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Tennessee Medicaid Fraud Control Unit: 2017 onsite inspection

Series Title(s):
Report in brief
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, June 2018
Language(s):
English
Format:
Text
Subject(s):
Fraud -- prevention & control
Medicaid
Federal Government
State Government
Humans
Tennessee
United States
United States. Department of Health and Human Services.
Genre(s):
Technical Report
Abstract:
What OIG Found. The Tennessee Medicaid Fraud Control Unit (MFCU or Unit) reported strong case outcomes for fiscal years (FYs) 2014--2016. From the data we reviewed, we found that the Unit generally operated in accordance with applicable laws, regulations, policy transmittals, and the MFCU performance standards. However, we made four findings, two involving the Unit's adherence to program requirements and two potentially affecting the Unit's success and impact: (1) The Unit investigated 11 cases that were ineligible for Federal matching funds because they involved allegations of patient abuse or neglect in nonfacility settings. (2) Although the Unit reported all convictions and adverse actions to Federal partners, it did not always do so within the established timeframes. (3) The Unit's staff size had not kept pace with increasing Medicaid program expenditures. (4) The Unit made program integrity recommendations to the Medicaid agency orally, limiting its ability to monitor responses. In addition to the four findings, we made observations regarding Unit operations and practices, many of which were favorable, including: (1) A high level of collaboration with Federal law enforcement; (2) Low turnover of management and staff; and (3) Good training opportunities for staff, including an annual training conference for all Unit staff that provided valuable training and team building. What OIG Recommends and How the Unit Responded. To address the four findings, we recommend that the Unit: (1) repay Federal matching funds spent on cases that were ineligible for Federal funding and ensure that cases it investigates are within grant authority; (2) implement processes to ensure that it reports convictions and adverse actions to Federal partners within the appropriate timeframes; (3) continue to pursue its proposed expansion plan and work towards increasing Unit staff size to be commensurate with Medicaid expenditures; and (4) develop a policy to document its program recommendations to the State Medicaid agency and to monitor the response to those recommendations. The Unit concurred with all four 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 (29 pages))
Illustrations:
Illustrations
NLM Unique ID:
101738037 (See catalog record)
Series Title(s):
Report in brief
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, June 2018
Language(s):
English
Format:
Text
Subject(s):
Fraud -- prevention & control
Medicaid
Federal Government
State Government
Humans
Tennessee
United States
United States. Department of Health and Human Services.
Genre(s):
Technical Report
Abstract:
What OIG Found. The Tennessee Medicaid Fraud Control Unit (MFCU or Unit) reported strong case outcomes for fiscal years (FYs) 2014--2016. From the data we reviewed, we found that the Unit generally operated in accordance with applicable laws, regulations, policy transmittals, and the MFCU performance standards. However, we made four findings, two involving the Unit's adherence to program requirements and two potentially affecting the Unit's success and impact: (1) The Unit investigated 11 cases that were ineligible for Federal matching funds because they involved allegations of patient abuse or neglect in nonfacility settings. (2) Although the Unit reported all convictions and adverse actions to Federal partners, it did not always do so within the established timeframes. (3) The Unit's staff size had not kept pace with increasing Medicaid program expenditures. (4) The Unit made program integrity recommendations to the Medicaid agency orally, limiting its ability to monitor responses. In addition to the four findings, we made observations regarding Unit operations and practices, many of which were favorable, including: (1) A high level of collaboration with Federal law enforcement; (2) Low turnover of management and staff; and (3) Good training opportunities for staff, including an annual training conference for all Unit staff that provided valuable training and team building. What OIG Recommends and How the Unit Responded. To address the four findings, we recommend that the Unit: (1) repay Federal matching funds spent on cases that were ineligible for Federal funding and ensure that cases it investigates are within grant authority; (2) implement processes to ensure that it reports convictions and adverse actions to Federal partners within the appropriate timeframes; (3) continue to pursue its proposed expansion plan and work towards increasing Unit staff size to be commensurate with Medicaid expenditures; and (4) develop a policy to document its program recommendations to the State Medicaid agency and to monitor the response to those recommendations. The Unit concurred with all four 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 (29 pages))
Illustrations:
Illustrations
NLM Unique ID:
101738037 (See catalog record)