U.S. Department of Health and Human Services 
Office of Inspector General 
 
 
 
Kansas Medicaid 
Fraud Control 
Unit: 2018 Onsite 
Inspection 
 
OEI-12-18-00210  Suzanne Murrin 
July 2019  Deputy Inspector General 
  for Evaluation and Inspections 
oig.hhs.gov  Report in Brief  U.S. Department of Health and Human Services 
July 2019 
Office  of Inspector General 
OEI-12-18-00210 
 
 
Kansas Medicaid Fraud Control Unit:  2018 Onsite 
Unit Case Outcomes 
Inspection 
FYs 2015-2017 
  28 indictments 
What OIG Found  
  32 convictions  
The Kansas Medicaid Fraud Control Unit (MFCU or Unit) reported 28 indictments; 
  33 civil settlements and 
32 convictions; 33 civil settlements and judgments; and over $16 million in recoveries for 
judgments 
fiscal years (FYs) 2015-2017.  From the data and information we reviewed, we found that 
  Over $16 million in 
the Unit operated in accordance with applicable laws, regulations, and policy transmittals.  
recoveries with 
However, we identified one finding involving the Units adherence to MFCU performance 
$10 million from 
standards: 
global* civil cases, 
  Unit investigators and other staff carried large caseloads.  $4.8 million from 
  nonglobal civil cases, 
In addition to the finding, we made observations regarding Unit operations and practices,  and $1.5 million from 
the most significant of which were as follows:  criminal cases 
  The Unit conducted outreach to encourage referrals. 
Unit Snapshot   
  The Units increased use of its electronic case management system allowed more 
At the time of OIGs 
efficient access to case information. 
May 2018 onsite inspection, 
  The Unit investigated many cases jointly with OIG and actively participated in cases 
the Unit had 16 staff, located 
with the United States Attorneys Office. 
in its single office location in 
We also identified the following beneficial practice that may be useful as a model to other  Topeka, Kansas. 
Units: 
The Unit is a division of the 
  The Units nurse investigator encouraged referrals to the Unit by working closely  Kansas Attorney Generals 
with other State agencies.  Office. 
What OIG Recommends  The Unit operates in a State 
We recommend that the Unit review its caseload management practices and develop an  where the Medicaid program 
action plan to lower staff members caseloads.  The Unit concurred with the  is 88 percent managed care.  
recommendation.     
*Global recoveries derive from civil 
 
settlements or judgments involving 
the U.S. Department of Justice and 
 
a group of State MFCUs and are 
  facilitated by the National 
Association of Medicaid Fraud 
  Control Units. 
   
Full report can be found at oig.hhs.gov/oei/reports/oei-12-18-00210.asp  TABLE OF CONTENTS 
BACKGROUND  1 
PERFORMANCE ASSESSMENT  6 
Case Outcomes  6 
From FYs 2015 through 2017, the Unit reported 28 indictments; 32 convictions; and 33 civil 
settlements and judgments 
The Unit reported total recoveries of over $16 million for FYs 2015-2017   
Performance Standard 1: Compliance with requirements  7 
From the data and information we reviewed, the Kansas Unit complied with applicable 
laws, regulations, and policy transmittals 
Performance Standard 2:  Staffing   7 
Unit investigators and other staff carried large caseloads 
Performance Standard 3:  Policies and procedures  8 
The Unit revised its written policies and procedures in calendar year 2016 
Performance Standard 4:  Maintaining adequate referrals  9 
The Unit conducted outreach to encourage referrals 
The Units nurse investigator encouraged referrals to the Unit by working closely with 
other State and local agencies 
Performance Standard 5:  Maintaining a continuous case flow  10 
All sampled case files, with one exception, contained supervisory approval of openings and 
closings    
Performance Standard 6:  Case mix  10 
The Units caseload included both cases of fraud and cases of patient abuse or neglect, 
covering a broad mix of provider types 
Performance Standard 7:  Maintaining case information  10 
All sampled case files opened in FY 2016 or later contained documentation of periodic 
supervisory reviews, but five earlier files contained no such documentation 
The Units increased use of its electronic case management system allowed more efficient 
access to case information   
Performance Standard 8:  Cooperation with Federal authorities on fraud cases  11 
The Unit investigated many cases jointly with OIG and actively participated in cases with 
the United States Attorneys Office 
Performance Standard 9:  Program recommendations   12   
The Unit made program integrity recommendations regarding program deficiencies to the 
State Medicaid agency 
Performance Standard 10:  Agreement with State Medicaid agency    12 
The Units Memorandum of Understanding with the State Medicaid agency reflected 
current practice, policy, and legal requirements 
Performance Standard 11:  Fiscal control  12 
From our limited review, we identified no deficiencies in the Units fiscal control of its 
resources 
Performance Standard 12:  Training  13 
The Unit maintained a training plan that included an annual minimum number of training 
hours for each professional discipline 
CONCLUSION AND RECOMMENDATION  14 
Review Unit caseload management practices and develop an action plan to lower staff   
members caseloads 
UNIT COMMENTS AND OIG RESPONSE    15 
APPENDICES   
A.  MFCU Performance Standards  16 
B.   Unit Referrals by Source for Fiscal Years 2015 Through 2017  21 
C.   Detailed Methodology  22 
D.   Unit Comments  25 
ACKNOWLEDGMENTS  27 
   
