U.S. Department of Health and Human Services 
 
Office of Inspector General 
 
 
 
Mississippi Medicaid Fraud 
Control Unit: 2020 Inspection  
 
 
 
 
 
Suzanne Murrin 
Deputy Inspector General for Evaluation and Inspections 
August 2021, OEI-12-20-00200  U.S. Department of Health and Human Services 
O  ffice of Inspector General 
   
Report in Brief 
 
Au gust 2021, OEI-12-20-00200 
 
Mississippi Medicaid Fraud Control Unit: 
Unit Case Outcomes 
Federal fiscal years (FYs) 2017  2020 Inspection 
through 2019: 
  139 indictments 
What OIG Found 
  167 convictions (152 of 
Our inspection of the Mississippi MFCU for FYs 2017 through 2019 found 
patient abuse or neglect and 
that reporting requirements contained in the Mississippi Vulnerable Persons 
15 of Medicaid provider 
Act imposed a significant workload on the Unit that led to many convictions 
fraud) 
of patient abuse or neglect but also presented challenges to Unit operations.  
  35 civil settlements and 
The Unit received about 2,000 complaints of patient abuse or neglect for 
judgments 
each year of the review period and devoted half of its investigative staff and 
  $24 million in recoveries 
90 percent of its caseload to patient abuse or neglect.  The Units chief 
 
investigator devoted more than half of his time to screening complaints and 
Unit Snapshot 
encountered difficulties conducting periodic supervisory reviews of the large 
At the time of the inspection in 
caseload.  We also found significant unexplained investigative delays in 18 
August 2020, the Mississippi 
percent of cases.  
Medicaid Fraud Control Unit (MFCU 
or Unit) had 34 staff, primarily  We observed a different picture with the Units fraud cases.  During the 
located in Jackson, Mississippi.  review period, the Units fraud caseload and numbers of fraud convictions 
were low, compared to those of similarly sized MFCUs.  We found that the 
During FYs 2017 through 2019,  
Unit took some steps to maintain an adequate volume and quality of fraud 
90 percent (2,047) of the Units 
referrals, but its efforts to maintain fraud referrals from the Medicaid agency 
cases involved patient abuse or 
were inconsistent and the Unit received few fraud referrals.  We also found 
neglect and 10 percent (224) 
that the Unit maintained limited communication and coordination with OIG 
involved fraud. 
and that the Unit stopped working joint cases with Federal partners in 2018.   
The Mississippi Vulnerable Persons 
We also found that certain operational issues have persisted since OIGs prior 
Act mandates that staff at care 
onsite review in 2014.  We found that the Units policies and procedures 
facilities and home health 
manual did not reflect all aspects of Unit operations, including for periodic 
agencies, as well as any other 
supervisory reviews.  We also found that the Unit did not timely report a 
individuals with knowledge of 
substantial number of convictions to OIG for purposes of excluding providers 
patient abuse or neglect in care 
from Federal health care programs, and that the Units timeliness declined 
facilities, make a report both to the 
significantly since OIGs 2014 onsite review.   
MFCU and the Mississippi State 
Department of Health.  As a result  What OIG Recommends and How the Unit Responded  
of the reporting mandate, the Unit  To address the findings about cases of patient abuse or neglect and fraud, 
received 5,996 complaints of  we recommend that the Unit (1) examine the Units intake process for 
patient abuse or neglect during the  complaints of patient abuse or neglect and identify improvements; (2) take 
review period.  steps to avoid investigative delays and ensure that delays are documented in 
the case management system; (3) develop and implement a plan to increase 
 
fraud referrals from the Medicaid agency and other sources; and (4) improve 
communication and coordination with OIG investigators and other Federal 
 
partners.  We also make eight recommendations to address other findings 
    related to the Units compliance with legal requirements and adherence to 
MFCU performance standards.  The Unit concurred with 11 of our 
recommendations and did not concur with 1 recommendation. 
     
TABLE OF CONTENTS 
 
 
 
 
BACKGROUND  1   
PERFORMANCE ASSESSMENT  7 
Case Outcomes                                7 
The Unit reported 139 indictments, 167 convictions, and 35 civil settlements and 
judgments for FYs 2017 through 2019 
The Unit reported total recoveries of $24 million for FYs 2017 through 2019 
Performance Standard 1: Compliance with requirements  8 
Two cases were ineligible for Federal matching funds during the review period 
Performance Standard 2: Staffing   9 
The Unit was nearly fully staffed at the time of our review but experienced significant 
turnover during the review period 
Performance Standard 3: Policies and procedures  10 
The Units policies and procedures manual did not reflect all aspects of Unit operations 
Performance Standard 4: Maintaining adequate referrals  11 
Although the Unit took some steps to maintain an adequate volume and quality of 
fraud referrals, its efforts to maintain fraud referrals from the Medicaid agency were 
inconsistent 
The Unit received an unusually large number of patient abuse or neglect complaints 
because of reporting requirements contained in the Mississippi Vulnerable Persons Act, 
which in turn imposed a significant workload on the Unit 
Performance Standard 5: Maintaining a continuous case flow  13 
Some of the Units cases had significant unexplained delays in the investigation phase  
Nearly all case files contained documentation of supervisory approval to open and, as 
appropriate, supervisory approval to close 
Performance Standard 6: Case mix  14 
The Units caseload was skewed heavily toward cases of patient abuse or neglect, 
attributable to the large number of complaints of patient abuse or neglect received and 
the resulting cases opened    
The Unit investigated few cases of Medicaid provider fraud, as compared to those of 
similarly sized MFCUs 
Performance Standard 7: Maintaining case information  16 
  The Units case management system lacked some capabilities but was adequate for 
monitoring case progression 
The Unit lacked a policy for periodic supervisory review and procedures for conducting 
and documenting supervisory review in the Units case management system 
Performance Standard 8: Cooperation with Federal authorities on fraud cases  18 
The Unit maintained limited communication and coordination with OIG, and the Units 
joint cases with Federal partners ceased during the review period.   
The Unit did not timely report a substantial number of convictions and adverse actions 
to Federal partners as required 
Performance Standard 9: Program recommendations  20 
The Unit made no program recommendations to the State Medicaid agency during the 
review period 
Performance Standard 10: Agreement with Medicaid agency  20 
The Units MOU with the State Medicaid agency did not reflect two recent requirements 
Performance Standard 11: Fiscal control  21 
The Unit did not properly report program income during the review period 
The Unit reported retaining certain settlement proceeds rather than working with the 
State Medicaid agency to ensure the appropriate return of the Federal Governments 
share of those recoveries 
Performance Standard 12: Training  22 
Unit staff received training, but the Units training plan did not clearly specify annual 
training hours for each professional discipline  
 
CONCLUSION and RECOMMENDATIONS  24    
Patient Abuse or Neglect Cases  25 
Examine the Units intake process for complaints of patient abuse or neglect and 
identify improvements. 
Take steps to avoid investigative delays and ensure that delays are documented in the 
case management system 
Fraud Cases  26 
Develop and implement a plan to increase fraud referrals from the Medicaid agency and 
other sources  
Take steps to improve communication and coordination with OIG investigators and 
other Federal partners 
Compliance With Legal Requirements  26 
Implement processes to ensure that it reports convictions and adverse actions to 
Federal partners within the appropriate timeframes 
  Revise its MOU with the Mississippi Division of Medicaid to reflect current law 
Repay Federal matching funds spent on cases that were ineligible for Federal funding 
Develop a procedure to ensure that it reports all program income properly on its 
Federal financial reports 
Work with the Mississippi Division of Medicaid to ensure the return of the Federal 
Governments share of all recoveries   
Adherence to MFCU Performance Standards  27 
Update its policies and procedures manual to reflect Unit operations and enhance the 
manuals organization 
Develop written policies and procedures and take other steps to ensure that periodic 
supervisory reviews are conducted and documented in the case files. 
Update its training plan to include annual training hours for each professional discipline 
  
  UNIT COMMENTS AND OIG RESPONSE  29   
  DETAILED METHODOLOGY  31 
  APPENDICES  34 
A. Unit Referrals by Source for Fiscal Years 2017 Through 2019  34 
B. Point Estimates and 95-Percent Confidence Intervals of Case File Reviews  35 
C. Unit Comments  36 
  ACKNOWLEDGMENTS AND CONTACT  37 
  ABOUT THE OFFICE OF INSPECTOR GENERAL  37 
 
   
BACKGROUND 
 
 
Objectives 
To examine the performance and operations of the Mississippi Medicaid Fraud 
Control Unit (MFCU or Unit). 
Medicaid Fraud Control Units 
MFCUs investigate (1) Medicaid provider fraud and (2) patient abuse or neglect in 
facility settings, and prosecute those cases under State law or refer them to other 
prosecuting offices.1, 2, 3  Under the Social Security Act (SSA), a MFCU must be a 
single, identifiable entity of State government, separate and distinct from the State 
Medicaid agency, and employ one or more investigators, attorneys, and auditors.4  
Each State must operate a MFCU or receive a waiver.5   
Currently, 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands 
operate MFCUs.6  Each Unit receives a Federal grant award equivalent to 90 percent of 
total expenditures for new Units and 75 percent for all other Units.7  In Federal fiscal 
year (FY) 2020, combined Federal and State expenditures for the MFCUs totaled 
approximately $306 million.8   
   
