Kansas Medicaid Fraud Control Unit: 2018 Onsite Inspection

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.

HOW WE DID THIS STUDY

We conducted the onsite review of the Kansas MFCU in May 2018. Our review period covered Federal fiscal years (FYs) 2015-2017. We based our review on an analysis of data from seven sources: (1) Unit documentation; (2) financial documentation; (3) structured interviews with key stakeholders; (4) structured interviews with the Unit's managers and selected staff; (5) a review of a simple random sample of 50 case files that were open at any point during the review period; (6) a review of all convictions submitted to OIG for program exclusion and all adverse actions submitted to the National Practitioner Data Bank during the review period; and (7) observations of Unit operations.

WHAT WE FOUND

During FYs 2015-2017, the Kansas MFCU generally operated in accordance with applicable laws, regulations, policy transmittals, and the MFCU performance standards. However, from the data we reviewed, we identified one area in which the Unit should improve its adherence to performance standards: Unit investigators and other staff carried large caseloads.

WHAT WE RECOMMEND

We recommend that the Unit review its caseload management practices and develop an action plan to lower staff's caseloads and maximize effectiveness. The Unit concurred with the recommendation.