Fwd: OIG posts report, advisory opinion and news about enforcement actions - 8/25

---------- Forwarded message ----------
From: HHS Office of Inspector General <donotreply@subscriptions.hhs.gov>
Date: Mon, Aug 25, 2014 at 7:28 AM
Subject: OIG posts report, advisory opinion and news about enforcement actions - 8/25
To: iammejtm@gmail.com

Good morning from Washington, DC. Today OIG posts a report, an advisory opinion and news about enforcement actions. As always, you can use the links provided to go directly to the new material.   ------------------------------------------------------------------------------   Mississippi State Medicaid Fraud Control Unit: 2014 Onsite Review (OEI 09-13-00700) http://go.usa.gov/mXSw   WHY WE DID THIS STUDY OIG oversees the activities of all State Medicaid Fraud Control Units (MFCUs or Units). As part of this oversight, OIG conducts periodic reviews of all Units and prepares public reports based on these reviews. The reviews assess Unit performance in accordance with the 12 MFCU performance standards and monitor Unit compliance with Federal grant requirements.   HOW WE DID THIS STUDY We conducted an onsite review in January 2014. We based our review on an analysis of data from seven sources: (1) a review of policies, procedures, and documentation on the Unit's operations, staffing, and caseload for fiscal years (FYs) 2011 through 2013; (2) a review of financial documentation; (3) structured interviews with key stakeholders; (4) a survey of Unit staff; (5) structured interviews with the Unit's management and selected staff; (6) an onsite review of a sample of case files that were open in FYs 2011 through 2013; and (7) an onsite observation of Unit operations.   WHAT WE FOUND From FYs 2011 through 2013, the Unit reported recoveries of $52 million, 174 convictions, and 37 civil judgments and settlements. A Unit supervisor approved the opening and closing of most case files; however, 44 percent of case files lacked documentation of periodic supervisory reviews. In addition, the Unit did not adequately safeguard some of its case files. The Unit did not investigate 5 percent of cases before the statute of limitations expired, and may not have enough investigators assigned to patient abuse and neglect cases. The Unit also did not refer 11 sentenced individuals to OIG for program exclusion within an appropriate timeframe. Finally, the Unit's policies and procedures manual did not reflect current Unit operations. WHAT WE RECOMMEND We recommend that the Mississippi Unit (1) ensure that supervisors approve the opening and closing of cases and that periodic supervisory reviews are conducted and documented in Unit case files; (2) ensure that case files are secure; (3) ensure that all cases are investigated or closed, as appropriate, before the statute of limitations expires; (4) assess the allocation of existing staff levels; (5) ensure that it refers all sentenced individuals for exclusion to OIG within an appropriate timeframe; and (6) revise its policies and procedures manual to reflect current operations. The Unit concurred with all six of our recommendations.     ------------------------------------------------------------------------------   Advisory Opinion 14-07 http://go.usa.gov/mXKV   This advisory opinion concerns the use of a "preferred hospital" network as part of Medicare Supplemental Health Insurance ("Medigap") policies.    ------------------------------------------------------------------------------    August 22, 2014; U.S. Attorney; Middle District of Pennsylvania Tioga County Physician and Three Others Indicted for Unlawful Distribution of Controlled Substances and Health Care Fraud http://go.usa.gov/NXZP    ------------------------------------------------------------------------------   August 22, 2014; U.S. Attorney; Southern District of Texas Humble Man Sentenced for Multiple Convictions in Health Care Fraud Conspiracy http://go.usa.gov/NXZP   ------------------------------------------------------------------------------   State Enforcement Actions Updated http://go.usa.gov/NXWh   ------------------------------------------------------------------------------   That's all we have for today. If we can be of any further assistance, please send an Email to public.affairs@oig.hhs.gov   I hope your week has started well.   Marc Wolfson – Office of External Affairs   OIG's privacy policy can be found at http://oig.hhs.gov/notices/privacy-notice.asp Follow us on Twitter: http://twitter.com/OIGatHHS Inquiries? Contact us: Public.Affairs@oig.hhs.gov Manage your OIG subscriptions: update your preferences or unsubscribe Questions about this service? Visit subscriberhelp.govdelivery.com This email was sent to iammejtm@gmail.com using GovDelivery, on behalf of the U.S. Dept. of Health & Human Services · 200 Independence Avenue SW · Washington DC 20201 · 1-877-696-6775

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Jeremy Tobias Matthews