_____________________________________________________________________________________________________________________________ 
1 SSA  1903(q)(3).  Regulations at 42 CFR  1007.11(b)(1) clarify that a Units responsibilities include the 
review of complaints of misappropriation of patients private funds in health care facilities. 
2 As of December 27, 2020, MFCUs may also receive Federal financial participation to investigate and 
prosecute abuse or neglect of Medicaid beneficiaries in a noninstitutional or other setting.  Consolidated 
Appropriations Act, 2021, Public Law 116-260, Division CC, Section 207. 
3 References to State in this report refer to the States, the District of Columbia, and the U.S. territories. 
4 SSA  1903(q). 
5 SSA  1902(a)(61). 
6 The territories of American Samoa, Guam, and the Northern Mariana Islands have not established Units. 
7 SSA  1903(a)(6).  For a Units first 3 years of operation, the Federal Government contributes 90 percent 
of funding and the State contributes 10 percent.  Thereafter, the Federal Government contributes 
75 percent and the State contributes 25 percent. 
8 OIG analysis of MFCU annual statistical reporting data for FY 2020.  The Federal FY 2020 was from 
October 1, 2019, through September 30, 2020. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Background | 1  OIG Grant Administration and Oversight of Medicaid Fraud 
Control Units 
The Office of Inspector General (OIG) administers the grant award to each Unit and 
provides oversight of Units.9, 10  As part of its oversight, OIG conducts a desk review of 
each Unit as part of the annual recertification process.  OIG also conducts periodic 
inspections and reviews.  Finally, OIG provides ongoing training and technical support 
to the Units. 
In its annual recertification review, OIG examines the Units reapplication materials, 
case statistics, and questionnaire responses from Unit stakeholders.  Through the 
recertification review, OIG assesses a Units performance, as measured by the Units 
adherence to published performance standards;11 the Units compliance with 
applicable laws, regulations, and OIG policy transmittals;12 and the Units case 
outcomes. 
OIG further assesses Unit performance by conducting inspections and reviews on 
selected Units.  These inspections and reviews result in public reports of findings and 
recommendations for improvement.  OIG reports may also include observations 
regarding Unit operations and practices, including beneficial practices that may be 
useful to share with other Units.  Finally, OIG provides training and technical 
assistance to Units during inspections and reviews, as appropriate. 
Mississippi MFCU 
The Mississippi Unit is located within the Mississippi Attorney Generals Office (AGO) 
in Jackson.  At the time of our August 2020 inspection, the Unit director served as the 
chief attorney and directly supervised the five Unit attorneys, and also supervised the 
chief investigator, another supervisor (Bureau Director II), and Unit support staff.13  
The chief investigator supervised the fraud supervisor and nine Unit investigators who 
were assigned to conduct patient abuse or neglect investigations.  The fraud 
_____________________________________________________________________________________________________________________________ 
9 As part of grant administration, OIG receives and examines financial information from Units, such as 
budgets and quarterly and final Federal Financial Reports that detail MFCU income and expenditures. 
10 The SSA authorizes the Secretary of Health and Human Services to award grants (SSA  1903(a)(6)) and 
to certify and annually recertify the Units (SSA  1903(q)).  The Secretary delegated these authorities to 
OIG in 1979. 
11 MFCU performance standards are published at 77 Fed. Reg. 32645 (June 1, 2012).  The performance 
standards were developed by OIG in conjunction with the MFCUs and were originally published at 59 
Fed. Reg. 49080 (Sept. 26, 1994). 
12 OIG occasionally issues policy transmittals to provide guidance and instruction to MFCUs.  Policy 
transmittals are located at https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp.  
13 The Unit had two directors during the inspections review period of FYs 2017 through 2019: the first 
director commenced employment in March 2010 and departed the Unit in October 2018, and the 
subsequent director was promoted to the position in October 2018 and retired in January 2020.  A new 
director began in February 2020 but stayed in the position for 1 month and was replaced by another 
director who was in place at the time of the inspection in August 2020. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Background | 2  supervisor oversaw the seven Unit investigators who were assigned to conduct 
provider fraud investigations, and carried his own fraud caseload.  The Bureau 
Director II supervised the two Unit auditors and the three nurse investigators, and also 
was classified as a fraud investigator and carried a fraud caseload.  (See Exhibit 1 for 
an organizational chart of the Unit at the time of the inspection.) 
Exhibit 1: Organizational chart of the Mississippi Medicaid Fraud Control 
Unit 
 
Referrals 
The Mississippi Vulnerable Persons Act mandates that staff at care facilities and home 
health agencies and any other individuals with knowledge of patient abuse or neglect 
in facilities make a report to the Mississippi State Department of Health (MSDH) and 
the MFCU.14, 15  The Mississippi Vulnerable Persons Act requires the MSDH and the 
MFCU to conduct an initial review of the complaint to determine whether there is 
substantial potential for criminal prosecution, and if so, the unit [MFCU] will 
investigate and prosecute the complaint or refer it to an appropriate criminal 
investigative or prosecutive authority.16  The chief investigator reviews these 
complaints of abuse or neglect and determines whether to open a case.  The chief 
investigator also assigns a priority level to all opened cases.17 
_____________________________________________________________________________________________________________________________ 
14 MS Code  43-47-37 (2019). 
15 The MSDH includes the Division of Health Facilities Licensure and Certification.  The Division is 
responsible for licensing and certifying health facilities for participation in the Medicare and Medicaid 
programs and for ensuring health facilities compliance with State and Federal standards, including 
protecting patients and residents from abuse and neglect. 
16 MS Code  43-47-37(2)(d) (2019). 
17 Cases that involve a death or alleged sexual assault are assigned the highest priority and receive an 
immediate response by the assigned investigator.  Other cases that involve abuse, neglect, or 
exploitation allegations are assigned second priority, and within those priority cases, felony cases take 
priority over misdemeanor cases. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Background | 3  When the Unit receives fraud referrals, the fraud supervisor and the Bureau Director II, 
in consultation with the Unit director, review all referrals and make a joint decision on 
whether to open a case.   
Investigations and Prosecutions   
The Unit has different procedures for assigning staff to investigate and prosecute 
fraud cases and patient abuse or neglect cases.  For newly opened fraud cases, the 
fraud supervisor assigns the case to a two-person investigative team with one 
investigator designated as the lead.  The director assigns an attorney to the case who 
remains involved during both the investigative and prosecutive phases.  
For newly opened cases of patient abuse or neglect, the chief investigator makes an 
assignment to an investigator, usually on the basis of the regional assignment of the 
investigator.  Following the investigation, the chief investigator reviews the case and, 
if appropriate, submits it to the director for prosecution consideration.  Once the 
director approves a case for prosecution, he or she assigns the case to a Unit attorney.    
Mississippi Medicaid Program 
The Mississippi Division of Medicaid (DOM) administers Mississippis Medicaid 
program.  In March 2020, a total of 670,300 beneficiaries were enrolled in Medicaid.18  
In State FY 2019, approximately 65 percent of beneficiaries were enrolled in a 
managed care plan for most services.19, 20  In FY 2019, total Medicaid expenditures 
were $5.7 billion.21  
The DOMs Office of Program Integrity (OPI) is responsible for Medicaid program 
integrity efforts, including the referral to the MFCU of suspected fraud, some of which 
originates with the managed care plans.  
Prior OIG Report 
OIG conducted a previous onsite review of the Mississippi Unit in 2014.22  In that 
review, OIG found that:  
_____________________________________________________________________________________________________________________________ 
18 Division of Medicaid, Medicaid Enrollment Report Calendar Year 2020, https://medicaid.ms.gov/wp-
content/uploads/2020/05/2020-Enrollment-Reports.pdf.  Accessed on May 20, 2020. 
19 The State of Mississippis FY 2019 was July 1, 2018, through June 30, 2019. 
20 Division of Medicaid, 2019 Annual Report, page 8, https://medicaid.ms.gov/wp-
content/uploads/2019/09/Fiscal-Year-2019-Annual-Report.pdf.  Accessed on June 3, 2021. 
21 OIG, MFCU Statistical Data for FY 2019, https://oig.hhs.gov/fraud/medicaid-fraud-control-units-
mfcu/expenditures_statistics/fy2019-statistical-chart.pdf.  Accessed on May 20, 2020. 
22 OIG, Mississippi State Medicaid Fraud Control Unit: 2014 Onsite Review, 
https://oig.hhs.gov/oei/reports/oei-09-13-00700.asp.  Accessed on May 20, 2020. 
 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Background | 4  1.  A Unit supervisor approved the opening and closing of most case files; 
however, 44 percent of case files lacked documentation of periodic 
supervisory reviews.   
2.  The Unit did not adequately safeguard some of its case files.  
3.  The Unit did not investigate 5 percent of cases before the statute of limitations 
expired.   
4.  The Unit may not have had enough investigators assigned to patient abuse or 
neglect cases.   
5.  The Unit also did not refer 11 sentenced individuals to OIG for program 
exclusion within an appropriate timeframe.   
6.  The Units policies and procedures manual did not reflect current Unit 
operations.   
OIG recommended 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.  On the 
basis of information received from the Unit in 2015, OIG considered the 
recommendations implemented.  As we discuss further below, several issues from the 
prior OIG report continue to exist in this inspection. 
Methodology 
OIG conducted the inspection of the Mississippi MFCU in August 2020.  Because of 
the COVID-19 public health emergency, the OIG team was not able to conduct the 
inspection onsite as planned and instead conducted the inspection using a remote 
format.  Our inspection covered the 3-year period of FYs 2017 through 2019.   
We based our inspection on an analysis of data and information from 6 sources:      
(1) Unit documentation; (2) financial documentation; (3) structured interviews with key 
stakeholders; (4) structured interviews with the Units managers and selected staff;   
(5) a review of a random sample of 100 case files from the 2,250 nonglobal case files 
that were open at some point during the review period; and (6) a review of all 
convictions submitted to OIG for program exclusion and all adverse actions submitted 
to the National Practitioner Data Bank (NPDB) during the review period.  (See the 
Detailed Methodology on page 31.)  In examining the Units operations and 
performance, we applied the published performance standards, but we did not assess 
adherence to every performance indicator for every standard. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Background | 5  Standards 
We conducted this inspection in accordance with the Quality Standards for Inspection 
and Evaluation issued by the Council of the Inspectors General on Integrity and 
Efficiency.  These inspections differ from other OIG evaluations in that they support 
OIGs direct administration of the MFCU grant program, but they are subject to the 
same internal quality controls as are other OIG evaluations, including internal and 
external peer review. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Background | 6  PERFORMANCE ASSESSMENT  
 
In assessing the performance and operations of the Mississippi Unit, OIG 
identified the Units case outcomes, evaluated whether the Unit complied 
with legal requirements, and assessed whether the Unit adhered to each 
of the 12 performance standards.  We identified a series of findings and 
observations regarding the Units performance and operations, with a 
total of 12 recommendations for improvement.   
CASE OUTCOMES   
 
Observations  The Unit reported 139 indictments, 167 convictions, and 35 civil 
settlements and judgments for FYs 2017 through 2019.  Of the 
167 convictions, 152 involved patient abuse or neglect and 15 involved 
 
Medicaid provider fraud.  Compared to those of similarly sized MFCUs, 
the number of patient abuse or neglect convictions was significantly 
higher, while the number of fraud convictions was low.23, 24, 25, 26   
 
 
The Unit reported total recoveries of $24 million for FYs 2017 through 
2019.  (See Exhibit 2 for the sources of those recoveries.)  
_____________________________________________________________________________________________________________________________ 
23 In FY 2019, 10 MFCUs had staff sizes ranging from 30 to 44 employees, including the 
Mississippi Unit with 37 staff.     
24 Of similarly sized MFCUs, convictions of patient abuse or neglect ranged from zero to 31 
during the review period.  Of all MFCUs, only the California MFCU with 199 staff in FY 2019 
had more convictions of patient abuse or neglect (178) during the review period than the 
Mississippi Unit.  Of similarly sized MFCUs, convictions of provider fraud ranged from 23 to 
118.  Many factors other than a MFCUs staff size can affect case outcomes.   
25 OIG provides information on MFCU operations and outcomes but does not direct or 
encourage MFCUs to investigate or prosecute a specific number of cases.  MFCU 
investigators and prosecutors should apply professional judgment and discretion in 
determining what criminal and civil cases to pursue. 
26 In FY 2020, the Unit reported 10 fraud convictions, a significant increase from each 
previous year of the review period. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 7   
Exhibit 2: The Unit reported combined civil and criminal 
recoveries of $24 million (FYs 2017 through 2019). 
 
