Wisconsin Medicaid Fraud Control Unit: 2024 Inspection

Why OIG Did This Review

OIG administers the Medicaid Fraud Control Unit (MFCU or Unit) grant awards, annually recertifies each Unit, 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 issues public reports of its findings.

What OIG Found

The Unit shared supervision of its special agent positions with another division in the Wisconsin Department of Justice, but lacked a memorandum of understanding (MOU) to ensure that these positions are supervised in compliance with Federal requirements.

The Unit’s electronic case management system did not allow the Unit to efficiently access and maintain case information and performance data.

The Unit lacked adequate policies and procedures for effectively maintaining case files.

The Unit did not consistently document periodic supervisory reviews or supervisory approvals to open cases in its case files during our review period.

The Unit maintained positive working relationships with Federal law enforcement partners but lacked policies for deconflicting cases with these partners.

The Unit did not report four convictions and one adverse action to Federal partners during the review period, as required.

The Unit’s MOU with the State Medicaid agency did not reflect several legal requirements.

What OIG Recommends

1. Establish an MOU with the Division of Criminal Investigations to ensure that special agents are supervised in accordance with Federal requirements.
2. Implement a comprehensive case management system that allows the Unit to efficiently access and maintain case information and performance data.
3. Establish policies and procedures to help ensure that case files are maintained effectively.
4. Ensure that supervisory reviews and supervisory approvals to open cases are consistently documented in accordance with Unit policy.
5. Establish written policies for deconflicting cases with Federal partners.
6. Take steps to report all convictions and adverse actions to Federal partners within the appropriate timeframes.
7. Revise its MOU with the State Medicaid agency to reflect applicable legal requirements.

The Unit reported taking alternative steps to address the first recommendation and concurred with the other six recommendations.