Why OIG Did This Review. The Office of Inspector General (OIG) administers the MFCU grant awards, annually recertifies each Unit, and oversees the Unit's performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic onsite reviews of Units and prepares public reports. What OIG Found. During fiscal years (FYs) 2015--2017, we found that the New Jersey Medicaid Fraud Control Unit (the Unit) did not comply with all applicable legal requirements or adhere to all performance standards. Specifically, we identified six areas in which the Unit should improve its adherence to program requirements: (1) The Unit Director lacked supervisory authority over Unit detectives and independent decision-making authority over day-to-day Unit operations. (2) The Unit pursued few "nonglobal" civil fraud cases, and the memorandum of understanding (MOU) with the Office of the State Comptroller's Medicaid Fraud Division (MFD) lacked guidance for handling such cases. (3) Although the Unit and the MFD communicated regularly, fraud referrals from the MFD were low and had decreased in recent years. (4) Low staffing levels affected the Unit's ability to investigate cases and accept referrals. (5) The Unit did not always follow its internal control procedures for time and attendance. (6) Thirty-four percent of case files lacked documentation of supervisory oversight. What OIG Recommends and How the Unit Responded. We recommend that the Unit (1) change the supervisory structure to provide the Unit Director with supervision of all Unit staff, oversight of all its caseload, and independence to make management decisions; (2) develop and implement a plan to pursue more nonglobal fraud cases as civil matters, and revise the MOU with MFD to include guidance for handling such cases; (3) take additional steps to ensure that the Unit receives an adequate number and quality of fraud referrals from the MFD; (4) assess the adequacy of existing staffing levels and, if appropriate, consider a plan to expand the size of the Unit; (5) follow its internal controls for time and attendance; and (6) ensure that all case files include documentation of supervisory oversight. The Unit concurred with all six recommendations.
The National Library of Medicine believes this item to be in the public domain. (More information)