Source: OIG analysis of Unit statistical data, FYs 2017 through 2019. 
Note: Global civil recoveries derive from civil settlements or judgments in global cases, which are 
cases that involve the Department of Justice and a group of State MFCUs and are facilitated by the 
National Association of Medicaid Fraud Control Units. 
 
STANDARD 1  A Unit conforms with all applicable statutes, regulations, and policy 
  directives. 
 
Two cases were ineligible for Federal matching funds during the review 
Finding 
period.  According to statutes and regulations in effect during the review 
  period, MFCUs can receive Federal funds only for the investigation and 
prosecution of cases of patient abuse or neglect that occur in Medicaid-
funded health care facilities or in board and care facilities.27  From our 
review of a sample of case files open during the review period, we found 
that two cases of patient abuse or neglect did not involve alleged abuse 
or neglect in a Medicaid-funded facility or board and care facility, and 
were thereforeaccording to Federal grant statutes and regulationsnot 
eligible for Federal financial participation (FFP).28  One investigation 
involved alleged abuse occurring in a private residence and the other 
investigation involved alleged abuse occurring as a patient was being 
_____________________________________________________________________________________________________________________________ 
27 SSA  1903(q)(4)(A) and (a)(6).  42 CFR  1007.11(b) and 1007.19(d)(1). 
28 Although the two cases identified in the inspection were not eligible for FFP under 
existing statute during the review period, Division CC, Section 207 of the Consolidated 
Appropriations Act, 2021, Public Law 116-260 (December 27, 2020), amended Section 
1903(q)(4)(A)(ii) of the SSA to expand MFCU statutory grant authority to investigate and 
prosecute patient abuse or neglect of Medicaid beneficiaries in noninstitutional or other 
settings. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 8  transported from the hospital to the patients home.  Costs associated 
with these cases were not eligible for FFP.  
 
STANDARD 2  A Unit maintains reasonable staff levels and office locations in relation 
  to the States Medicaid program expenditures and in accordance with 
staffing allocations approved in its budget. 
 
The Unit was nearly fully staffed at the time of our inspection but 
Observation 
experienced significant turnover during the review period.  The Unit was 
approved by OIG for 36 staff in FYs 2017 through 2018 and 37 staff in FY 
2019.  At the time of our review, the Unit was staffed at 34 and had two 
vacant attorney positions and one vacant investigator position.   
During the review period and before our inspection, the Unit experienced 
significant turnover of staff: eight attorneys, six investigators, and two 
auditors left the Unit.  As a result of the departures of staff and prior 
vacancies, the Unit hired six attorneys, seven investigators, and two 
auditors.   
Attorney turnover included turnover of Unit directors.  During the review 
period, the Unit had two directorsone long-time director who left the 
Unit in 2018 and a subsequent director who was promoted to the position 
from within the MFCU and retired after the review period in early 2020.  A 
new director was hired and remained in place for only 1 month after 
being appointed by the governor to another position.  The current 
director was hired in April 2020.   
In explaining the cause of the turnover, Unit management and staff 
reported that low compensation levels by the AGO made it difficult to 
retain staff.  Management and staff also attributed the turnover to a lack 
of career advancement opportunities in the MFCU as well as general 
attrition.   
Unit managers and staff further reported that staff turnover affected the 
Units cases.  Managers and staff reported that reassignment of cases led 
to delays in both the investigation and prosecution of cases.   
 
 
 
 
 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 9  STANDARD 3  A Unit establishes written policies and procedures for its operations 
  and ensures that staff are familiar with, and adhere to, policies and 
procedures. 
 
The Units policies and procedures manual did not reflect all aspects of 
Finding 
Unit operations.  Performance Standard 3(a) states that the Unit should 
have written guidelines or manuals that contain current policies and 
procedures, consistent with the performance standards, for the 
investigation and prosecution of Medicaid fraud and patient abuse or 
neglect.  The Unit maintained a policies and procedures manual, which 
contained general procedures for investigations, such as procedures for 
arrests, evidence, and firearms, but it did not address key Unit operations, 
such as procedures for the intake of referrals and assignment of cases.  
Consistent with findings from our 2014 onsite review, the manual also did 
not contain policies and procedures for supervisors approving opening of 
cases or for conducting and documenting periodic supervisory review of 
cases.   
In response to the 2014 report recommendations, the Unit provided OIG 
with excerpts from an amended policies and procedures manual, showing 
policies and procedures for those areas found lacking.  OIG closed the 
2014 recommendations on the basis of a review of those amended 
provisions.  However, we found during this inspection that the Unit did 
not incorporate those changes to its manual and was still operating with 
the same manual from 2014.  
In addition to the many gaps in the policies and procedures manual, we 
found the manual to be disorganized, with no logical order to its 
contents, minimal formatting to aid a reader, and no table of contents or 
page numbers.  The Unit director, who came on board in April 2020, 
reported taking steps to improve the manual.   
A policies and procedures manual that reflects current operations and is 
user friendly is critical, especially given the high level of turnover of staff 
at the Unit and the need to inform new staff of Unit operations. 
 
 
 
 
 
 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 10  STANDARD 4  A Unit takes steps to maintain an adequate volume and quality of 
  referrals from the State Medicaid agency and other sources. 
 
Although the Unit took some steps to maintain an adequate volume 
Finding 
and quality of fraud referrals, its efforts to maintain fraud referrals from 
  the Medicaid agency were inconsistent.  The Unit received 143 fraud 
referrals from all sources during the review period, which we determined 
to be low compared to those of other MFCUs, as measured by Medicaid 
program expenditures.  We also found that the Unit received only 29 
referrals from the DOMs OPI, which is typically a major source of MFCU 
fraud referrals.  The Unit received 7 fraud referrals from OPI in FY 2017, 2 
in FY 2018, and 20 in FY 2019.29, 30  See Appendix A for all sources of 
referrals involving fraud as well as patient abuse or neglect during FYs 
2017 through 2019. 
Performance Standard 4 states that a Unit will take steps to maintain an 
adequate volume and quality of referrals from the State Medicaid agency 
and other sources.  OIG found, consistent with this standard, that the Unit 
took some steps to encourage fraud referrals during the review period. To 
encourage fraud referrals, the Unit gave presentations to the Board of 
Licensing, the Board of Pharmacy, hospice organizations, and managed 
care organizations (MCOs).  The Unit also maintained a hotline telephone 
number and an online form for reporting referrals of suspected fraud to 
the Unit.   
However, with respect to OPI, we found that the Units efforts to maintain 
an adequate volume and quality of fraud referrals were inconsistent.  On 
one hand, we found that the Unit and OPI maintained a good relationship 
and that Unit representatives, such as the fraud supervisor, had regular, 
informal communications with OPI personnel.  On the other hand, we also 
found that a previous Unit director had no contact with the OPI director.  
Additionally, the Unit and OPI did not hold regular monthly meetings 
during the review period to discuss new complaints and possible referrals, 
as was specified in the memorandum of understanding (MOU) between 
the Unit and the DOM.31   
The program integrity director stated to us his belief that holding 
regularly scheduled meetings between the two agencies and including the 
_____________________________________________________________________________________________________________________________ 
29 The increase in referrals in FY 2019 was the result of OPI focusing on personal care 
services providers. 
30 The OPI referral data may include referrals originating from managed care organizations 
(MCOs).  Unit management estimated that it had received a total of three to four referrals 
in recent years from OPI originating from MCOs. 
31 The Unit and the DOM amended their MOU in March 2020 to require quarterly rather 
than monthly meetings. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 11  Units director in those meetings would enhance their working 
relationship.  Monthly meetings were planned to commence during 2020, 
but the meetings had not commenced at the time of the inspection.   
The Unit also had limited contact with MCOs during the review period 
and until the time of our inspection.  A Unit manager reported to us that 
he asked to participate in meetings that OPI holds with MCOs and had 
attended one such meeting in October 2019.    
Finally, we found another possible factor in the low number of fraud 
referrals from OPI to the Unit, in that the two agencies had not provided 
cross-training for staff in more than 4 years.  Performance Standard 12(e) 
states that a Unit will participate in cross-training with the program 
integrity unit staff, and as part of such training, a Unit should provide 
training on the elements of successful fraud referrals.  The MOU between 
the agencies was amended in 2020 to require the MFCU to provide 
annual training to OPI staff on the progression of cases from 
investigation through prosecution.  Although an expectation of annual 
training is useful, we observed that the training would be especially useful 
if, as suggested by the performance standard, the training included 
information about the elements of successful fraud referrals.  
OIG found that the Units efforts to encourage referrals would be 
enhanced by meeting regularly with OPI and MCOs and providing cross-
training to OPI, and that the failure to take these steps constituted a 
missed opportunity.  Meetings with stakeholders and providing training 
to OPI would allow the MFCU to educate the organizations about its role, 
provide guidance on the information needed in a good fraud referral, and 
build working relationships. 
The Unit received an unusually large number of patient abuse or 
Finding 
neglect complaints because of reporting requirements contained in the 
  Mississippi Vulnerable Persons Act, which in turn imposed a significant 
workload on the Unit.  The Mississippi Vulnerable Persons Act mandates 
that staff at care facilities and home health agencies, as well as any other 
individuals with knowledge of patient abuse or neglect in care facilities, 
make a report both to the Mississippi State Department of Health (MSDH) 
and to the MFCU.  The Mississippi Vulnerable Persons Act requires the 
MSDH and the MFCU to conduct an initial review of the complaint to 
determine whether there is substantial potential for criminal 
prosecution, and if so, the unit [MFCU] will investigate and prosecute 
the complaint or refer it to an appropriate criminal investigative or 
prosecutive authority.  
  