 
   
BACKGROUND 
Objective 
To examine the performance and operations of the Kansas State 
Medicaid Fraud Control Unit. 
Medicaid Fraud  Medicaid Fraud Control Units (MFCUs or Units) investigate (1) Medicaid 
provider fraud and (2) patient abuse or neglect in facility settings, and 
Control Units 
prosecute those cases under State law or refer them to other prosecuting 
offices.1, 2 Under the Social Security Act (SSA), a MFCU must be a single, 
identifiable entity of State government, be separate and distinct from the 
State Medicaid agency, and employ one or more investigators, attorneys, 
and auditors.3  Each State must operate a MFCU or receive a waiver.4  
Currently, 49 States, the District of Columbia, Puerto Rico, and the 
U.S. Virgin Islands operate MFCUs.5  Each Unit receives a Federal grant 
award, equivalent to 90 percent for new Units and 75 percent of total 
expenditures for all other Units.6  In fiscal year (FY) 2018, combined Federal 
and State expenditures for all Units totaled approximately $294 million.7 
   
 
1 SSA  1903(q)(3).  Regulations at 42 CFR  1007.11(b)(1) clarify that Units responsibilities 
include the review of complaints of misappropriation of patients private funds in health care 
facilities. 
2 References to State in this report refer to the States, the District of Columbia, and the 
U.S. territories. 
3 SSA  1903(q). 
4 SSA  1902(a)(61). 
5 The State of North Dakota and the territories of American Samoa, Guam, and the Northern 
Mariana Islands have not established Units. 
6 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 of Unit funding.  Thereafter, the 
Federal government contributes 75 percent and the State contributes 25 percent. 
7 OIG analysis of MFCU annual statistical reporting data for FY 2018.  The Federal FY 2018 was 
from October 1, 2017, through September 30, 2018. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  1 
OEI-12-18-00210   
OIG Grant  The Office of Inspector General (OIG) administers a grant award and 
provides oversight to each Unit.8, 9  As part of its oversight, OIG reviews and 
Administration and 
recertifies each Unit annually and conducts periodic onsite reviews, such as 
Oversight of the 
this review.   
MFCUs 
In its recertification review, OIG examines the following (collectively referred 
to as recertification data):  the Units annual report; questionnaire 
responses from the Units director and stakeholders; and annual case 
statistics.  Through the recertification review, OIG assesses a Units 
performance, as measured by the Units adherence to published 
performance standards;10 the Units compliance with applicable laws, 
regulations, and OIG policy transmittals;11 and the Units case outcomes.  See 
Appendix A for MFCU performance standards, including performance 
indicators for each standard.    
OIG further assesses a Units performance by conducting onsite Unit reviews 
that may identify findings and make recommendations for improvement.  
During an onsite review, OIG also makes observations regarding Unit 
operations and practices, and may identify beneficial practices that may be 
useful to other Units.  Finally, OIG provides training and technical assistance, 
as appropriate, to Units while onsite and on an ongoing basis.  
Kansas MFCU  The Kansas MFCU, known as the Medicaid Fraud and Abuse Division, is part 
of the Kansas Attorney Generals Office.  The Unit is located in Topeka, 
Kansas.   
At the time of OIGs May 2018 onsite inspection, the Kansas Unit employed 
16 staff.  Unit staff included a director and deputy director; a special agent in 
charge (SAC); five special agents; a nurse investigator; a chief auditor; 
four auditors; two attorneys (in addition to the director and deputy); and 
a legal assistant.  The Unit director has been employed by the MFCU since 
2016.  During the review period of FYs 2015-2017, Unit expenditures were 
approximately $4 million, with a State share of $994,000. 
Referrals.  The primary sources of fraud referrals to the Unit are private 
citizens, managed care organizations (MCOs), and the State Medicaid 
 
