Arizona State Medicaid Fraud Control Unit: 2015 Onsite Review

WHY WE DID THIS STUDY

The Office of Inspector General (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 all Units and prepares public reports based on these reviews. These reviews assess Unit performance in accordance with the 12 MFCU performance standards and Unit compliance with applicable Federal requirements.

HOW WE DID THIS STUDY

We conducted an onsite review of the Arizona Unit in July 2015. We based our review on analysis of data from seven sources: (1) a review of policies, procedures, and documentation related to the Unit's operations, staffing, and caseload for fiscal years (FYs) 2012 through 2014; (2) a review of financial documentation for FYs 2012 through 2014; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with the Unit's management; (6) an onsite review of files for cases that were open in FYs 2012 through 2014; and (7) an onsite observation of Unit operations.

WHAT WE FOUND

The Unit was in general compliance with applicable laws, regulations, and policy transmittals; however, we identified one area for improvement. For FYs 2012 through 2014, the Arizona Unit reported 185 criminal convictions and combined criminal and civil recoveries of $4 million. We found that almost all case files contained documentation of supervisory approval to open and close cases as well as of periodic supervisory reviews. In addition, we noted that the Unit collaborates with external stakeholders and educates the community to generate referrals. However, the Unit did not report all convictions and adverse actions to Federal partners within required timeframes. Subsequent to the period of our review, the Unit implemented processes to ensure future timely reporting.

WHAT WE RECOMMEND

We recommend that the Arizona Unit update its policies and procedures manual to include the Unit's new processes for reporting convictions and adverse actions to Federal partners within required timeframes. The Unit concurred with our recommendation.

---