Vermont Medicaid Fraud Control Unit: 2024 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 inspections of Units and issues public reports of its findings.

What OIG Found

The Vermont MFCU reported 32 indictments, 28 convictions, 10 civil settlements, and nearly $1.3 million in recoveries during our review period of fiscal years 2022–2024. In addition to the findings below, we observed that the Unit undertook several efforts to build strong relationships with other agencies, increase awareness of its mission in the community, and improve its operations. OIG identified the following four findings:

• Despite the Unit taking steps to encourage fraud referrals, the State’s Accountable Care Organization did not submit any fraud referrals to the Department of Vermont Health Access Special Investigations Unit or the MFCU during our review period or at any time prior to our review period.
• The Unit lacked a central repository for case information, making access to case data and pertinent case documents inefficient.
• The Unit maintained positive working relationships with Federal law enforcement partners but lacked established practices on how to coordinate with these partners.
• The Unit did not report two of its four adverse actions to the National Practioner Data Bank within the appropriate timeframes during our review period.

What OIG Recommends

To address the findings, we recommend that the Unit (1) build upon its efforts to increase fraud referrals from relevant partners; (2) implement a comprehensive case management system that allows the Unit to efficiently access, maintain, and report case information and performance data; (3) develop and implement a plan to improve communication and coordination with OIG and other Federal partners; and (4) take steps to report all adverse actions to Federal partners within the appropriate timeframes.

The MFCU concurred with all four recommendations.