As a result of this reporting mandate, the Unit received 5,996 complaints 
of patient abuse or neglect during the review period, or approximately 
2,000 complaints in each year of the review period.  With such a 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 12  significant volume of incoming complaints, the Units chief investigator 
reported spending 50 percent or more of his time screening and 
prioritizing these complaints.   
In the judgment of OIGs investigative staff, assigning the chief 
investigator to be the sole person responsible for reviewing such a large 
volume of incoming complaints presented a management challenge for 
the Unit.  In addition to the sheer volume of complaints assigned to one 
person, we found that the review function impeded the chief 
investigators ability to spend time on other responsibilities.  The chief 
investigator acknowledged that he found it challenging to conduct 
regular periodic supervisory reviews on the Units large caseload of 
patient abuse or neglect.  (See also Performance Standards 6 and 7.) 
We observed that conducting the initial screening of all incoming 
complaints of patient abuse or neglect was an unusual role for a MFCU.  
Typically, State agencies other than the MFCU will review incoming 
complaints and determine which of these complaints have potential for 
criminal prosecution within the MFCUs jurisdiction and refer those 
complaints to the MFCU.  In Mississippi, however, both the MFCU and 
MSDH staff screened the same incoming complaints.   
We asked questions about whether the Unit and MSDH coordinated their 
reviews of the same set of allegations.  According to MSDH staff, MSDH 
reviewed the complaints to identify potential deficiencies in quality of 
care, following protocols of the Centers for Medicare & Medicaid Services 
(CMS).32  The Unit reviewed the complaints to identify potential criminal 
acts.  Although the two agencies did not coordinate the initial screening 
of complaints, Unit managers and staff stated that investigators 
coordinated regularly with MSDH staff before opening a case for 
investigation and would request the MSDH report that might be relevant 
to the Units investigation. 
STANDARD 5  A Unit takes steps to maintain a continuous case flow and to 
  complete cases in an appropriate timeframe based on the complexity 
of the cases. 
 
Some of the Units cases had significant unexplained delays in the 
Finding 
investigation phase.  According to Performance Standard 5, a MFCU 
should take steps to maintain a continuous case flow and to complete 
_____________________________________________________________________________________________________________________________ 
32 According to the CMS State Operations Manual, a State survey agency reviews a 
complaintan allegation of noncompliance with Federal and/or State requirementsand 
determines the severity and urgency of the allegations, so that appropriate and timely 
action can be pursued.  The survey agency investigates the complaint, determines whether 
the allegations are substantiated, and takes administrative actions to remedy the 
noncompliance.  
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 13  cases in an appropriate timeframe based on the complexity of the cases.  
In addition, Performance Standard 5(c) states that delays in investigation 
and prosecution should be limited to situations imposed by resource 
constraints or other exigencies.  Our review found that 18 percent of 
investigations had significant delays during the investigation phase that 
were not explained in the case file.33  Of the 18 (of 100) cases in our 
sample that had unexplained delays, all 18 involved allegations of patient 
abuse or neglect, 5 had delays of 911 months, 8 had delays of 1218 
months, and 6 had delays of 1836 months.34  As one example of a case 
with an extended unexplained delay, the Unit opened a case in early 
August 2016 and the assigned investigator appeared to complete his 
investigation in less than 2 weeks.  The case file showed no further 
investigative activities (nor explanations for the delay) until the day before 
the case was submitted for prosecution in August 2018.  The case was 
scheduled to go to grand jury in March 2019 when it was discovered that 
the victim, whose testimony would have been critical to the case, had 
died. 
As a possible explanation for the delays, and as also observed under 
Performance Standard 2, managers and staff reported that reassignment 
of cases due to turnover of staff led to delays in the investigation and 
prosecution of cases. 
Nearly all case files contained documentation of supervisory approval 
Observation 
to open and, as appropriate, supervisory approval to close.  Ninety-
eight percent of cases contained documentation of supervisory approval 
to open them, and 97 percent of the cases that were closed at the time of 
our review (73 percent) contained documentation of supervisory approval 
to close them. 
STANDARD 6  A Units case mix, as practicable, covers all significant provider types 
  and includes a balance of fraud and, where appropriate, patient 
abuse and neglect cases. 
 
The Units caseload was skewed heavily toward cases of patient abuse 
Observation 
or neglect, attributable to the large number of complaints of patient 
abuse or neglect received and the resulting cases opened.  Performance 
Standard 6(d) states that a Unit should maintain a balance of fraud and 
patient abuse or neglect cases.  The Units caseload consisted 
predominantly of cases of patient abuse or neglect.  Of the 2,271 cases 
that were open during FYs 2017 through 2019, we found that 90 percent 
_____________________________________________________________________________________________________________________________ 
33 For the purposes of this report, we defined a delay as a period of at least 9 months 
with no documented activity in the case file. 
34 Of the 18 cases, one had two separate significant delaysof 10 months and 12 months, 
respectivelyso that case is included twice in these data. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 14  (2,047 cases) involved allegations of patient abuse or neglect and 10 
percent (224) involved allegations of Medicaid provider fraud.  This was 
an unusual case mix compared to other MFCUs; in FY 2019, the average 
case mix of all MFCUs was 17 percent patient abuse or neglect cases and 
83 percent fraud cases.35 
We found that the MFCU reviewed an unusually large volume of patient 
abuse or neglect complaints because of mandatory reporting 
requirements of the Mississippi Vulnerable Persons Act (see Performance 
Standard 4) and opened a large number of those complaints as cases.  
After the Units chief investigator reviewed the 5,996 complaints received 
during the review period, the Unit opened 21 percent of the complaints 
(1,263 cases) for investigation.  Consequently, over the 3-year review 
period, the Unit carried an average of 609 open cases of patient abuse or 
neglect per year, which constituted the highest number of patient abuse 
or neglect cases of the 52 MFCUs operating during the review period.  
We observed that the high number of total patient abuse or neglect cases 
resulted in large caseloads for individual investigators, as with the finding 
in the 2014 onsite review.  In that review, OIG found that the Unit had 7 
investigators investigating cases of patient abuse or neglect, with 
caseloads of 6080 cases each.  During that review, Unit management 
stated its opinion that the ideal caseload would be 50 or fewer cases and 
reported taking steps to get the caseload for each investigator to a 
manageable level, including implementing a new intake procedure to 
screen complaints for sufficiency of evidence.  OIG recommended that the 
Unit assess the allocation of existing staff levels and take appropriate 
action.  In response to the OIG recommendation, the Unit hired two 
additional patient abuse or neglect investigators.   
In our current inspection, we observed that the Units investigator 
caseload had declined but remained relatively high.  The Unit employed 9 
patient abuse or neglect investigators at the time of the inspection (half 
its investigative staff), each of whom carried a caseload of approximately 
5060 cases.   
Despite the apparently large patient abuse or neglect caseloads, 
investigators and the Unit director reported the caseloads to be 
manageable.  Investigators reported that they managed their caseloads 
according to priority designations.  On the other hand, the chief 
investigator expressed concern that the large caseload did not always 
allow the Unit to meet its goals for concluding investigations of patient 
abuse or neglect.  
_____________________________________________________________________________________________________________________________ 
35 Analysis of case mix derived from data reported by all MFCUs with cases open at the 
end of FY 2019.  At the end of FY 2019, the Mississippi Unit reported a case mix of 87 
percent patient abuse or neglect cases and 13 percent fraud cases. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 15  We observed that the Unit had mechanisms for handling the large 
caseloads.  To ensure that investigators prioritized their caseloads 
appropriately, the chief investigator assigned a priority level to each case.  
To investigate cases efficiently, the chief investigator assigned each 
patient abuse or neglect investigator to investigate only cases in a 
particular geographic region of the State.  On the other hand, we found 
that some of the Units cases had significant unexplained delays in the 
investigation phase (see Performance Standard 5).  We did not find the 
relatively high caseloads for each of the investigators to raise other 
performance issues for the Unit, and the Unit achieved many successful 
resolutions to the cases (see Case Outcomes). 
The Unit investigated few cases of Medicaid provider fraud, as 
Observation 
compared to those of similarly sized MFCUs.  Over the 3-year period, the 
  Unit carried an average of 113 open cases of Medicaid provider fraud per 
year.  We observed that this was the lowest average number of fraud 
cases, compared to those of similarly sized MFCUs.  Each of the 7 fraud 
investigators, as well as the fraud supervisor and the Bureau Director II, 
carried a caseload of approximately 820 cases.   
As one explanation for the relatively few cases of provider fraud 
investigated by the Unit, we found under Performance Standard 4 above 
that the Unit received few fraud referrals during the review period.  As 
another explanation, we found under Performance Standard 8 below that 
the Unit had stopped opening joint cases with OIG after 2017.   
The Units fraud cases covered 32 different provider types in FY 2019, the 
most common of which were personal care services attendants or 
agencies (22 percent), hospice (12 percent), and clinical social workers  
(9 percent).  
 
STANDARD 7  A Unit maintains case files in an effective manner and develops a case 
  management system that allows efficient access to case information 
and other performance data. 
 
