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Maryland State Medicaid Fraud Control Unit: 2016 Onsite Review

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 onsite reviews of all Units and prepares public reports based on these reviews. These reviews assess Units' adherence to the 12 MFCU performance standards and Units' compliance with applicable Federal statutes and regulations.

HOW WE DID THIS STUDY

We conducted an onsite review of the Maryland Unit in March 2016. We based our review on an analysis of data from seven sources: (1) policies, procedures, and documentation related to the Unit's operations, staffing, and caseload; (2) financial documentation for fiscal years (FYs) 2013 through 2015; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with the Unit's management; (6) a sample of files for cases that were open in FYs 2013 through 2015; and (7) observation of Unit operations.

WHAT WE FOUND

For FYs 2013 through 2015, the Maryland Unit reported 42 convictions, 61 civil judgments and settlements, and combined criminal and civil recoveries of over $70 million. Our review found that the Unit was generally in compliance with applicable laws, regulations, and policy transmittals. The Unit maintained proper fiscal control of its resources and developed an internal "boot camp" training for staff. However, we identified three areas where the Unit should improve its operations. First, 22 percent of the case files lacked documentation of at least one required periodic supervisory review. Second, although the Unit reported all convictions and adverse actions to Federal partners, it did not report some within required timeframes. Finally, the Unit's staff levels were significantly below the number of staff that the Unit requested and OIG approved. Over one-quarter of the Unit's approved positions were vacant, including two supervisory positions.

WHAT WE RECOMMEND

We recommend that the Maryland Unit: (1) ensure it conducts and documents supervisory reviews of Unit case files according to the Unit's policies and procedures, (2) ensure that convictions and adverse actions are consistently reported to Federal partners within required timeframes, and (3) maintain staff levels in accordance with staffing allocations the Unit requested and OIG approved. The Unit concurred with all three recommendations.

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

Download the complete report.

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201