Arkansas Medicaid Fraud Control Unit: 2019 Onsite Inspection

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 reviews of all Units and prepares public reports based on these reviews.

HOW WE DID THIS STUDY

OIG conducted the onsite inspection of the Arkansas MFCU in September 2019. Our review covered the 3-year period of fiscal years 2016 through 2018. We based our inspection on an analysis of data and information from 7 sources: (1) Unit documentation; (2) financial documentation; (3) structured interviews with key stakeholders; (4) structured interviews with the Unit's managers and selected staff; (5) a review of a random sample of 92 case files from the 554 nonglobal case files that were open at some point during the review period; (6) 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 (7) observation of Unit operations.

WHAT WE FOUND

From the information we reviewed, we found that the Arkansas Unit generally complied with applicable legal requirements, but the Unit did not always comply with Federal regulations regarding its fiscal controls. We also found that the Unit did not regularly communicate and worked few joint cases with OIG's Office of Investigations. Additionally, we found that the Unit staff did not report all convictions and adverse actions to Federal partners within the appropriate timeframes.

WHAT WE RECOMMEND AND HOW THE UNIT RESPONDED

To address the three findings, we recommend that the Arkansas Unit (1) strengthen its fiscal controls in the four areas the report identified; (2) take steps to improve its communication and seek more opportunities to investigate joint cases with OIG's Office of Investigations; and (3) take steps to ensure that its staff reports all convictions and adverse actions to Federal partners within the appropriate timeframes. The Unit concurred with all three recommendations.