Rhode Island Medicaid Fraud Control Unit: 2022 inspection

Rhode Island Medicaid Fraud Control Unit: 2022 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, March 2023
Language(s):
English
Format:
Text
Subject(s):
Fraud -- legislation & jurisprudence
Fraud -- prevention & control
Government Regulation
Medicaid
Rhode Island
Genre(s):
Technical Report
Abstract:
What OIG Found. Our inspection of the Rhode Island MFCU for FYs 2019–2021 found that the Unit maintained strong working relationships and investigated cases jointly with OIG and the U.S. Attorney’s Office. The Unit also took steps to maintain an adequate volume and quality of fraud and patient abuse or neglect referrals, including maintaining strong relationships with State partners. However, we made three findings related to the Unit’s management of case files and case information. First, we found that the Unit did not have an information management system with the functionality to manage and track case information from initiation to resolution, which posed challenges for monitoring cases and reporting case information and performance data. Further, we found that the Unit did not have adequate policies or procedures, or consistent practices, for effectively maintaining case files. We also found that 60 percent of applicable case files contained no documentation of periodic supervisory reviews and that the Unit’s policies and procedures manual did not describe the procedures for or frequencies of supervisory reviews. We made four additional findings related to other aspects of the Unit’s operations. We found that some parts of the Unit’s policies and procedures manual lacked adequate guidance and some parts did not describe the Unit’s current practices. In addition, we found that the Supervisor of Investigations performed auditing duties and carried an investigative caseload in addition to his managerial responsibilities, which may have impeded the efficiency and effectiveness of the Unit’s operations. We also found that the Unit did not consistently report convictions and adverse actions to Federal partners within the appropriate timeframes. Finally, we found that Unit supervisors did not track and verify that staff met training requirements. What OIG Recommends and How the Unit Responded. To address the findings, we recommend that the Unit (1) assess whether the Office of the Attorney General’s case management system can be modified to fully meet the Unit’s needs, and if appropriate, seek approval to implement its own case management system; (2) establish policies and/or procedures to ensure that case files are maintained in an effective manner; (3) develop a plan to ensure that case files include documentation of periodic supervisory reviews and update the Unit’s policies and procedures manual to describe the Unit’s current practices for periodic supervisory reviews; (4) update its policies and procedures manual to reflect current practices; (5) assess the duties of the Supervisor of Investigations, and if warranted, develop a plan to reduce his nonmanagerial duties; (6) take steps to ensure that convictions and adverse actions are reported to Federal partners within the appropriate timeframes; and (7) take steps to track and verify that Unit staff meet requirements in its training plan. The Unit concurred with all seven 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 (34 pages))
Illustrations:
Illustrations
NLM Unique ID:
9918715888706676 (See catalog record)
Permanent Link:
http://resource.nlm.nih.gov/9918715888706676