point during the review period; (7) a review of all convictions submitted to OIG for program exclusion and all adverse actions submitted to the National Practitioner Data Bank during the review period; and (8) observation of Unit operations.

WHAT WE FOUND

During FYs 2015-2017, the Nevada MFCU generally operated in accordance with applicable laws, regulations, policy transmittals, and the MFCU performance standards. However, from the data we reviewed, we identified three areas in which the Unit should improve its adherence to performance standards: (1) the Unit did not maintain approved staffing levels because of air contamination in the workspace, and it declined to fill vacant positions until this issue was resolved; (2) the Unit investigated few cases of patient abuse or neglect; and (3) the Unit did not maintain an annual training plan.

WHAT WE RECOMMEND

We recommend that the Unit (1) fill vacant positions now that the Unit is in a temporary workspace and continue to ensure that the Unit has a safe and adequate work environment; (2) continue to take steps to increase the number of investigations of patient abuse and neglect; and (3) establish an annual training plan covering all professional disciplines within the Unit. The Unit concurred with all three recommendations.