Ohio State Medicaid Fraud Control Unit: 2014 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 conducted an onsite review of the Ohio Unit in April 2014. We based our review on an 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) 2011 through 2013; (2) a review of financial documentation for FYs 2011 through 2013; (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 a sample of files for cases that were open in FYs 2011 through 2013; and (7) an onsite observation of Unit operations.

WHAT WE FOUND

For FYs 2011 through 2013, the Ohio Unit reported 403 criminal convictions and recoveries of nearly $214 million. Our review found that the Unit did not consistently submit reports of convictions within the appropriate timeframe to OIG for the purpose of program exclusion. Our review also found that 13 percent of case files lacked documentation of supervisory approval for the closing of cases; nearly all case files contained documentation of periodic supervisory review. Finally, the Unit allowed non Unit personnel to use its vehicles, resulting in unallowable expenditures.

WHAT WE RECOMMEND

We recommend that the Ohio Unit (1) submit reports of all convictions within the appropriate timeframe to OIG for the purpose of exclusion from Federal health care programs, (2) include documentation of supervisory approval for the closing of all case files, and (3) ensure that vehicles are used exclusively by Unit personnel and repay grant funds for unallowable vehicle related expenditures. The Unit concurred with our first and third recommendations and did not concur with our second recommendation, but said that it took action to address all of our recommendations.

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