8 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. 
9 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.        
10 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). 
11 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. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  2 
OEI-12-18-00210   
agency.12  The Unit also receives a large number of referrals of patient abuse 
or neglect from the State survey and certification agencythe Kansas 
Department for Aging and Disability Services (KDADS)and from private 
citizens.  Appendix B lists Unit referrals by source for FYs 2015 through 2017.   
Investigations.  Once the Unit opens an investigation, Unit supervisors 
assign a team to the case.  Teams generally include an attorney and 
investigator, and, as appropriate for the case, a nurse investigator and/or an 
auditor.  For cases of patient abuse or neglect, teams consist of an attorney, 
an investigator, and a nurse investigator.   
The Units policies and procedures require the SAC to conduct quarterly 
case file reviews on all open investigations with the special agent assigned 
to each case.  The quarterly reviews of case files cover case statuses and the 
next steps in the investigations.  The policy requires Unit staff to document 
these reviews in its electronic case management system. 
Prosecutions.  The Kansas MFCU has Statewide authority to investigate and 
prosecute cases of suspected Medicaid fraud.  Additionally, the Unit may 
prosecute violations of State laws related to the abuse, neglect, or 
exploitation of dependent adults and the elderly.   
If a case is not within the Units prosecutorial authority, the Unit will refer the 
case for administrative action to the State Medicaid agencys Program 
Integrity Division and/or to the appropriate licensing entity.  When the Unit 
determines that Federal health care programs other than Medicaid are the 
primary victims, the Unit will refer the case to the United States Attorneys 
Office or to OIG.  Two Unit attorneys are cross-designated as Special 
Assistant United States Attorneys.  These attorneys work directly with the 
United States Attorneys Office on Medicaid fraud cases litigated in the 
United States District Court. 
Kansas Medicaid  KanCare.  The Kansas Medicaid program, known as KanCare, provides care 
Program  to more than 415,000 beneficiaries.  Kansas contracts with three MCOs to 
coordinate health care services for all Medicaid beneficiaries.  In FY 2018, 
88-percent of State Medicaid payments were for care provided by MCOs.  
The fiscal agent of the Kansas Medicaid program receives, processes, and 
pays Medicaid claims.  In FY 2018, total KanCare expenditures were 
$3.6 billion.13 
   
 
12 Referrals from the State Medicaid agency include referrals from the State Medicaid Agency 
for Surveillance and Utilization Review Subsystem (SURS) or Program Integrity (PI) Unit as 
well as other offices within the State Medicaid agency. 
13 OIG, MFCU Statistical Data for FY 2018, February 2019, available at 
https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/expenditures_statistics/fy2018-
statistical-chart.pdf. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  3 
OEI-12-18-00210   
MCO Contract.  The Kansas Medicaid Managed Care Model Contract 
(adopted for all 3 MCOs in Kansas) requires MCOs to refer abusive or 
fraudulent Medicaid claims to the State Medicaid agency.  The Units 
Memorandum of Understanding (MOU) with the State Medicaid agency 
requires the State Medicaid agency to inform the Unit at the earliest 
practical time regarding any matter that raises a suspicion of Medicaid 
provider fraud or abuse.   
Prior OIG Report  OIG conducted a previous onsite review of the Kansas Unit in 2012.  In that 
review, OIG found that (1) for FYs 2009 and 2010, the Unit had several 
internal control weaknesses and inadequate policies and procedures related 
to certain expenditures; (2) the Unit did not report the identities of all 
convicted providers to OIG within 30 days of sentencing for the purpose of 
program exclusion; (3) the Unit did not establish annual training plans for its 
professional disciplines; and (4) the Units case files had inconsistent 
documentation of supervisory approval for key stages of investigations, 
although cases generally proceeded timely.14   
OIG recommended that the Unit (1) develop policies and procedures to 
address internal control weaknesses; (2) develop a protocol to ensure that 
identities of convicted providers are reported to OIG; (3) establish annual 
training plans for professional disciplines; and (4) ensure that all case files 
contain opening and closing investigative memoranda, documented 
supervisory approval, and documented periodic supervisory reviews.   
In response to OIG recommendations, the Unit (1) developed policies and 
procedures to ensure that claimed expenditures are reconciled to the Units 
accounting records; (2) modified its case management system to include 
a section for indicating that exclusion paperwork has been submitted to OIG 
and began generating monthly reports for the Unit Director to verify that 
each conviction was reported to OIG timely; (3) developed a training plan 
for all professional staff; and (4) developed policies and procedures to 
ensure that all Unit case files contain forms to document opening, closing, 
and periodic supervisory reviews.  Based on information we received from 
the Unit, OIG considered these recommendations implemented.       
Methodology  We conducted the onsite inspection of the Kansas MFCU in May 2018.  Our 
inspection covered the 3-year period of FYs 2015-2017.  We analyzed data 
from seven 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 simple random 
sample of 50 case files that were open at any point during the review 
period; (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; and (7) observations of Unit 
 
