OIG finds deficiencies in Rhode Island's Medicaid Fraud Control Unit

Rhode Island's Medicaid Fraud Control Unit (MFCU) has not been doing its job adequately, a government report reveals.

From fiscal years 2012 through 2014, the state's MFCU saw a decreasing number of fraud referrals, failed to refer convictions to the Office of Inspector General's (OIG) exclusion program and did not report adverse actions against physicians to the National Practitioner Data Bank (NPDB), according to a report released by the OIG.

Although Rhode Island's MFCU recovered more than $8 million in civil and criminal investigations between 2012 and 2014, the vast majority of that money came from multi-state cases coordinated at a national level. Over the three year period, referrals to the MFCU decreased 93 percent. In particular, fraud referrals from the state Medicaid agency dropped from 37 to four over that time period, primarily because of policy changes within the Centers for Medicare & Medicaid Services that prevented states from sending "certain personally identifiable information."

Additionally, of the 33 individuals sentenced for fraud charges from 2012-2014, only two were reported to the OIG for exclusion within 30 days, and nearly half (15) were referred more than 100 days after sentencing. Additionally the MFCU failed to report physician adverse actions to the NPDB.

The OIG recommended that the Rhode Island MFCU work with the State Medicaid agency to increase referrals, report exclusion data to the OIG in a timely manner, and report adverse actions to the NPDB, all of which the MFCU concurred with.

In June, the OIG announced a new civil litigation team that would focus specifically on civil monetary penalties and exclusion cases following last year's move to expand its sanction authority. Previously, FierceHealthPayer: Antifraud reported that efficiency reigns supreme when it comes to MFCU programs.

For more:
- here's the OIG report

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