OObbsseerrvvaattiioonn   The Units case management system lacked some capabilities but was 
adequate for monitoring case progression.  Performance Standard 7(f) 
states that a Unit should have a system that allows for the monitoring and 
reporting of case information.  The Units case management system had 
been used by the AGO since 2006.  Unit management and staff reported 
that the system allowed for monitoring of case progression.  However, the 
Unit had difficulties reporting accurate data to OIG because of limitations 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 16  of the system.36  Some Unit managers and staff described other concerns 
with the case management system, such as storage limits that did not 
allow staff to upload audio and video recordings into the case 
management system.  As a result, staff stored these materials outside of 
the case management system in different ways. 
The Unit lacked a policy for periodic supervisory review and procedures 
Finding 
for conducting and documenting supervisory reviews in the Units case 
management system.  Performance Standard 7(a) states that supervisory 
 
reviews should be conducted periodically, consistent with MFCU policies 
and procedures, and noted in the case file.  Periodic supervisory review of 
cases during the investigation and prosecution phases can help ensure 
timely completion of cases, and documenting those reviews in the case 
files can help ensure that cases are properly managed.    
In response to OIGs 2014 recommendation, the Unit agreed to establish 
policies and procedures for periodic supervisory review of the Units cases.  
In 2015, the Unit provided OIG with an excerpt from an amended policies 
and procedures manual stating that supervisory reviews were to be 
conducted quarterly and noted in the case management system.  The Unit 
also reported adding a supervisory review event to its case management 
system for purposes of recording and labeling supervisory reviews in the 
system.  In our current inspection, we found that the Unit had not 
incorporated the amendment into its policies and procedures manual and 
still lacked a written policy or procedure for supervisory review, but that 
the Units case management system had been modified to include a 
supervisory review event.   
We found that the Units practice of conducting and documenting 
supervisory review of case files varied depending on whether the case 
involved fraud or involved patient abuse or neglect.  For the Units cases 
of patient abuse or neglect, the chief investigator reported to us that he 
tried to review the cases in-depth once per year, but that this was 
challenging with the caseloads of 5060 cases for each investigator.  The 
chief investigator also reported that under some circumstances, he 
documented the periodic supervisory review in the case management 
system, but under other circumstances the investigator handled this task. 
For the Units fraud cases, the fraud supervisor reported to us that before 
2019, he conducted quarterly supervisory reviews but did not always 
document the reviews in the case management system.  On the other 
hand, Unit investigators stated that supervisory reviews were not 
conducted on a regular basis, but that they met with the fraud supervisor 
as needed to discuss particular cases.  In 2019, one Unit attorney started 
_____________________________________________________________________________________________________________________________ 
36 MFCU regulations require statistical reporting to OIG annually on the MFCUs staffing, 
caseload, outcomes, collections, and referrals.  42 CFR  1007.17(a)(2).   
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 17  holding monthly meetings with the fraud teams to discuss all active cases.  
The fraud supervisor actively participated in the monthly meetings, and he 
believed that the meetings helped ensure timely investigations.  He 
discontinued the separate quarterly supervisory reviews once the monthly 
meeting practice began.  
We also found that the Unit did not conduct periodic supervisory reviews 
during the prosecution phase.  We identified no documentation 
demonstrating that these reviews were conducted, and the current 
director reported that his engagements with prosecutors during that 
phase of a case was limited to informal meetings.  The director stated that 
he planned to improve the supervisory review process with prosecutors, 
and that process would include documenting the reviews in the case file.    
In evaluating whether supervisory reviews were being conducted and 
documented during the review period, we applied a quarterly standard, 
which was reported to OIG as the standard in 2015 and appeared to be 
the intended practice for fraud cases before 2019.  We found that 86 
percent of case files open more than 3 months contained documentation 
of at least 1 supervisory review.  However, of those files that contained at 
least 1 documented review, we found that 69 percent lacked regular, 
quarterly documentation of reviews.  OIGs 2014 onsite review found that 
44 percent of case files lacked documentation of supervisory reviews.37    
STANDARD 8  A Unit cooperates with OIG and other Federal agencies in the 
  investigation and prosecution of Medicaid and other health care fraud. 
 
The Unit maintained limited communication and coordination with OIG, 
Finding 
and the Units joint case work with Federal partners ceased during the 
review period.  Performance Standard 8 states that a Unit should 
communicate regularly and coordinate with OIG and other Federal 
partners.38  Routine communication and coordination between the Unit 
and OIGs Office of Investigations was lacking.  In particular, the Units 
director and chief investigator and OIG managers did not meet or 
communicate, and the Unit did not deconflict its Medicaid-only cases 
with the local OIG agent.  However, coordination with OIG did occur when 
the Unit found that cases also involved Medicare.  The Unit fraud 
supervisor referred these cases to the OIG agent and instructed Unit 
_____________________________________________________________________________________________________________________________ 
37 During the 2014 onsite review, Unit management reported that the chief investigator 
conducted supervisory reviews three times per year, so OIG applied that standard to its 
review of case files, rather than a quarterly standard.  As a result, we were unable to 
compare the results from the two reviews.   
38 Current Federal regulations, which were effective May 21, 2019, also state that the Unit 
will coordinate with and establish a practice of regular meetings or communication with 
OIG and other Federal partners (42 CFR  1007.11(e)(2) and (3)). 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 18  investigators to periodically contact the OIG agent for updates on these 
referred cases.  The Unit kept these referred cases open, but the Unit 
investigators did not actively work these cases.   
Although the Unit and OIG reported limited coordination on cases with 
Medicaid and Medicare fraud allegations, both agencies acknowledged 
that as of 2018 they were not opening joint cases.  During FYs 2017 
through 2019, the Unit reported 24 joint cases open with OIG, but the 
Unit opened only 3 new joint cases during that period, all in December 
2017.  Joint case work stopped in 2018 when a MFCU investigator, who 
had worked closely with the local OIG agent on the joint cases, left the 
Unit.  Unit investigators, however, remained cooperative and continued to 
provide support to OIG when requested such as assisting with search 
warrants and transporting patients to trial.  We identified a similar history 
of interactions between the Unit and the two United States Attorneys 
Offices (USAOs) in the State, both of which had no joint cases with the 
MFCU after the MFCU investigator departed in 2018.   
OIG management expressed a desire to increase its partnership with the 
Unit and suggested that the Unit join the Gulf Coast Strike Force.  During 
our inspection, both the Unit director and AGO management expressed 
an interest in becoming involved with Federal partners through the Gulf 
Coast Strike Force.   
The Unit did not timely report a substantial number of convictions and 
Finding 
adverse actions to Federal partners as required.  Performance Standard 
8(f) states that the Unit should transmit information on convictions to OIG 
within 30 days of sentencing so that convicted individuals can be 
excluded from Federal health care programs.39  The Unit did not report 49 
percent of convictions (93 of 190) to OIG within 30 days of sentencing.40  
This represents a significant decline in timeliness of the Units reporting of 
convictions to OIG from the 2014 onsite review, which found that the Unit 
did not report timely 6 percent of sentenced individuals (11 of 174).  In 
addition to untimely reporting of convictions, the Unit did not report to 
OIG 5 of the 190 convictions; all 5 were joint cases with OIG.  The Unit 
believed that it did not need to submit those convictions because OIG 
_____________________________________________________________________________________________________________________________
39 Effective May 21, 2019, 42 CFR 1007.11(g) required the Unit to transmit information on 
convictions within 30 days of sentencing, or as soon as practicable if the Unit encounters 
delays in receiving the necessary information from the court. 
40 Specifically, the Unit reported 51 convictions from 3160 days after sentencing, 14 
convictions from 6190 days after sentencing, and 28 convictions more than 90 days after 
sentencing. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 19  would submit them for exclusion.41  However, the Unit should report all 
convictions to OIG, even joint cases with OIG.42   
Federal regulations also require that Units report any adverse actions 
resulting from investigations or prosecution of health care providers to 
the NPDB within 30 calendar days of the date of the final adverse action.   
Performance Standard 8(g) also states that the Unit should report 
qualifying cases to the NPDB.   During the review period, we found that 
the Unit did not report 31 percent of its adverse actions (59 of 190) within 
established timeframes.    
Although the Unit had written procedures to ensure reporting to OIG and 
the NPDB, Unit staff did not always follow the procedures and the 
procedures did not specifically address timeliness.  The Units policies and 
procedures manual required the attorney, upon disposition of a case, to 
submit the file to the administrative assistant for purposes of notifying the 
Federal Government of all convictions and adverse actions.  However, as 
Unit management explained, in some instances Unit attorneys did not 
provide the case information to the administrative assistant within 
appropriate timeframes, but in many other instances, the administrative 
assistant, despite having received the case information timely, did not 
submit to OIG and the NPDB within the appropriate timeframes. 
STANDARD 9  A Unit makes statutory or programmatic recommendations, when 
warranted, to the State government. 
The Unit made no program recommendations to the State Medicaid 
Observation 
agency during the review period. 
STANDARD 10  A Unit periodically reviews its Memorandum of Understanding (MOU) 
with the State Medicaid agency to ensure that it reflects current 
practice, policy, and legal requirements. 
The Units MOU did not reflect two recent requirements.  The MFCU 
Finding 
and the DOM had a current MOU, amended in March 2020.  OIG 
regulations were amended in 2019 to require the Unit and the Medicaid 
agency to establish procedures for the referrals of potential fraud from 
MCOs.43  Although the Unit and OPI reported establishing procedures 
_____________________________________________________________________________________________________________________________
41 We found that OIG staff had submitted the five sentenced individuals who were then 
excluded. 
42 During the review period, State Fraud Policy Transmittal No. 2014-2 provided guidance 
to report all convictions to OIG, which included joint cases. 
43 42 CFR  1007.9(d)(3)(iv). 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 20  for MCO referrals, those procedures were not included in the 2020 
 
amended MOU.  In State FY 2019, 65 percent of Medicaid beneficiaries 
  in Mississippi were enrolled in a managed care plan.  Memorializing the 
established procedures in the MOU could help encourage the referral of 
potential fraud from MCOs.44 
OIG regulations were also amended to require the Unit and the 
Medicaid agency to agree to review and, as necessary, update the MOU 
no less frequently than every [5] years to ensure that the agreement 
reflects current law and practice.45  In contrast, the current MOU 
between the Unit and the DOM does not require the parties to agree to 
review the MOU at least every 5 years, but rather the MOU automatically 
renews for 1-year periods until one of the parties desires to make a 
change, at which time the agreement may be amended by mutual 
consent.  
 
STANDARD 11  A Unit exercises proper fiscal control over its resources. 
 