14 Kansas State Medicaid Fraud Control Unit: 2012 Onsite Review, OEI-07-12-00200, September 
2012, available at https://oig.hhs.gov/oei/reports/oei-07-12-00200.asp. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  4 
OEI-12-18-00210   
operations.  (See Appendix C for a detailed methodology.)  In examining the 
Units operations and performance, we applied the published performance 
standards in Appendix A but did not consider every performance indicator 
for every standard. 
Standards  We conducted this study 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 quality controls as other OIG evaluations, 
including internal and external peer review. 
   
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  5 
OEI-12-18-00210   
PERFORMANCE ASSESSMENT 
Below are the results of OIGs assessment of the performance and 
operations of the Kansas Unit.  OIG identified the Units case outcomes; 
found that the Unit complied with legal and policy requirements; and 
offered either a finding or observation(s) for each of the performance 
standards.  OIG found that the caseloads of Unit investigators and other 
staff were large and, among other observations, OIG identified a beneficial 
practice designed to encourage referrals to the Unit.  Finally, OIG 
recommended that the Unit develop an action plan to address the large 
caseloads. 
CASE OUTCOMES   
 
Observations  From FYs 2015 through 2017, the Unit reported 28 indictments; 
32 convictions; and 33 civil settlements and judgments.  Of the 
32 convictions, 29 involved provider fraud and 3 involved patient abuse or 
 
neglect. 
 
 
 
 
 
The Unit reported total recoveries of over $16 million for  
FYs 20152017.  See Exhibit 1 for a breakdown of the Units recoveries.  
Exhibit 1:  The Unit reported combined civil and criminal recoveries 
of over $16 million (FYs 20152017).
 
Source:  OIG analysis of Unit statistical data FYs 2015-2017. 
Note:  Global recoveries derive from civil settlements or judgments involving the U.S. Department of 
Justice and a group of State MFCUs and are facilitated by the National Association of Medicaid Fraud 
Control Units. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  6 
OEI-12-18-00210   
STANDARD 1  A Unit conforms with all applicable statutes, regulations, and policy 
directives. 
Observation  From the data and information we reviewed, the Kansas Unit complied 
with applicable laws, regulations, and policy transmittals.  From the 
statistical data and other information we reviewed, we did not identify 
 
