Sneak Preview: La. MCFU Aims To Submit Timely Referral Letters

January 25, 2013 | By Jerry Ashworth | Post a Comment

(The following was excerpted from an article in the Federal Grants Management Handbook.) The Louisiana State Medicaid Fraud Control Unit has developed new procedures to ensure that it submits referral letters of substantiated fraudulent and convicted providers in a timely manner to the Department of Health and Human Services Office of Inspector General for program exclusion.

HHS provides grant funds to states to establish MFCUs that investigate and prosecute Medicaid provider fraud and patient abuse and neglect under state law. Every state except North Dakota has created a MFCU. In fiscal year 2011, MFCUs nationwide reported 1,230 convictions and 906 civil settlements or judgments that led to about $1.7 billion in recoveries.

The Louisiana MFCU receives provider fraud referrals from the state Medicaid agency — the Louisiana Department of Health and Hospitals — and from federal sources such as the OIG. From FY 2009 to FY 2011, the MFCU received more than 1,000 referrals, reported recoveries of $95 million and obtained 192 convictions and 86 civil judgments or settlements.

When a convicted Medicaid provider is sentenced, HHS standards require a MFCU to send a referral letter to OIG within 30 days or other reasonable time period for program exclusion. A recent OIG audit of the Louisiana MFCU found that although the unit sent most of its referrals within the appropriate timeframe, 14 percent of sentenced providers were not referred in a timely manner. In response, the Louisiana MFCU now has implemented new procedures that send an automated case tracking system email to investigators and supervisors reminding them to submit a referral letter to OIG upon sentencing a provider.


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