Indiana State Medicaid Fraud Control Unit: 2013 Onsite Review

WHY WE DID THIS STUDY

OIG oversees the activities of all Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements.

HOW WE DID THIS STUDY

We conducted an onsite review in May 2013. We based our review on an analysis of data from seven sources: (1) a review of policies, procedures, and documentation on the Unit's operations, staffing, and caseload for fiscal years (FYs) 2010 through 2012; (2) a review of financial documentation for that timeframe; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with the Unit's management; (6) an onsite review of a sample of case files that were open in FYs 2010 through 2012; and (7) an onsite observation of Unit operations.

WHAT WE FOUND

From FYs 2010 through 2012, the Unit reported combined civil and criminal recoveries exceeding $110 million and 105 convictions. The Unit did not exercise proper fiscal controls over claimed expenditures and program income, and it did not maintain adequate internal controls of the equipment in its possession. Documented supervisory approval to open cases was missing in an estimated 77 percent of the case files, and documented supervisory approval to close cases was missing in an estimated 18 percent of the closed-case case files. In addition, the Unit did not maintain a training plan that included an annual minimum number of training hours for each professional discipline and the Unit's MOU with Indiana's State Medicaid agency did not reflect current law and practice. Finally, the Unit did not timely refer 25 convictions to OIG for the purpose of program exclusion.

WHAT WE RECOMMEND

We recommend that the Unit work with OIG's MFCU oversight division to ensure compliance with the 12 performance standards. The Indiana Unit concurred with all five of our recommendations.

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