compliance-related concerns. 
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. 
Finding  Unit investigators and other staff carried large caseloads.  According to 
Performance Standard 2(b), the Unit should employ a total number of 
professional staff that is commensurate with the States total Medicaid 
program expenditures and that enables the Unit to effectively investigate 
  and prosecute (or refer for prosecution) an appropriate volume of case 
referrals and workload for both Medicaid fraud and patient abuse and 
neglect.  
In examining the Unit staffs caseloads, we observed that the Units staff 
levels were similar to those of Units in States with similar Medicaid 
expenditures.  Kansas Medicaid expenditures in FY 2017 were 
approximately $3.4 billion, and the Unit employed 15 staff, similar to the 
Unit staff sizes in States with similarly sized Medicaid programs.  However, 
as Unit managers and staff reported, and as OIGs judgment, experience, 
and observations confirmed, the caseloads for all professional groups were 
too large.15    
Unit managers and staff with whom we spoke expressed concerns about 
caseloads.  One Unit manager stated that the timeliness of cases suffers as 
a result of the large caseloads, and another staff member explained that 
the large caseloads interfered with the ability to receive training.  Another 
Unit manager stated that investigators were overworked and were 
especially challenged when forced to shift focus between complex cases 
and a large number of allegations requiring immediate response, such as 
those involving patient abuse or neglect. 
In OIGs judgment and experience, Unit investigators caseloads were 
double or triple the amount that a Federal investigator would typically 
handle, and the caseloads of attorneys and auditors were also too large. 
See Exhibit 2 for the caseloads for Unit investigators, attorneys, and 
auditors at the time of the onsite inspection.     
 
 
15 OIG was ultimately unable to determine why the caseloads were so large. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  7 
OEI-12-18-00210   
Exhibit 2:  Unit staff caseloads were large  
 
Source:  Unit case assignment list, May 2018. 
 
In OIGs judgment, depending on the complexity of the particular cases, 
carrying caseloads of this magnitude can lead to overworked staff.  Further, 
in OIGs judgment, staff with such caseloads may not adequately document 
their cases.  Moreover, when cases go to trial, there are likely to be delays 
to the many other cases handled by the attorney, investigator, or auditor. 
In addition to having supervisory responsibilities, the Units SAC also carried 
a large caseload.  At the time of OIGs inspection, the SAC carried a 
caseload of 31 cases.  In OIGs experience, it is unusual for an investigative 
supervisor to carry a large caseload while also having management duties.  
In addition to his supervisory responsibilities, the SAC was also responsible 
for completing an initial assessment of each referral, determining whether 
to open a full investigation, and preparing an electronic case file for each 
referral.   
 
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. 
Observation  The Unit revised its written policies and procedures in calendar year 
2016.  The Units policies and procedures manual, the Kansas MFCU 
Standard Operating Guidelines (Operating Guidelines), is available to staff in 
hard copy format and in electronic format on the Units computer network.   
Unit management revised the Operating Guidelines in calendar year (CY) 
2016 after a change in key leadership positions.  One notable revision 
required more frequent periodic supervisory reviews (see pages 9-10).  
   
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  8 
OEI-12-18-00210   
STANDARD 4  A Unit takes steps to maintain an adequate volume and quality of 
  referrals from the State Medicaid agency and other sources. 
Observations  The Unit conducted outreach to encourage referrals.  The Unit took steps 
to maintain volume and quality of referrals through outreach efforts.  To 
encourage referrals, the Unit meets monthly with staff from the State 
Medicaid agencys program integrity unit, MCOs, and the fiscal agent.  
Topics of discussion at the monthly meetings include identification of fraud 
trends and improper or suspicious Medicaid billing practices.  The Unit also 
reported on its efforts to educate providers, State agencies, and citizens 
about the Units function and operations.  For example, Unit staff provided 
training to KDADS, the survey and certification agency, about the illegal 
diversion of controlled substances by providers.  Additionally, the Unit 
reported that it generates referrals by participating in the Attorney Generals 
Senior Consumer Protection Advisory Council and the Federal Elder Abuse 
Task Force.16 
Beneficial Practice  The Units nurse investigator encouraged referrals to the Unit by 
working closely with other State and local agencies.  The Units nurse 
 
investigator, hired in 2016, was charged with reviewing various sources to 
identify complaints of patient abuse or neglect that might warrant further 
review by the Unit.17  As part of these duties, the nurse investigator reviewed 
closed complaints of alleged abuse or neglect of nursing home residents on 
file with the State Medicaid agency, KDADS, and other State regulatory 
agencies that oversee health care facilities to determine if any of the 
complaints should be investigated by the Unit.     
The nurse investigator also arranged for the Unit to receive complaints of 
patient abuse or neglect from KDADS at the same time as local law 
enforcement.  Previously, when KDADS received a complaint of a possible 
crime, it notified local law enforcement agencies, such as the local police 
department or county sheriffs office.  The nurse investigator requested that 
KDADS also include the Unit on these email notifications.  As a result, the 
Units nurse investigator and SAC now receive these notifications at the 
same time as local law enforcement.   
The nurse investigator, after reviewing the notifications, (1) contacted local 
law enforcement that also received the notifications to determine whether 
they planned to take any action; (2) contacted the health care facilities 
involved with the allegations to obtain additional information; and (3) if the 
allegations involved matters within the Units authority, she sent the 
additional information to the Units SAC to determine whether to open 
 
