OIG: Arkansas Medicaid Fraud Control Unit Did Not Meet Performance Standards

HHS' Office of the Inspector General has released the results from its onsite review of the Arkansas Medicaid Fraud Control Unit that reveals the unit did not meet all of the Medicaid Fraud Control Unit performance standards.

The OIG found Arkansas' control unit failed to meet the performance standards in the following ways:

1. Lacked policies and procedures. The Medicaid Fraud Control Unit performance standards require all state units to have policies and procedures in place for their operations. The OIG found Arkansas' fraud unit did not have established policies and procedures for investigation and prosecution.

2. Memorandum of Understanding lacked current law. The Medicaid Fraud Control Unit performance standards require each state unit to periodically review its Memorandum of Understanding with its state's Medicaid agency to ensure the memorandum is up-to-date and contains current law. The OIG found Arkansas' memorandum did not include the law which requires payment suspension of any provider against whom there is a credible allegation of fraud.

3. Lacked adequate workload. The Medicaid Fraud Control Unit performance standards require each state unit to take steps to ensure that it maintains adequate workloads through referrals from the state Medicaid agency. The OIG found Arkansas' unit accepted only 10 fraud referrals from 2010 to 2012, which was deemed to be insufficient given the large number of participants in Arkansas' Medicaid program. 

4. Case files lacked documentation. The Medicaid Fraud Control Unit performance standards require unit supervisors to perform periodic reviews of all open case files and to note the review in the file. The OIG found 64 percent of the files at the Arkansas unit lacked documentation of periodic supervisory review.

The performance standards also require supervisory approval for the opening and closing of all case files. The approval must be noted in the case file. The OIG found 14 percent of the files at the Arkansas unit lacked documentation of approval to open.

5. Incorrectly reported costs. The Medicaid Fraud Control Unit performance standards require all state units to apply accepted accounting principles in their control unit funding. The OIG found Arkansas' unit incorrectly reported indirect costs.

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