New York 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, September 2018
Language(s):: English
Format:: Text
Subject(s):: Fraud -- prevention & control
Medicaid
Federal Government
State Government
Humans
New York
United States
United States. Department of Health and Human Services.
Genre(s):: Technical Report
Abstract:: What OIG Found. The New York Medicaid Fraud Control Unit (MFCU or Unit) reported 370 indictments; 348 convictions; 211 civil settlements and judgments; and over $670 million in recoveries 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 identified five findings involving the Unit's adherence to program requirements: (1) Unit practices left some case files vulnerable to unauthorized access. (2) The Unit did not have a written policy for conducting periodic supervisory reviews and noting the reviews in the Unit's case files. (3) The Unit did not report all convictions and adverse actions to Federal partners within the appropriate timeframes. (4) The Unit generally exercised proper fiscal controls, but it did not exercise proper fiscal controls over the sale and transfer of Unit vehicles. (5) Three Unit professional staff temporarily performed non-Unit duties, and the Unit did not deduct the associated costs from claimed Unit expenditures. In addition to the five findings, we made observations regarding Unit operations and practices, including the following that we identified as beneficial practices that may be useful as a model to other Units: (1) The Unit developed a strategic plan to increase efficiency in MFCU casework and to protect Medicaid program integrity. (2) The Unit established data-analytics working groups to facilitate the Unit's data mining processes. (3) Unit staff participated in moot court training to prepare for settlement negotiations and opening statements. What OIG Recommends. We recommend that to address the five findings, the Unit (1) take steps to ensure that MFCU staff adhere to policies and procedures for securing case files; (2) create policies and procedures for conducting periodic supervisory reviews of Unit case files, and take steps to ensure that case files include documentation of periodic supervisory reviews; (3) ensure that the Unit consistently reports convictions and adverse actions to Federal partners within the appropriate timeframes; (4) ensure that--consistent with Unit policy--the Unit reimburses the Federal Government its share of proceeds received from the sale and transfer of vehicles and any other equipment; and (5) strengthen internal controls to ensure that the Unit excludes from its claimed grant expenditures all costs related to time spent by staff on non-Unit activities.
Copyright:: The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:: 1 online resource (1 PDF file (37 pages))
Illustrations:: Illustrations
NLM Unique ID:: 101738152 (See catalog record)
Permanent Link:: http://resource.nlm.nih.gov/101738152

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, September 2018
Language(s):: English
Format:: Text
Subject(s):: Fraud -- prevention & control
Medicaid
Federal Government
State Government
Humans
New York
United States
United States. Department of Health and Human Services.
Genre(s):: Technical Report
Abstract:: What OIG Found. The New York Medicaid Fraud Control Unit (MFCU or Unit) reported 370 indictments; 348 convictions; 211 civil settlements and judgments; and over $670 million in recoveries 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 identified five findings involving the Unit's adherence to program requirements: (1) Unit practices left some case files vulnerable to unauthorized access. (2) The Unit did not have a written policy for conducting periodic supervisory reviews and noting the reviews in the Unit's case files. (3) The Unit did not report all convictions and adverse actions to Federal partners within the appropriate timeframes. (4) The Unit generally exercised proper fiscal controls, but it did not exercise proper fiscal controls over the sale and transfer of Unit vehicles. (5) Three Unit professional staff temporarily performed non-Unit duties, and the Unit did not deduct the associated costs from claimed Unit expenditures. In addition to the five findings, we made observations regarding Unit operations and practices, including the following that we identified as beneficial practices that may be useful as a model to other Units: (1) The Unit developed a strategic plan to increase efficiency in MFCU casework and to protect Medicaid program integrity. (2) The Unit established data-analytics working groups to facilitate the Unit's data mining processes. (3) Unit staff participated in moot court training to prepare for settlement negotiations and opening statements. What OIG Recommends. We recommend that to address the five findings, the Unit (1) take steps to ensure that MFCU staff adhere to policies and procedures for securing case files; (2) create policies and procedures for conducting periodic supervisory reviews of Unit case files, and take steps to ensure that case files include documentation of periodic supervisory reviews; (3) ensure that the Unit consistently reports convictions and adverse actions to Federal partners within the appropriate timeframes; (4) ensure that--consistent with Unit policy--the Unit reimburses the Federal Government its share of proceeds received from the sale and transfer of vehicles and any other equipment; and (5) strengthen internal controls to ensure that the Unit excludes from its claimed grant expenditures all costs related to time spent by staff on non-Unit activities.
Copyright:: The National Library of Medicine believes this item to be in the public domain. (More information)
Extent:: 1 online resource (1 PDF file (37 pages))
Illustrations:: Illustrations
NLM Unique ID:: 101738152 (See catalog record)
Permanent Link:: http://resource.nlm.nih.gov/101738152