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Mississippi Medicaid Fraud Control Unit: 2020 inspection
Mississippi Medicaid Fraud Control Unit: 2020 inspection
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Report in brief (United States. Department of Health and Human Services. Office of Inspector General)
- 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, August 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Fraud -- prevention & control
Government Regulation
Medicaid -- legislation & jurisprudence
Mississippi
United States
United States. Department of Health and Human Services - Genre(s):
- Technical Report
- Abstract:
- What OIG Found. Our inspection of the Mississippi MFCU for FYs 2017 through 2019 found that reporting requirements contained in the Mississippi Vulnerable Persons Act imposed a significant workload on the Unit that led to many convictions of patient abuse or neglect but also presented challenges to Unit operations. The Unit received about 2,000 complaints of patient abuse or neglect for each year of the review period and devoted half of its investigative staff and 90 percent of its caseload to patient abuse or neglect. The Unit’s chief investigator devoted more than half of his time to screening complaints and encountered difficulties conducting periodic supervisory reviews of the large caseload. We also found significant unexplained investigative delays in 18 percent of cases. We observed a different picture with the Unit’s fraud cases. During the review period, the Unit’s fraud caseload and numbers of fraud convictions were low, compared to those of similarly sized MFCUs. We found that the Unit took some steps to maintain an adequate volume and quality of fraud referrals, but its efforts to maintain fraud referrals from the Medicaid agency were inconsistent and the Unit received few fraud referrals. We also found that the Unit maintained limited communication and coordination with OIG and that the Unit stopped working joint cases with Federal partners in 2018. We also found that certain operational issues have persisted since OIG’s prior onsite review in 2014. We found that the Unit’s policies and procedures manual did not reflect all aspects of Unit operations, including for periodic supervisory reviews. We also found that the Unit did not timely report a substantial number of convictions to OIG for purposes of excluding providers from Federal health care programs, and that the Unit’s timeliness declined significantly since OIG’s 2014 onsite review.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (42 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918383969306676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918383969306676