16 In our review, we did not determine whether the Units efforts resulted in a greater number 
of referrals from these sources. 
17 The nurse investigator is a registered nurse who conducts investigations of possible 
Medicaid fraud and patient abuse or neglect. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  9 
OEI-12-18-00210   
a formal investigation.  The number of referrals of patient abuse or neglect 
that the Unit received increased from 23 in FY 2016 to 44 in FY 2017.  Unit 
management attributed the increase to the nurse investigators interaction 
with KDADS. 
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. 
Observation  All sampled case files, with one exception, contained supervisory 
approval of case openings and, as appropriate, case closings.  According 
to Performance Standard 5(b), supervisors should approve the opening and 
closing of all investigations, review the progress of cases, and take action as 
necessary to ensure that each stage of an investigation and prosecution is 
completed in an appropriate timeframe. Of the 50 sampled case files 
we reviewed, 49 case files contained documentation supporting case 
opening.  All 31 closed case files in the sample contained documentation 
supporting case closing.   
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. 
Observation  The Units caseload included both cases of fraud and cases of patient 
abuse or neglect, covering a broad mix of provider types.  During the 
review period, 89 percent of the Units cases involved fraud and 11 percent 
involved patient abuse or neglect.  At the end of FY 2017, the Units cases 
covered 37 provider types, including physicians, licensed practitioners, 
health care facilities, and medical service providers.   
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. 
Observations  All sampled case files opened in FY 2016 or later contained 
documentation of periodic supervisory reviews, but five earlier files 
contained no such documentation.18  During OIGs 2012 onsite review of 
the Unit, we recommended that the Unit ensure that all case files contain 
documentation of periodic supervisory reviews.  In response to OIGs 
recommendation, the Unit implemented a policy requiring that all open 
case files would include periodic-review forms, approved by the SAC 
or Director, for every 6-month period that a case was open.  The Unit 
 
18 Of the 50 case files in OIGs sample, the Unit opened 26 cases prior to FY 2016 and 24 in FY 
2016 or later. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  10 
OEI-12-18-00210   
revised this policy in CY 2016 to require that periodic supervisory reviews of 
all open cases be conducted quarterly, rather than every 6 months, and be 
documented in the case file. 
According to Performance Standard 7(a), reviews by supervisors should be 
conducted periodically, consistent with the Units policies and procedures, 
and should be noted in the case file.  We found that five case files for cases 
opened and closed prior to FY 2016 did not contain documentation of 
periodic supervisory reviews consistent with the Units policy at that time.  
One of these case files was open for approximately 3 years but contained 
documentation of only one periodic supervisory review.  Four of these case 
files contained no documentation of periodic supervisory reviews.  However, 
we found that all files for sampled cases opened in FY 2016 or later 
contained documentation of supervisory reviews consistent with the Units 
revised policy.  
The Units increased use of its electronic case management system 
allowed more efficient access to case information.  While conducting 
case file reviews, OIG found that it was difficult to locate documentation for 
some of the Units older case files, i.e., those opened prior to 2016.  OIG 
observed that Unit staff had not entered documentation for some of the 
Units older cases into the Units electronic case management system.  For 
other cases, OIG observed that Unit staff had entered documentation into 
the electronic case management system but had scanned all documents 
from paper case files into a single attachment rather than attaching and 
labeling each case document separately.  This made it difficult to locate 
specific documents in the electronic case management system.   
However, OIG observed a noticeable change with cases opened during or 
after CY 2016, when staff began to enter case information directly into the 
Units electronic case management system during the course of 
investigations.  OIG observed that the Units increased use of this system 
made it easier to find, review, and track case information in case files 
opened during or after 2016.  A Unit manager also observed that the Unit 
saved significant time by entering case information directly into the 
electronic system. 
STANDARD 8  A Unit cooperates with OIG and other Federal agencies in the 
investigation and prosecution of Medicaid and other health care fraud. 
 
