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Washington Medicaid Fraud Control Unit: 2023 Inspection

Issued on  | Posted on  | Report number: OEI-09-23-00230

Why OIG Did This Review

The Office of Inspector General (OIG) administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies each Unit, and oversees the Units’ performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic inspections of Units and issues public reports of its findings.

What OIG Found

Overall, the Washington MFCU operated in accordance with grant requirements.

The Unit reported case outcomes of 60 indictments; 28 convictions; 40 civil settlements and judgments; and $63.6 million in recoveries for FYs 2020–2022.

The Unit cooperated with Federal partners to pursue joint cases.

The Unit made programmatic recommendations to the State Medicaid agency and provided nonmanagerial staff with extensive training.

The Unit established a digital forensic laboratory and hired digital forensic investigators to support investigations.

The Unit did not report all convictions and adverse actions to Federal partners as required and lacked policies and procedures for those processes.

What OIG Recommends

We recommend that the Washington MFCU implement new policies and procedures to ensure required reporting of convictions and adverse actions to Federal partners. The Unit concurred with our recommendation.