Alaska Medicaid Fraud Control Unit: 2023 Inspection

Why OIG Did This Review

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 reviews of Units and issues public reports of its findings.

What OIG Found

Inconsistent communication and collaboration across professional disciplines and other ineffective Unit practices contributed to significant delays in nearly half of the Unit’s cases.

The Unit did not maintain case files in an effective manner due to limitations of its case management system and inconsistent practices for maintaining case information.

The Unit did not maintain adequate staffing for its administrative functions.

The Unit took steps to encourage referrals but could expand these efforts.

The Unit maintained positive working relationships with its Federal partners but lacked procedures to communicate and coordinate regularly with them.

The Unit did not maintain an accurate, regularly updated equipment inventory, and one inventory item was not properly secured.

Some aspects of the Unit’s supervisory review policies were ineffective and the Unit did not consistently follow other aspects of these policies.

The Unit did not conform with two Federal grant requirements.

What OIG Recommends

We made 13 recommendations for improvement across 8 aspects of the Unit’s operations, including (1) maintaining a continuous case flow; (2) maintaining case information; (3) maintaining adequate staffing; (4) maintaining adequate referrals; (5) cooperating with Federal authorities; (6) exercising proper fiscal control; (7) conducting periodic supervisory reviews; and (8) complying with requirements. The Unit concurred with all 13 recommendations.