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New Hampshire Medicaid Fraud Control Unit: 2017 onsite review

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 Hampshire
United States
United States. Department of Health and Human Services.
Genre(s):
Technical Report
Abstract:
Why OIG Did This Review The primary purpose of this onsite review was to identify and address factors that contributed to the MFCU's low case outcomes during FYs 2014--2016. The Office of Inspector General (OIG) administers MFCU grant awards, annually recertifies each MFCU, and oversees MFCU performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic onsite reviews of MFCUs and prepares public reports. This onsite review supplements OIG's annual recertification of this MFCU. What OIG Found. The case outcomes of the New Hampshire Medicaid Fraud Control Unit (MFCU)--i.e., the MFCU's convictions of fraud, patient abuse, or neglect; its criminal recoveries; its civil judgments and settlements; and its civil recoveries--were low during Federal fiscal years (FYs) 2014--2016. We found a variety of factors that contributed to the low case outcomes. These factors included: (1) a lack of incoming referrals from the Medicaid Program Integrity Unit and other key sources; (2) turnover in staffing and leadership; and (3) investigative delays and a lack of documented supervisory reviews of case files. What OIG Recommends. We recommend that the MFCU work with its State partners and managed care organizations and that it take steps to address the operational factors that contributed to its low case outcomes. Specifically, we recommend that the MFCU: (1) develop and implement a plan to increase referrals from the Medicaid Program Integrity Unit and managed care organizations; (2) develop and implement a plan to reduce turnover in staff and leadership; (3) implement policies and procedures to ensure that significant investigative delays are explained in the case files and that periodic supervisory reviews are documented; and (4) revise its fiscal control policies governing vehicle costs. The MFCU 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:
101738156 (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, September 2018
Language(s):
English
Format:
Text
Subject(s):
Fraud -- prevention & control
Medicaid
Federal Government
State Government
Humans
New Hampshire
United States
United States. Department of Health and Human Services.
Genre(s):
Technical Report
Abstract:
Why OIG Did This Review The primary purpose of this onsite review was to identify and address factors that contributed to the MFCU's low case outcomes during FYs 2014--2016. The Office of Inspector General (OIG) administers MFCU grant awards, annually recertifies each MFCU, and oversees MFCU performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic onsite reviews of MFCUs and prepares public reports. This onsite review supplements OIG's annual recertification of this MFCU. What OIG Found. The case outcomes of the New Hampshire Medicaid Fraud Control Unit (MFCU)--i.e., the MFCU's convictions of fraud, patient abuse, or neglect; its criminal recoveries; its civil judgments and settlements; and its civil recoveries--were low during Federal fiscal years (FYs) 2014--2016. We found a variety of factors that contributed to the low case outcomes. These factors included: (1) a lack of incoming referrals from the Medicaid Program Integrity Unit and other key sources; (2) turnover in staffing and leadership; and (3) investigative delays and a lack of documented supervisory reviews of case files. What OIG Recommends. We recommend that the MFCU work with its State partners and managed care organizations and that it take steps to address the operational factors that contributed to its low case outcomes. Specifically, we recommend that the MFCU: (1) develop and implement a plan to increase referrals from the Medicaid Program Integrity Unit and managed care organizations; (2) develop and implement a plan to reduce turnover in staff and leadership; (3) implement policies and procedures to ensure that significant investigative delays are explained in the case files and that periodic supervisory reviews are documented; and (4) revise its fiscal control policies governing vehicle costs. The MFCU 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:
101738156 (See catalog record)