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South Carolina Medicaid Fraud Control Unit: 2020 inspection
South Carolina 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, September 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Fraud -- legislation & jurisprudence
Government Regulation
South Carolina
United States
United States. Department of Health and Human Services - Genre(s):
- Technical Report
- Abstract:
- What OIG Found. We found that the South Carolina MFCU successfully investigated and prosecuted cases of Medicaid fraud and patient abuse or neglect when compared to MFCUs with similar staff sizes. We also observed that the Unit’s State and Federal partners reported positive, cooperative relationships and held the South Carolina MFCU in high respect. For FYs 2018–2020, we identified six areas in which the Unit should improve its adherence to program standards and/or requirements. We found that low staff levels and significant turnover contributed to large caseloads for Unit staff. We also found that in 16 percent of the Unit’s case files, the Unit did not document the reason for significant investigative delays. Further, the Unit’s case management system posed challenges for retrieving case information, and the Unit did not consistently document periodic supervisory reviews in its case files. Additionally, we found that the Unit did not consistently report convictions or adverse actions to Federal partners within the appropriate timeframes consistent with regulatory requirements. We also found that the Unit’s memorandum of understanding (MOU) with the State Medicaid agency generally reflected current practice, policy, and legal requirements with the exception of a regulatory requirement regarding procedures for the receipt of managed care referrals. We also made observations regarding Unit operations and practices, including a beneficial practice employed by the Unit that may serve as a model for other Units: Unit management notified referral sources of the Unit’s decision to open formal investigations of incoming referrals.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (32 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918383985106676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918383985106676