What OIG Found. The Idaho Medicaid Fraud Control Unit (MFCU or Unit) reported 13 indictments, 11 convictions, 28 civil settlements and judgments, and nearly $5.3 million in recoveries for fiscal years (FYs) 2015–2017. From the information we reviewed, we found that the Unit operated in accordance with applicable laws, regulations, and policy transmittals. However, we made three findings involving the Unit's adherence to the MFCU performance standards. (1) Although the Unit established a more frequent and robust practice for conducting periodic supervisory review of case files, it had not updated its policies and procedures manual to reflect the updated practices. (2) Some of the Unit's cases had significant unexplained investigative delays. (3) Nearly a quarter of case files lacked documentation of periodic supervisory review. In addition to the findings, we made a number of observations regarding Unit operations and practices, including two observations about barriers to pursuing certain cases as well as a beneficial practice that may be of interest to other MFCUs. (1) The Unit reported barriers that limited its ability to investigate and prosecute cases of patient abuse or neglect, including the Idaho statute's definition of vulnerable adults. (2) The Unit reported that Idaho's civil recovery statute limited its ability to pursue civil cases. (3) In addition to reporting its own convictions to OIG, the Unit reported convictions of patient abuse or neglect obtained by local authorities for possible program exclusion. What OIG Recommends and How the Unit Responded. To address the three findings, we recommend that the Unit: (1) update its policies and procedures manual to reflect current Unit practices for periodic supervisory case file review; (2) take steps to ensure that investigation delays are limited to situations imposed by resource constraints or other exigencies and that delays are documented in the case management system; and (3) ensure that the case management system includes documentation of supervisory oversight. The Unit concurred with all three recommendations.
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