Series: OIG Oversight of Medicaid Fraud Control Units

The Oklahoma Unit reported 55 indictments, 49 convictions, 17 civil settlements, and $10.1 million in recoveries during our review period of fiscal years 2022–2024. The Unit maintained positive working relationships with external partners; made recommendations to the State Medicaid agency to limit improper payments; and investigated fraud and patient abuse or neglect cases involving a mix of provider types. However, the Unit did not always adhere to the MFCU performance standards or comply with applicable requirements.

• The Unit’s policies and procedures did not address certain aspects of its operations.
• The Unit took steps to maintain an adequate volume and quality of fraud referrals from the Program Integrity Unit (PIU) and managed care organizations (MCOs), but the Unit received few fraud referrals from these sources during our review period.
• Sixteen percent of cases open during our review period had significant investigative delays.
• The Unit lacked a case management system capable of efficiently managing and reporting case information and performance data.
• The Unit did not consistently conduct and document periodic supervisory reviews of cases during our review period.
• The Unit did not report substantial proportions of its adverse actions and convictions to Federal partners within the required timeframes.
• The Unit’s memorandum of understanding (MOU) with the State Medicaid agency generally reflected current practice, policy, and legal requirements, but the MOU did not reference the CMS Performance Standard for Referrals.