HHS' Office of the Inspector General has released the results from its onsite review of
The OIG found the
1. Case files lacked documentation. The Medicaid Fraud Control Unit performance standards require unit supervisors to approve the opening and closing of all cases. This rule is in place to allow supervisors to efficiently manage case flow and case progress. The OIG found 39 percent of
The performance standards also require supervisory reviews to be conducted of the unit's case files, and require the review to be noted in the case file or in the electronic case file tracking system. The OIG found 60 percent of
2. All convicted individuals were not referred to the OIG. The Medicaid Fraud Control Unit performance standards require state fraud units to inform OIG of any individuals convicted of Medicaid fraud within their state within 30 days of the conviction for the purpose of program exclusion. OIG found
3. Unit manual was not up-to-date. The performance standards require all Medicaid fraud units to have their up-to-date policies and procedures included in a manual. OIG found Utah's control unit manual did not include the unit's procedures for case file review, documenting supervisory approval to open and close cases and documenting periodic reviews of case files.
4. Adverse actions weren't appropriately reported. Federal regulations and the Medicaid Fraud Control Unit performance standards require state Medicaid fraud units to report all adverse actions taken as a result of investigations or prosecutions of healthcare providers to the National Practitioner Data Bank. The OIG found
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