WHAT WE FOUND
For fiscal years 2011 through 2013, the Unit reported 10 criminal convictions, 63 civil judgments and settlements, and recoveries of over $63 million. We identified one issue of significant noncompliance with applicable laws, regulations, or policy transmittals – nearly half of the Unit’s civil settlements resulted from audits that were outside the MCFU’s grant authority. We also found multiple opportunities for improvement in the Unit’s performance. Only a small portion of Unit referrals-6 percent-came from the State Medicaid agency. The Unit did not have a cooperative working relationship with certain Federal partners and lacked written policies for referring cases to Federal and State agencies. The Unit also did not refer information about all convictions to OIG and did not send some information within the appropriate timeframe. Unit supervisors did not always conduct periodic case reviews and, when they did conduct such reviews, they did not include notations in case files.
via Alabama State Medicaid Fraud Control Unit: 2014 Onsite Review Report (OEI-06-13-00660) 04-10-2015.