 
The Unit did not properly report program income during the review 
Finding 
period.  Program income, defined as gross income earned as the result of 
a grant activity,46 must be used to pay the Units current costs before the 
Unit may use Federal funds.47  A Unit must report program income on its 
Federal financial report (FFR) to OIG to properly account for the Units 
reduced need for Federal funds.48  During FYs 2017 through 2019, the 
Unit did not report any of its program income, which totaled $7,645 
($5,734 Federal share), on its FFRs.49  As a result, the Unit withdrew $5,734 
in Federal funds from the Department of Health and Human Services 
(HHSs) Payment Management System to pay costs that should have been 
paid by the Units program income.50  To rectify the reporting error, the 
_____________________________________________________________________________________________________________________________ 
44 Since the 2019 amendments to the OIG regulations, OIG has observed that MFCUs in 
States with Medicaid managed care report that procedures exist by which the MFCU 
receives MCO referrals, and although some MFCUs have updated their MOUs to reflect the 
procedures, others plan to add the procedures to the MOU when the parties next review 
and update their MOU.  
45 42 CFR  1007.9(d)(3)(v). 
46 45 CFR  75.2. 
47 45 CFR  75.307(e)(1). 
48 A Units expenditures and indirect costs are also reported on the FFR, in addition to its 
program income. 
49 The Units program income derived from the reimbursement of investigative costs it 
incurred investigating patient abuse or neglect cases that did not involve Medicaid funds.  
50 The Payment Management System is a portal for Federal grant payments and recipient 
reporting. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 21  Unit reported the program income and adjusted its costs on its final FFR 
for FY 2020.   
The Unit reported retaining certain settlement proceeds rather than 
Finding 
working with the State Medicaid agency to ensure the appropriate 
return of the Federal Governments share of those recoveries.  
According to CMS policy, amounts recovered by a State through a State 
false claims action or other State action must be refunded at the Federal 
Medical Assistance Percentage (FMAP) rate.51, 52  The State Medicaid 
agency is responsible for returning the Federal share of those recoveries 
to the Federal Government.  The Unit reported submitting all settlement 
proceeds identified as Medicaid restitution to the DOM as required, but
contrary to the CMS guidancethe Unit retained any penalties, fees, or 
investigative costs that were part of civil settlements and used these funds 
for purposes of the State match requirement for the MFCU grant, rather 
than returning the FMAP portion of those amounts to the Federal 
Government.   
STANDARD 12  A Unit conducts training that aids in the mission of the Unit. 
Unit staff received training, but the Units training plan did not clearly 
Finding 
specify annual training hours for each professional discipline.  According 
to Performance Standard 12, a Unit should conduct training that aids the 
mission of the Unit.  MFCU regulations more specifically require that a 
Unit provide training for its professional employees for the purpose of 
establishing and maintaining proficiency in Medicaid fraud and patient 
abuse or neglect matters.53  Unit staff and managers reported that the 
Unit supported training opportunities and that staff received appropriate 
training.   
Although Unit staff received training, the Units training plan did not 
clearly specify the annual training hours required for each professional 
discipline.  Performance Standard 12(a) states that the Unit should 
maintain a training plan for each professional discipline that includes an 
_____________________________________________________________________________________________________________________________
51 CMS State Health Official Letter No. 08-004.  Accessed at 
https://oig.hhs.gov/fraud/medicaid-fraud-control-units-
mfcu/policy_transmittals/SHO%20Letter%2008-004.pdf on November 3, 2020. 
52 OIG State Fraud Policy Transmittal No. 10-01, Program Income, relied on and 
summarized the content of the CMS policy statement outlined in SHO Letter No. 08-004. 
Accessed at https://oig.hhs.gov/fraud/medicaid-fraud-control-units-
mfcu/policy_transmittals/2010-
1%20State%20Fraud%20Policy%20Transmittal%20Number%2010-
01%20Program%20Income%203-22-2010.pdf on November 3, 2020. 
53 42 CFR  1007.13(h). 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 22  annual minimum number of training hours and is at least as stringent as 
required for professional certification.  The Units training plan specified 
that licensed professional staff (attorneys, nurse investigators, and any 
other staff holding licenses or certifications) obtain training to at least 
minimally comply with requirements of their licenses, but it did not 
specify the annual minimum number of training hours required for these 
licensed professional staff.  The training plan specified that unlicensed 
staff were to receive at least 12 hours of training per year, but it did not 
specify which staff were included in this category.  Additionally, we found 
that staff and managers were not aware of what the annual training hour 
requirements were for their professional disciplines but believed that they 
met the requirements.   
 
 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Performance Assessment | 23   
CONCLUSION and RECOMMENDATIONS 
 
