Alabama's Medicaid fraud efforts come up short

Alabama's Medicaid Fraud Control Unit (MFCU) reported more than $63 million in recoveries between 2011 and 2013, but the agency is plagued with multiple inefficiencies, according to an onsite review conducted by the Office of Inspector General (OIG).

The Alabama MFCU tallied just 10 criminal convictions and 63 civil judgments and settlements over the course of three fiscal years; however, the OIG indicated that nearly half of civil settlements came from audits outside of the MCFU's authority. Many of these audits were directed at nursing homes and therapeutic foster care agencies that did not involve "substantial allegations or indications of fraud."

The OIG also found that only six percent of referrals came from the state Medicaid agency, in part because agency staff members did not know what constitutes a quality referral. Additionally, Alabama's MFCU did not have a "cooperative working relationship" with the OIG or the U.S. Attorney's Office, and the unit lacked written policies and procedures for referring cases to federal and state authorities for collection of overpayments or suspension of Medicaid payments.

The OIG included five recommendations, which Alabama's MFCU agreed to, in order to improve Medicaid fraud investigations and the working relationship with state and federal authorities.

In 2013, the Department of Health and Human Services claimed the Alabama Medicaid program had been overpaid more than $88 million after it miscalculated the number of children enrolled in the program. FierceHealthPayer: AntiFraud has previously reported on state Medicaid fraud prevention efforts that rely on efficiency to investigate improper payments, noting that states that take an aggressive approach tend to see better results.

For more:
- here's the OIG report (.pdf)

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.