OIG: Minnesota Medicaid Fraud Control Unit Failed to Meet Performance Standards

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

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

1. Memorandum of Understanding lacked current law. The Medicaid Fraud Control Unit performance standards require each unit to periodically review its Memorandum of Understanding with its state's Medicaid agency to make sure the memorandum is up-to-date and contains current law. The OIG found when Minnesota's control unit updated their memorandum in April 2013, it failed to include the law which requires payment suspension of any provider against whom there is a credible allegation of fraud.

2. Training manual lacked information. The Medicaid Fraud Control Unit performance standards require each unit's training manual to include a minimum number of training hours for each professional discipline. The OIG found Minnesota's training manual did not include a minimum number of training hours.

3. Files lacked documentation. The Medicaid Fraud Control Unit performance standards require unit supervisor's to periodically review ongoing investigations and to note the reviews in the case file. The OIG found 58 percent of the supervisory case file reviews at Minnesota's unit were not noted in the case file.

4. Some case files were accessible by non-unit staff. The Medicaid Fraud Control Unit performance standards require units to follow all applicable statutes and regulations. Federal regulations require units to safeguard the privacy rights of witnesses, victims and informants. The OIG found Minnesota's unit kept some case files in an unlocked cabinet that was accessible by non-unit staff.

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