Tribal Self-Governance Study
Description of Program,
Service, Function or Activity (PSFA)
INVENTORY
1. Agency Name: Department of Health and Human Services, Office of the Secretary, Office of Inspector General (OIG)
2. Program Name: State Medicaid Fraud Control Unit (SMFCU)
3. CFDA #: 93.775
4. Program Objectives: The SMFCU grant program provides Federal funding assistance to State Medicaid Fraud Control Units to investigate and prosecute violations of all applicable State laws pertaining to fraud in the administration of the Medicaid program, the provision of medical assistance, or the activities of providers of medical assistance under the State Medicaid plan. The units also review complaints alleging abuse or neglect of patients in health care facilities receiving payments under the State Medicaid plan, and in certain other facilities, and may review complaints of misappropriation of patients’s private funds in such facilities.
5. Titles and Descriptions of at least Three Funded Grantees: The State/agency grantees identified below are all currently operating as State/Federally funded Medicaid Fraud Control Units. A total of 47 States and the District of Columbia are currently participating in the grant program, including these three.
State of Georgia, State Health Care Fraud Control Unit
State of New York, Office of the Attorney General, Medicaid Fraud Control Unit
State of Alaska, Office of the Attorney General, Medicaid Fraud Control Unit
AUTHORITY
6. Authorizing Statute(s): 42 C. F. R. 1007, 42 U.S.C. 1396(a)(6), 1396b(b)(3) and 1396b(q),
7. Regulatory/Administrative Requirements: Units must submit applications containing proposed organization, administration, agreements, detailed budgets and procedures for certification of eligibility (see 42 CFR 1007). Costs will be determined in accordance with OMB Circular No. A-87. Governors in States applying for Federal assistance must approve the application pursuant to 42 CFR 1007.
8. Mandatory Statutory Changes Needed to Operate PSFA as a Demonstration: Unknown.
APPLICANTS, BENEFICIARIES and FORMULAS
9. Type of Funding: Formula Grants
10. Eligible Applicants: The 50 States and the District of Columbia.
11. Allotment Formulas, Etc.: States are reimbursed for 90 percent of their costs for the first 12 quarters, and 75 percent thereafter, computed against a quarterly maximum allowable of the higher of $125,000, or one-fourth of 1 percent of the sums expended by the Federal, State, or local government in carrying out the State plan under Title XIX of the Social Security Act.
12. Applicant Provisions/Allotments in Law for Indians: Not applicable.
13. Eligible Beneficiaries: The State governments will benefit from this program.
14. Beneficiary Provisions/Allotments in Law for Indians: Not applicable.
15. Amount and Percent of Total that is Mandatory for Indians: Not applicable.
FINANCIAL
16. Total FY 2000 Funding: Federal funding for the SMFCU grant program in FY 2000 was approximately $96,000,000.
17. Amount and Percent of Total Funding Awarded to Indians: None awarded.
18. For Awards to Tribes: Number, Range and Average Amounts: None awarded.
19. Total FY 2001 Funding and Amount for Indians, if known: None awarded.
OTHER
20. How long assistance is funded: The funding is indefinite. Funds are awarded quarterly based on an approved annual budget and limitations on entitlement.
-- Fund use restrictions: The statute authorizes 90 percent matching funds for 12 quarters, and 75 percent matching funds thereafter for investigation and prosecution of fraud and patient abuse in the State Medicaid Programs. The unit must be separate and distinct from the State Medicaid agency. The Unit must also employ sufficient professional, administrative and support staff to carry out its duties and responsibilities in an effective and efficient manner.
-- Reporting requirements: Annual reports and quarterly program and financial status reports are required
-- Audit requirements: HHS/OIG/Office of Audit Services performs periodic audits of the State program; HHS/OIG/Office of Investigations performs an annual re-certification review.
CONTACTS
21. DHHS Workgroup Contact: Melinda Golub, Senior Counsel
Office of
Counsel to the Inspector General, Office of Inspector General, Office of the
Secretary, Department of Health and Human Service
Room 5527 Cohen
Bld.
330 Independence Ave., SW
Washington, DC 20201
(202)
205-9428
22. HHS Agency/Program Contact: Joseph Prekker, Director
State
Medicaid Oversight and Policy Staff (SMOPS), Office of Investigations, Office
of Inspector General, Office of the Secretary, Department of Health and Human
Services
Room 5453,Cohen Bldg.
330 Independence Ave.,SW.
Washington,
DC 20201
(202) 619-3557