Montana Medicaid Fraud Control Unit: 2019 onsite inspection
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections. issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, March 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Fraud -- prevention & control Government Regulation Law Enforcement -- methods Medicaid -- legislation & jurisprudence Montana United States United States. Department of Health and Human Services
- Genre(s):
- Technical Report
- Abstract:
- What OIG Found. The Montana Medicaid Fraud Control Unit (MFCU or Unit) reported 13 indictments; 19 convictions; 33 civil settlements and judgments; and $3.4 million in recoveries for fiscal years (FYs) 2016–18. Based on the information we reviewed, we found that the Unit operated in accordance with applicable laws, regulations, and policy transmittals. However, we made two findings involving the Unit’s adherence to Performance Standard 7. 1. The Unit lacked a central repository for case information, making access to case data and pertinent case documents inefficient. 2. The Unit’s practices for conducting periodic supervisory review were not fully reflected in its policies and procedures manual. In addition to the findings, we made observations regarding Unit operations and practices, the most significant of which was as follows: • While the Unit received an adequate number of fraud referrals, few fraud referrals came from the Medicaid agency’s program integrity unit, Surveillance and Utilization Review (SURS). We also identified the following beneficial practice that may be useful as a model to other Units: • To encourage referrals, the Unit regularly trained cadets at the Montana Law Enforcement Academy and trained other law enforcement personnel through its participation in the Montana Elder Abuse Task Force. What OIG Recommends and How the Unit Responded. We recommend that, to address the two findings, the Montana Unit: (1) implement a comprehensive case management system that allows for efficient access to case documents and information; and (2) revise its policies and procedures manual to address the frequency of its periodic supervisory reviews. The Unit concurred with both recommendations.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (28 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918281677306676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918281677306676