Louisiana Medicaid Fraud Control Unit: 2020 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 Units and prepares public reports based on these reviews.

HOW WE DID THIS STUDY

OIG conducted the inspection of the Louisiana Unit in December 2020 using a remote format. Our inspection covered the 3-year period of Federal federal years (FYs) 2018-2020. We based our inspection on an analysis of data and information from the following 6 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 random sample of 98 case files from the 1,682 nonglobal case files that were open at some point during the review period; and (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.

WHAT WE FOUND

OIG found that the Louisiana Unit generally complied with applicable legal requirements, except that we found one case in our review of case files that was ineligible for Federal matching funds during the review period.

We found the Unit had strong case outcomes for FYs 2018-2020. We observed that a number of positive practices may have contributed to the Unit's success, including strong collaboration with Federal law enforcement. In fact, we identified two beneficial practices that may be useful as a model to other Units. First, the Unit hired an outreach coordinator to promote the Unit's mission among its stakeholders. Second, the Louisiana Unit and a neighboring Unit sponsored combined training events for employees of both Units.

WHAT WE RECOMMEND AND HOW THE UNIT RESPONDED

To address the one finding, we recommend that the Louisiana Unit repay the Federal matching funds spent on the case that was ineligible for Federal funding. The Unit concurred with our recommendation.