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2010 Health Care Fraud Annual Report

2010 Health Care Fraud Annual Report

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Published by Mike DeWine

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Published by: Mike DeWine on Sep 07, 2010
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01/30/2013

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Ohio MFCU 2010 Annual Report Page 1 of 36
 
Ohio Medicaid Fraud Control Unit
FY 2010 Annual Report
Keesha R. Mitchell, DirectorHealth Care Fraud Section150 E. Gay Street, 17
th
Fl.Columbus, OH 43215
 
Ohio MFCU 2010 Annual Report Page 2 of 36
Table of Contents
Page
Unit Performance
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
Investigations
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4Unit Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Summary By Case Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Summary By Provider Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Prosecutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Civil Settlements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Case Management System
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33
Training
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
The National Association of Medicaid Fraud Control Units
. . . . . . . . . . . . . . .
35
Ohio MFCU Staff
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
35
Certification of Drug-Free Workplace
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
Attachment A
: Special Agent Core Training Continuum
Attachment B
: Inventory of Training Courses Completed
Attachment C
: New Staff Basic Training Curriculum
Attachment D
: Staff Roster
 
Ohio MFCU 2010 Annual Report Page 3 of 36
Unit Performance
 The Ohio Medicaid Fraud Control Unit (“MFCU”) continues to aggressively pursue itsinvestigative responsibilities with respect to criminal and civil offenses against the Medicaid programand persons residing in the institutions served by it. Its well-trained and experienced staff continuesto have much success in this regard. As a unit, the MFCU stands as a significant deterrent to those who would defraud the Ohio Medicaid Program or abuse its recipients.During the period July 1, 2009 to June 30, 2010, the MFCU received seven hundred (700)complaints of Medicaid fraud and patient abuse or neglect. Of these, four hundred ninety-nine(499) related to allegations of Medicaid fraud and two hundred one (201) related to allegations of abuse or neglect in Ohio care facilities. The MFCU opened five hundred thirty-five (535) of thesecomplaints for active investigation, three hundred eighty-six (386) relating to Medicaid fraud andone hundred forty-nine (149) relating to patient abuse or neglect. During this period, the MFCUcompleted four hundred forty-four (444) investigations. Of those, two hundred eighty-eight (288)related to fraud allegations and one hundred fifty-six (156) related to allegations of patient abuse orpatient neglect.During the period July 1, 2009 to June 30, 2010, the MFCU obtained one hundred twenty-seven (127) indictments, bills of information, or complaints. Of these, one hundred twelve (112)pertained to fraud against the Ohio Medicaid program and fifteen (15) involved charges of patientabuse or neglect in Ohio care facilities. During this same period, the MFCU obtained convictionsagainst one hundred four (104) persons and business entities. Of these convictions, ninety (90) werein cases involving fraud against the Ohio Medicaid Program and fourteen (14) were in casesinvolving patient abuse or neglect. The MFCU also completed twenty-six (26) civil settlementsduring its recertification period. The total value of these criminal restitution orders and civilsettlements was $58,689,502.45. These numbers are particularly significant in light of the fact that itcost less than $5 million to fund the operation of the Unit, 25% of which was provided by the Ohio Attorney General and 75% of which was provided by a grant from the United States Department of Health and Human Services, Office of the Inspector General. The MFCU has continued to provide information to various groups of health care providers,law enforcement agencies, Medicaid advocates, and others around the state in the form of presentations and workshops. These efforts have proven valuable to the MFCU, both in terms of the quality of complaints concerning Medicaid fraud and patient abuse/neglect, and in terms of thetimeliness of such complaints. They have also served the important function of informing Medicaidproviders and caregivers of the serious criminal consequences that can result from the mistreatmentof those persons entrusted to their care, or the submission of fraudulent claims to the OhioMedicaid program.

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