Noncompliance with Performance Standards Contributed to Case Flow Delays at Alaska Medicaid Fraud Control Unit
A performance review of the Alaska Medicaid Fraud Control Unit by the Department of Health and Human Services’ Office of Inspector General (HHS-OIG) has uncovered multiple areas of concern, where the Units’ performance fell short of the requirements of a Medicaid Fraud Control Unit (MFCU) grant award.
MFCUs investigate Medicaid provider fraud and patient abuse/neglect and prosecute cases under state law or refer those cases to other prosecuting offices. Unless there is a waiver, each state must have an MFCU. Currently all 50 states, DC, Puerto Rico, and the U.S. Virgin Islands operate MFCUs. Each MFCU receives an annual grant award which covers 90% of expenditures for new units and 75% of expenditures for all other units, with the shortfall made up with collections from their enforcement activities. HHS-OIG has oversight of MFCUs and conducts reviews to assess performance against the requirements of the grant awards and recertify the Units.
HHS-OIG conducted a review of the Alaska MFCU in 2016 and identified a number of issues. Case files lacked documentation of periodic supervisory reviews, the training plan did not specify the minimum number of training hours that Unit staff were required to complete, paper case files were not properly secured, and the Unit did not appropriately remove costs associated with non-Unit activities from its Federal reimbursement request.
This year’s review identified issues that resulted in 13 recommendations for improvement across 8 different aspects of the Unit’s operations. Communication and collaboration were inconsistent across professional disciplines, ineffective practices contributed to significant delays in almost half of the unit’s cases, and case files were not maintained in an effective manner due to the limitations of its case management system and inconsistent practices for maintaining case information. While the unit had made some effort to encourage referrals, there was room for expansion.
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HHS-OIG determined there was inadequate staffing for administrative functions, a lack of effective procedures for communicating and coordinating regularly with Federal partners, the equipment inventory was incomplete, a lack of security on one inventoried item, supervisory review policies were not effective, and the Unit did not consistently follow other aspects of the policies. Further, the Unit did not conform with two Federal grant requirements. HHS-OIG made recommendations to correct all the identified issues and the Unit concurred with all 13 of the HHS-OIG recommendations.