We found that the Unit reported 139 indictments, 167 convictions, 35 civil settlements 
and judgments, and $24 million in recoveries in FYs 2017 through 2019.  We found 
that these high levels of outcomes were attributable to the Units concentration on 
patient abuse or neglect cases and that the Unit could take steps to increase its 
presence in combating Medicaid provider fraud.   
We found that mandatory reporting requirements imposed by the Mississippi 
Vulnerable Persons Act created a significant workload for the Unit that led to many 
convictions of patient abuse or neglect but also presented challenges to Unit 
operations.  The Unit received about 2,000 complaints of patient abuse or neglect 
each year and devoted half its investigative staff and 90 percent of its caseload to 
patient abuse or neglect.  As a result of this focus, 152 of the Units 167 convictions 
involved defendants who committed patient abuse or neglect.  We found operational 
challenges to this focus: The Units chief investigator devoted more than half of his 
time to screening and prioritizing patient abuse or neglect complaints and 
encountered difficulties conducting periodic supervisory reviews of the large 
caseload.  We also found significant unexplained investigative delays in 18 percent of 
cases.  
From the Units fraud referrals, caseload, and outcomes, we observed a different 
picture.  We observed that during the review period, the Units fraud caseload and 
numbers of fraud convictions (15) were low, compared to those of similarly sized 
MFCUs.  We found that although the Unit took some steps to maintain an adequate 
volume and quality of fraud referrals, its efforts to maintain fraud referrals from the 
Medicaid agency were inconsistent and the Unit received few fraud referrals.  Further, 
we found that the Unit maintained limited communication and coordination with OIG 
and that during the review period the Unit stopped actively working joint cases with 
Federal partners, which would be a way to increase its involvement in fraud cases.  
Following the review period, in FY 2020, the Unit reported a total of 10 fraud 
convictions, which was a significant increase from an average of 5 fraud convictions 
each previous year of the review period.  
We also found that some operational issues have persisted since OIGs prior onsite 
review in 2014.  We found that the Units policies and procedures manual did not 
reflect all aspects of Unit operations.  We found that the Unit still lacked a policy for 
periodic supervisory review and procedures for conducting and documenting 
supervisory reviews in the Units case management system.  We also found that the 
Unit did not timely report a substantial number of convictions and adverse actions to 
Federal partners as required.  In fact, the Units timeliness in reporting convictions to 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Conclusion and Recommendations | 24  OIG for purposes of excluding providers from Federal health care programs declined 
significantly since the 2014 review. 
To address the findings identified in this report, we make recommendations in 
categories related to the Units (1) patient abuse or neglect cases; (2) fraud cases; (3) 
compliance with legal requirements; and (4) adherence to MFCU performance 
standards.  
To address the findings, we recommend that the Mississippi 
Unit: 
Patient abuse or neglect cases 
1. Examine the Units intake process for complaints of patient
abuse or neglect and identify improvements.
To alleviate the burden on the chief investigator, the Unit should consider ways to 
improve the screening of the large volume of complaints of patient abuse or neglect.  
The intake function could be assigned to or rotated among several investigators, 
perhaps in addition to or in place of the chief investigators role.  Alternatively, the 
Unit could designate and train support staff to conduct or support the intake 
function.  The Unit should also consider whether additional coordination with the 
MSDH or local police is warranted for incoming complaints.   
2. Take steps to avoid investigative delays and ensure that
delays are documented in the case management system.
The Unit should take steps to ensure that it avoids unnecessary delays during the 
investigative phase of cases, unless delays are caused by resource constraints or other 
exigencies.  Unit managers should conduct regular periodic supervisory reviews of all 
cases to allow managers and investigators to plan for case progression (see also 
related Recommendation 11).  To demonstrate that extended delays were imposed by 
resource constraints or other exigencies, the Unit should document and explain such 
occurrences in the case management system.  OIGs 2014 report included a similar 
recommendation regarding case delays that resulted in expiration of the statute of 
limitations.   
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Conclusion and Recommendations | 25  Fraud cases 
3. Develop and implement a plan to increase fraud referrals
from the Medicaid agency and other sources.
As part of the plan, the Unit and the DOMs OPI should hold regularly scheduled 
meetings, as required by the MOU, that includes the management teams of each 
party.  The meetings should include discussions of possible referrals and feedback 
from the Unit on referrals.  The Unit should provide training to OPI on the elements of 
successful fraud referrals.  As part of this plan, the MFCU could also assess its 
outreach efforts and identify ways to improve the volume of fraud referrals from other 
potential sources, including MCOs. 
4. Take steps to improve communication and coordination with
OIG investigators and other Federal partners.
The Unit should establish a practice of regular meetings or communication with OIG 
investigators which should include deconfliction of all cases.  Additionally, the Unit 
should seek opportunities, as appropriate, to pursue joint cases with OIG investigators 
and the U.S. Attorneys Office, including participating in the Gulf Coast Strike Force.   
Compliance with legal requirements 
5. Implement processes to ensure that it reports convictions and
adverse actions to Federal partners within the appropriate
timeframes.
The Unit should take steps to ensure that it reports all convictions to OIG within 30 
days of sentencing, or as soon as practicable if the Unit encounters delays in receiving 
the necessary information from the court, and adverse actions to the NPDB within 30 
days of the action.  These steps should include developing procedures and 
expectations for Unit attorneys to provide conviction information in a timely manner 
to administrative staff, so that the submissions to OIG and the NPDB can be made 
within appropriate timeframes.  The Unit could implement a system of automated 
reminders, if feasible, to alert attorneys of this time-sensitive responsibility.   
6. Revise its MOU with the Mississippi Division of Medicaid to
reflect current law.
The Unit should revise its MOU with the DOM to establish procedures by which the 
Unit will receive referrals of potential fraud from MCOs either directly or through the 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Conclusion and Recommendations | 26  DOM.  The Unit should also revise its MOU to include the requirement that the Unit 
and the DOM agree to review and, as necessary, update the MOU no less frequently 
than every 5 years to ensure that the agreement reflects current law and practice.   
7. Repay Federal matching funds spent on cases that were
ineligible for Federal funding.
The Unit should work with OIG to identify staff hours and expenditures associated 
with investigating the ineligible cases and repay those Federal matching funds.   
8. Develop a procedure to ensure that it reports all program
income properly on its Federal financial reports.
The Unit should develop a process or procedure to ensure that it reports its program 
income according to Federal regulations.  As noted in the finding, the Unit reported 
the previously unreported program income of $5,734 for FYs 2017 through 2019 and 
adjusted its costs on its final FFR for FY 2020.   
9. Work with the Mississippi Division of Medicaid to ensure the
return of the Federal Governments share of all recoveries.
The Unit should work with the DOM to ensure that the Federal share of any penalties, 
fees, or investigative costs from Medicaid cases is appropriately returned to the 
Federal government, as it does with Medicaid restitution amounts.  Also, the Unit 
should implement procedures to ensure that the Unit works with the DOM to return 
the Federal share of the full settlement amount. 
Adherence to MFCU performance standards 
10. Update its policies and procedures manual to reflect Unit
operations and enhance the manuals organization.
The Unit should revise its policies and procedures manual to include current Unit 
procedures for all Unit operations, including policies and/or procedures for (1) intake 
of referrals and complaints; (2) supervisory approval to open cases; (3) assignment of 
cases; (4) periodic supervisory reviews (see also Recommendation 11); and (5) 
reporting convictions and adverse actions to OIG and the NPDB (see also 
Recommendation 5).  OIGs 2014 report included a similar recommendation.  The 
manuals organization should be enhanced to allow for greater readability and ease of 
use. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Conclusion and Recommendations | 27  11. Develop written policies and procedures and take other steps
to ensure that periodic supervisory reviews are conducted
and documented in the case files.
The Unit should develop a written policy(ies) for the frequency of periodic supervisory 
reviews of case files, for both the investigation and prosecution phase of cases.  The 
Unit should also develop procedures for supervisory review that are clear as to who 
conducts the supervisory reviews and who is responsible for documenting the reviews 
in the case management system.  The Unit should take steps to ensure that 
supervisory reviews are conducted and documented, according to the amended 
procedures.  As a step to ensure that Unit supervisors hold periodic supervisory 
reviews, the Unit could develop and use a systemelectronic or otherwisethat 
reminds supervisors to both conduct and document the reviews.  OIGs 2014 report 
included a similar recommendation regarding the lack of consistent supervisory 
reviews.   
12. Update its training plan to include annual training hours for
each professional discipline.
The Unit should revise its training plan to clearly specify the annual number of 
training hours for each professional discipline and ensure that Unit staff are aware of 
the training hour requirement for their professional disciplines.   
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Conclusion and Recommendations | 28  UNIT COMMENTS AND OIG RESPONSE 
The Mississippi Unit concurred with 11 of our recommendations and did not concur 
with 1 recommendation. 
The Unit concurred with our first recommendation to examine the Units intake 
process for complaints of patient abuse or neglect and identify improvements.  The 
Unit stated that it had established a new process for reviewing the large number of 
complaints of patient abuse or neglect received by the Unit and ensuring that those 
complaints not involving Medicaid are referred to the appropriate office. 
The Unit concurred with our second recommendation to take steps to avoid 
investigative delays and ensure that delays are documented in the case management 
system.  The Unit stated that it has created a new supervisory position to monitor the 
voluminous number of patient abuse or neglect cases.  The Unit stated that it 
modified its case management system for the purpose of monitoring statute of 
limitation deadlines.  Finally, the Unit stated that it implemented the use of quarterly 
supervisory reviews in 2020. 
The Unit concurred with our third recommendation to develop and implement a plan 
to increase fraud referrals from the Medicaid agency and other sources.  The Unit 
stated that it had increased its efforts to build partnerships with State and Federal 
agencies, including OPI, the Medicaid agency program integrity unit.  The Unit also 
stated that it will continue its efforts to hold regular meetings with OPI and managed 
care organizations, which meetings were interrupted by the pandemic.   
The Unit concurred with our fourth recommendation to take steps to improve 
communication and coordination with OIG investigators and other Federal partners.  
The Unit stated that, since 2020, it has conducted meetings, both in-person and 
telephonic, with the USAO.  The Unit also stated that it has increased efforts to 
pursue, when appropriate, joint investigations with OIG investigators and is seeking a 
Special Assistant United States Attorney designation for a Unit prosecutor. 
The Unit concurred with our fifth recommendation to implement processes to ensure 
that it reports convictions and adverse actions to Federal partners within the 
appropriate timeframes.  The Unit stated that all Unit staff have received training on 
the procedure for submitting conviction and adverse action information. 
The Unit concurred with our sixth recommendation to revise its MOU with the 
Mississippi Division of Medicaid to reflect current law.  The Unit stated that it will 
modify the MOU to incorporate procedures for receiving referrals from MCOs and will 
also add a provision to the MOU requiring the parties to review the MOU every 5 
years to ensure that it reflects current law and practice. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Unit Comments and OIG Response | 29  The Unit concurred with our seventh recommendation to repay Federal matching 
funds spent on cases that were ineligible for Federal funding.  The Unit stated that it 
will calculate and repay the appropriate Federal funds. 
The Unit concurred with our eighth recommendation to develop a procedure to 
ensure that it reports all program income properly on its Federal financial reports and 
adjusted its costs to account for previously unreported program income.  OIG 
continues to recommend that the Unit develop a procedure to ensure that future 
receipts of program income are properly reported.   
For the ninth recommendation, that the Unit work with the Mississippi Division of 
Medicaid to ensure the return of the Federal Governments share of all recoveries, the 
Unit acknowledged the recommendation, but stated that pursuant to Alabama v. 
Centers for Medicare & Medicaid Services, 780 F. Supp. 2d 1219 (M.D. Ala. 2011), it 
believes that appropriate calculations were made to ensure the return of the Federal 
Governments share of recoveries.  OIG continues to maintain that the Federal 
Government is entitled to the pro rata share of a States entire recovery, including 
penalties, fees, and investigative costs, in accordance with the OIG Policy Transmittal 
10-01 and CMSs State Health Official Letter No. 08-004.  Those directives require that
a States fraud recoveries, including penalties, fees, and investigative costs, be
apportioned between the State and Federal governments on the basis of the
applicable FMAP rate.  The Alabama decision applies to a Federal judicial district that
does not include Mississippi, and the CMS policy is supported by other court and
administrative decisions.
The Unit concurred with our tenth recommendation to update its policies and 
procedures manual to reflect Unit operations and enhance the manuals organization.  
The Unit stated that it is making additions and revisions to its manual.  
The Unit concurred with our eleventh recommendation to develop written policies 
and procedures and take other steps to ensure that periodic supervisory reviews are 
conducted and documented in the case files.  The Unit stated that it will update its 
manual to reflect the quarterly reviews that have been conducted since 2020.  
The Unit concurred with our twelfth recommendation to update its training plan to 
include annual training hours for each professional discipline.  The Unit stated that it 
will update its manual to specify the training hours for each professional discipline 
and will track and document annual training requirements for individual staff.  
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Unit Comments and OIG Response | 30   
 DETAILED METHODOLOGY 
 
Data Collection and Analysis 
We collected and analyzed data from the six sources set forth below to identify any 
opportunities for improvement and instances in which the Unit did not adhere to the 
performance standards or was not operating in accordance with laws, regulations, or 
policy transmittals.  We also used the data sources to make observations about the 
Units case outcomes as well as the Units operations and practices concerning the 
performance standards.    
Review of Unit Documentation
Before the inspection, we reviewed the recertification analysis for FYs 2017 through 
2019, which involved examining the Units recertification materials, including (1) the 
annual reports; (2) the Unit directors recertification questionnaires; (3) the Units MOU 
with the State Medicaid agency, Mississippis DOM; (4) the DOM program integrity 
directors questionnaires; and (5) the OIG Special Agent in Charge questionnaires.  We 
also reviewed the Units policies and procedures manual and the Units self-reported 
case outcomes and referrals included in its annual statistical reports for FYs 2017 
through 2019.  We examined the recommendations from the 2014 OIG onsite review 
report and the Units implementation of those recommendations.   
Review of Unit Financial Documentation
We conducted a limited review of the Units control over its fiscal resources.  Before 
the inspection, we analyzed the Units response to a questionnaire about internal 
controls and conducted a desk review of the Units financial status reports.  We 
followed up with the Mississippi AGO and Unit officials to clarify issues identified in 
the questionnaire about internal controls.   
Interviews With Key Stakeholders
In March 2020, we interviewed key stakeholders, including officials in the DOM and 
the U.S. Attorneys office.  We also interviewed a manager and a special agent from 
OIGs Office of Investigations.  We focused these interviews on the Units relationship 
and interaction with the stakeholders, as well as opportunities for improvement.  We 
used the information collected from these interviews to develop subsequent interview 
questions for Unit management and staff.  We also interviewed an official from the 
MSDH after the inspection. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Detailed Methodology | 31  Interviews With Unit Management and Selected Staff  
We conducted structured interviews with the Units management and selected staff in 
August 2020.  Of the Unit management, we interviewed the director, the chief 
investigator, the fraud supervisor, and the Bureau Director II.  Of the selected staff, we 
interviewed one attorney, four investigators, two auditors, and one nurse investigator.  
In addition, we interviewed the supervisor of the Unitthe Deputy Attorney General 
of the AGOs Criminal Division.  We asked these individuals questions related to       
(1)Unit operations; (2) Unit practices that contributed to the effectiveness and
efficiency of Unit operations and/or performance; (3) opportunities for the Unit to
improve its operations and/or performance; (4) clarification regarding information
obtained from other data sources; and (5) the Units training and technical assistance
needs.
Review of Case Files
To craft a sampling frame, we requested that the Unit provide us with a list of cases 
that were open at any time during FYs 2017 through 2019 and include the status of 
the case; whether the case was criminal, civil, or global; and the dates on which the 
case was opened and closed, if applicable.  The total number of cases was 2,271.   
We excluded all global cases from our review of the Units case files because global 
cases are civil false claims actions that typically involve multiple agencies, such as the 
Department of Justice and a group of State MFCUs.  We excluded 21 global cases, 
leaving 2,250 case files.   
We then selected a simple random sample of 100 cases from the population of 2,250 
cases.  This sample allowed us to make estimates of the overall percentage of case 
files with various characteristics with an absolute precision of +/- 10 percent at the 
95-percent confidence level.  We reviewed the 100 case files for adherence to the
relevant performance standards and compliance with statute, regulation, and policy
transmittals.  During the review of the sampled case files, we consulted MFCU staff to
address any apparent issues with individual case files, such as missing documentation.
Review of Unit Submissions to the Office of Inspector General 
and the National Practitioner Data Bank
We also reviewed all convictions submitted to OIG during the review period so that 
convicted individuals could be excluded from programs (190) and all adverse actions 
submitted to the NPDB during the review period (190).  We reviewed whether the 
Unit submitted information on all sentenced individuals and entities to OIG for 
program exclusion and all adverse actions to the NPDB for FYs 2017 through 2019.  
We also assessed the timeliness of the submissions to OIG and the NPDB.   
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Detailed Methodology | 32  Review of Unit Operations   
Because we conducted the inspection remotely, we were unable to observe the 
workspace and operations of the Units office in Jackson.   
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Detailed Methodology | 33   
APPENDIX A 
 
