Minnesota Medicaid Fraud Control Unit: 2022 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 an onsite inspection of the Minnesota MFCU in October-November 2022. Our inspection covered Federal fiscal years (FYs) 2020-2022. We based the inspection on an analysis of data and information from 7 sources: (1) Unit documentation; (2) financial documentation; (3) structured interviews with key stakeholders; (4) structured interviews with Unit management and selected staff; (5) a review of a random sample of 86 case files from the Unit's 442 non-global 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) an onsite review of Unit operations.

WHAT WE FOUND

We found that the Minnesota MFCU operated in accordance with applicable laws, regulations, and policy transmittals, and reported strong case outcomes for FYs 2020-2022. From the data we reviewed, we found that the Unit maintained positive working relationships with Federal partners and investigated cases jointly. The Unit also reported nearly all convictions and adverse actions to Federal partners within the appropriate timeframes, including cases of patient abuse or neglect that were investigated and prosecuted by local authorities. However, we made four findings regarding the Unit's adherence to the MFCU performance standards and compliance with Federal regulations. First, we found that the director was the only supervisor in the Unit, which limited the oversight of Unit operations. Second, we found that, although the Unit took steps to coordinate with other State agencies, it received few referrals of patient abuse or neglect. Third, we found that the Unit lacked a case management system that allowed efficient and secure access to case information and case outcomes data, which posed challenges for locating documents and tracking case statuses. Finally, we found that the Unit did not consistently conduct periodic supervisory reviews or document supervisory approvals in its case files. In addition to these findings, we made several observations regarding Unit operations and practices.

WHAT WE RECOMMEND

To address the findings, we recommend that the Unit (1) continue efforts to hire a second-line supervisor and assess whether additional supervisors are warranted to meet the Unit's oversight needs; (2) build upon its efforts to increase referrals of patient abuse or neglect; (3) implement a comprehensive case management system that allows for efficient access to case documents and information; and (4) take steps to ensure that periodic supervisory reviews are conducted on a consistent basis and that case files include documentation of supervisory approvals. The Unit concurred with all four recommendations.