Arkansas State Medicaid Fraud Control Unit: 2013 Onsite Review

WHY WE DID THIS STUDY

OIG oversees all Medicaid Fraud Control Units (MFCU or Unit) with respect to Federal grant compliance. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews describe the Units' caseloads; assess performance in accordance with the 12 MFCU performance standards; identify any opportunities for improvement; and identify any instances of noncompliance with laws, regulations, and policy transmittals.

HOW WE DID THIS STUDY

We based our review on an analysis of data from seven sources: (1) a review of policies, procedures and documentation of the Unit's operations, staffing, and caseload; (2) a review of financial documentation; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with the Unit director and supervisors; (6) an onsite review of case files; and (7) an onsite review of Unit operations conducted in January 2013.

WHAT WE FOUND

For fiscal years (FY) 2010 through 2012, the Arkansas Unit obtained 27 criminal convictions and 43 civil settlements, and reported recoveries of nearly $42 million. Our review of compliance issues found no evidence of significant noncompliance with applicable laws, regulations, or policy transmittals. However, we identified six instances in which the Unit did not fully adhere to performance standards. Opportunities for improvement in the Unit's adherence to the performance standards include, but are not limited to, establishing policies and procedures specific to the Unit's operations, updating the Unit's memorandum of understanding with the State Medicaid agency to reflect current law, working with the State Medicaid agency to ensure an adequate number of referrals from the State Medicaid agency, including supervisory review and approval documentation in case files, ensuring indirect costs are correctly reported, and establishing and maintaining an annual training plan.

WHAT WE RECOMMEND

On the basis of these findings, we recommend specific improvements to ensure that the Arkansas Unit fully adheres to each of the performance standards for which we had findings. The Unit concurred with each of our six recommendations.

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