Unit Referrals by Source for Fiscal Years 2017 Through 2019 
 
 
FY 2017  FY 2018  FY 2019  Grand Totals  
Fraud  Abuse or  Fraud  Abuse or  Fraud  Abuse or  Fraud  Abuse or 
Referral Source 
Neglect  Neglect  Neglect  Neglect 
HHS OIG  0    5    7    12   
Law enforcement
4    2    3    9   
other  
Licensing board  3    5    2    10   
Managed care 
0    0    0    0   
organizations 
Medicaid agency
7    2    20    29   
PI/SURS1 
Medicaid agency
0    1    0    1   
other 
Private citizen  10    12    10    32   
Provider  9  1,918  15  1,968  8  2,110  32  5,996 
Other  7    6    5    18   
     Total  40  1,918  48  1,968  55  2,110  143  5,996 
     Annual Total  1,958  2,016  2,165  6,139 
Source: OIG analysis of Unit Annual Statistical Reports, FYs 2017 Through 2019. 
1 Program Integrity/Surveillance and Utilization Review Subsystem. 
 
   
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Appendix A | 34   
APPENDIX B 
 
Point Estimates and 95-Percent Confidence Intervals of Case File 
Reviews 
95-Percent Confidence
Point 
Interval 
Estimate Description  Sample Size 
Estimate 
Lower  Upper 
Percentage of All Cases Closed at 
100  73.0%  63.4%  81.2% 
the Time of Our Review 
Percentage of All Cases That Had 
100  98.0%  93.1%  99.8% 
Supervisory Approval To Open 
Percentage of All Closed Cases That 
73  97.3%  90.6%  99.7% 
Had Supervisory Approval To Close  
Percentage of All Cases That Had 
Significant Unexplained Delays in  100  18.0%  11.2%  26.8% 
Investigative Phase 
Percentage of All Cases Open 
100  83.0%  74.4%  89.6% 
Longer Than 90 Days 
Percentage of All Case Files Open 
Longer Than 90 Days and That 
83  85.5%  76.3%  92.2% 
Contained at Least One Periodic 
Supervisory Review 
Percentage of All Case Files Open 
Longer Than 90 Days and That 
Contained Some Periodic  71  69.0%  57.1%  79.3% 
Supervisory Review, But Not 
Quarterly Supervisory Review 
Source: OIG analysis of Mississippi MFCU case files, 2020. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Appendix B | 35  M M
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APPENDIX C:  Unit Comments
JV/ I/
ATTORNEYG ENERAL 
MEDICAFIRDA UD 
DIVISION 
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SuzaMnunrer in 
DepuItnys pGeecnteoforrrEa  vla luaantIdin osnpse ctions 
Offiocfte h Ien spGeecnteorra l 
DeparotfmH eenaatln tHdhu  maSne rvices 
33I0n depeAnvdeennSucWee ,  
Roo5m6 6C0o,h Beuni lding 
WashinDgCt 2o0n2,0 1 
Re:M issiMsesdiipFcpraiia Cduo dn tUrnoilt : 
202I0n specFtYi2 o0n1/7o-rO2 E0l1-91,2 -20-00200 
DeaMrsM .u rrin: 
ThMei ssiMsesdiipcFpariia Cduo dn tUrnoiiltis  n r ecoefiyp otuc ro rrespdoantJdeuedln yc e 
2,2 02e1n,c lotshMiein sgs iMsesdiipcFpariia dCu odn tUrnoi2lt0 :2I 0n speOcEtli-o1n2,- 
20-00W2e0t 0h.a ynokau n ydo utre afomrt  hper ofessiaonnddae ldiiscma tiotno exhibited 
improtvhiUenn gid tu rtihnrgee  vipeewr iWoodr.k wiintgyh o aun ydo utre awma vse ry
insightful.
Wew elcome rpeevriaienowtddsh iv eca  luianbfolrem aatnfiidno dni tnhgaaslt l tohwUe n it 
toa dvaanncidem  proWveae p.p retchoiepa ptoer ttoru ensipttoyotn  hfiden  dirnegasc hed. 
Recommen1d:aE txiaomnit nhUeen  iitn'tspa rkoec feoscrso  mploafpi anttise nt 
abusnee golaren icddt e nitmipfryo vements. 
ResponWsee c:o ncwuirtt hh ree commendTahteUi noirnte. c eived 
approxi5m9a9tc6eo lmyp laoifna tbsu snee,g leacntd,  
exploidtuartitinhogren e  vipeewr iuondd Meirs sissippi's 
mandatroerpyo rsttiantguW thei.lt eh mea joroiftt hye  
complraeicnetisv ed ionar c iagrfaiecn ialstieettdyt  ing, there 
werseo mceo mpltahiwanettr dsee  tertmohi anveoedr  iginated 
inap  rivate haoftmeterh i ens veetsttibineggga aItnn2i. 0o 2n0 , 
witthhc eh anignle e adeurnsdtheihrnpe e  Awt toGrneenye ral, 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection
OEI-12-20-00200                      Appendix C | 36 Mississippi Medicaid Fraud Control Unit: 2020 Inspection
OEI-12-20-00200                                 Appendix C | 37 Mississippi Medicaid Fraud Control Unit: 2020 Inspection
OEI-12-20-00200                            Appendix C | 38 Mississippi Medicaid Fraud Control Unit: 2020 Inspection
OEI-12-20-00200                             Appendix C | 39 Mississippi Medicaid Fraud Control Unit: 2020 Inspection
OEI-12-20-00200                                  Appendix C | 40  
 ACKNOWLEDGMENTS AND CONTACT 
 
Acknowledgments 
Susan Burbach of the Medicaid Fraud Policy and Oversight Division served as the 
team leader for this inspection.  Keith Peters of the Medicaid Fraud Policy and 
Oversight Division also participated in the inspection.  Office of Evaluation and 
Inspections staff who provided support include Kevin Farber and Sara Swisher.  OIG 
staff who provided support include Elizabeth Lohr. 
Two agents from the Office of Investigations also participated in the inspection and 
provided technical assistance to the Unit.  
This report was prepared under the direction of Richard Stern, Director of the 
Medicaid Fraud Policy and Oversight Division. 
Contact 
To obtain additional information concerning this report, contact the Office of Public 
Affairs at Public.Affairs@oig.hhs.gov.  OIG reports and other information can be found 
on the OIG website at oig.hhs.gov. 
Office of Inspector General 
U.S. Department of Health and Human Services 
330 Independence Avenue, SW 
Washington, DC 20201 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  Acknowledgments and Contact | 41   
ABOUT THE OFFICE OF INSPECTOR GENERAL 
 
 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-
452, as amended, is to protect the integrity of the Department of Health and Human 
Services (HHS) programs, as well as the health and welfare of beneficiaries served by 
those programs.  This statutory mission is carried out through a nationwide network 
of audits, investigations, and inspections conducted by the following operating 
components: 
The Office of Audit Services (OAS) provides auditing services for HHS, 
either by conducting audits with its own audit resources or by overseeing audit work 
done by others.  Audits examine the performance of HHS programs and/or its 
grantees and contractors in carrying out their respective responsibilities and are 
intended to provide independent assessments of HHS programs and operations.  
These audits help reduce waste, abuse, and mismanagement and promote economy 
and efficiency throughout HHS. 
The Office of Evaluation and Inspections (OEI) conducts national 
evaluations to provide HHS, Congress, and the public with timely, useful, and reliable 
information on significant issues.  These evaluations focus on preventing fraud, waste, 
or abuse and promoting economy, efficiency, and effectiveness of departmental 
programs.  To promote impact, OEI reports also present practical recommendations 
for improving program operations. 
The Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of fraud and misconduct related to HHS programs, operations, and 
beneficiaries.  With investigators working in all 50 States and the District of Columbia, 
OI utilizes its resources by actively coordinating with the Department of Justice and 
other Federal, State, and local law enforcement authorities.  The investigative efforts 
of OI often lead to criminal convictions, administrative sanctions, and/or civil 
monetary penalties. 
The Office of Counsel to the Inspector General (OCIG) provides 
general legal services to OIG, rendering advice and opinions on HHS programs and 
operations and providing all legal support for OIGs internal operations.  OCIG 
represents OIG in all civil and administrative fraud and abuse cases involving HHS 
programs, including False Claims Act, program exclusion, and civil monetary penalty 
cases.  In connection with these cases, OCIG also negotiates and monitors corporate 
integrity agreements.  OCIG renders advisory opinions, issues compliance program 
guidance, publishes fraud alerts, and provides other guidance to the health care 
industry concerning the anti-kickback statute and other OIG enforcement authorities. 
Mississippi Medicaid Fraud Control Unit: 2020 Inspection 
OEI-12-20-00200  About the OIG | 42