Florida State Medicaid Fraud Control Unit: 2015 Onsite Review

WHY WE DID THIS STUDY

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies the Units, and oversees the Units' performance in accordance with the requirements of the grant. As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. These reviews assess Units' adherence to the 12 MFCU performance standards and its compliance with applicable Federal statutes and regulations.

HOW WE DID THIS STUDY

We conducted an onsite review of the Florida Unit in September 2015. We based our review on an analysis of data from seven sources: (1) policies, procedures, and documentation related to the Unit's operations, staffing, and caseload; (2) financial documentation for fiscal years (FYs) 2012 through 2014; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with Unit's management; (6) a sample of files for cases that were open in FYs 2012 through 2014; and (7) observation of Unit operations.

WHAT WE FOUND

For FYs 2012 through 2014, the Florida Unit reported 193 convictions, 91 civil judgments and settlements, and combined criminal and civil recoveries of nearly $382 million. The Unit also maintained proper fiscal control of its resources. Unit management and OIG reported that colocation of staff promoted joint investigative work. However, we identified a few areas where the Unit should improve its operations. Specifically, 42 percent of the case files did not contain all periodic supervisory reviews of cases, as required by Unit policy. The Unit did not report all convictions and adverse actions to Federal partners within required timeframes, and it investigated one sampled case that was not eligible for Federal funding.

WHAT WE RECOMMEND

We recommend that the Florida Unit: (1) ensure that it conducts and documents supervisory reviews of Unit case files according to the Unit's policies and procedures; (2) implement processes to ensure it reports convictions and adverse actions to Federal partners within required timeframes; and (3) repay Federal matching funds spent on a case that was not eligible for Federal funding. The Unit concurred with all three recommendations.

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