 
Observation  The Unit investigated many cases jointly with OIG and actively 
participated in cases with the United States Attorneys Office.  During 
the review period, the Unit jointly investigated with OIG a total of 40 cases, 
involving 60 different suspects.  Additionally, the Unit actively participated in 
cases with prosecutors from the Criminal and Civil Divisions of the Kansas 
United States Attorneys Office.  The Units Director and Deputy Director are 
themselves both cross-designated as Special Assistant United States 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  11 
OEI-12-18-00210   
Attorneys and prosecute many of their own cases in United States District 
Court.  One Assistant United States Attorney described the MFCU as very 
effective and stated her belief that the MFCU Director is able to bring the 
relevant parties together very quickly to discuss potential issues and the 
scope of investigations. 
STANDARD 9  A Unit makes statutory or programmatic recommendations, when 
  warranted, to the State government. 
Observation  The Unit made written recommendations regarding program 
deficiencies to the State Medicaid agency.  The Unit informed the State 
Medicaid agency of potential program deficiencies identified through 
MFCU investigations.  For example, during our review period, the Unit 
recommended that the State Medicaid agency (1) work with the MCOs to 
strengthen the documentation requirements related to transportation 
services and (2) implement safeguards to the system used to report and 
monitor services that personal care attendants provide to Medicaid 
beneficiaries.  The Unit director stated that he remains in contact with the 
appropriate State Medicaid agency staff to monitor the recommendations 
and any actions taken in response to them.    
SSTTAANNDDAARRDD  910   AA  UUnniitt  mpearkioeds isctaaltlyu troervyie owrs p irtos gMraemmmoraatnicd ruemco omf mUnendderasttiaonnds,i nwgh (eMn OU) 
 
  wwaitrhr atnhtee Sdt, attoe  tMhee dSitcaatied g aogveenrcnym teon et.n sure that it reflects current 
practice, policy, and legal requirements. 
Observation  The Units MOU with the State Medicaid agency reflected current 
practice, policy, and legal requirements.  The Units MOU with the State 
Medicaid agency was executed on November 1, 2012.  OIG confirmed that 
 
the MOU reflected current practice, policy, and legal requirements.  
STANDARD 11  A Unit exercises proper fiscal control over its resources. 
 
From our limited review, we identified no deficiencies in the Units fiscal 
Observation 
control of its resources.  From the responses to a detailed fiscal controls 
questionnaire and interviews with fiscal staff, we identified no internal 
controls issues related to the Units budget process, accounting system, 
cash management, procurement, electronic data security, property, or 
personnel.  In our inventory review, we located 30 of the 30 sampled 
inventory items. 
 
 
 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  12 
OEI-12-18-00210   
STANDARD 12  A Unit conducts training that aids in the mission of the Unit. 
Observation  The Unit maintained a training plan that included an annual minimum 
number of training hours for each professional discipline.  The Unit had 
an annual training plan that required Unit attorneys, investigators, and 
auditors to complete an annual minimum number of training hours.  The 
plan required new Unit employees to complete in-house basic training and 
required all Unit employees to complete training programs on Medicaid 
fraud and discipline-specific training programs.   
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  13 
OEI-12-18-00210   
CONCLUSION AND RECOMMENDATION 
For FYs 2015 through 2017, the Kansas Unit reported 28 indictments; 
32 convictions; 33 civil settlements and judgments; and combined criminal 
and civil recoveries of over $16 million.   
From the data and information we reviewed, we determined that the Kansas 
Unit generally adhered to applicable legal requirements and the 
performance standards.  We also made observations regarding Unit 
operations and practices, including a beneficial practice that the Unit 
employed that may serve as a model for other Units:  the Units nurse 
investigator identified and encouraged referrals to the Unit by working 
closely with other State agencies.   
However, we identified one finding: Unit staff maintained caseloads that 
were too high.  Although the Units staff levels were similar to those of other 
Units with similarly sized Medicaid programs, Unit staff reportedand OIGs 
review confirmedthat large caseloads left staff overworked and may have 
affected their efficiency.   
We recommend that to address this finding, the Kansas Unit: 
Review its caseload management practices and develop 
an action plan to lower staff members caseloads 
The Unit should review its caseload management practices and determine 
why the caseloads assigned to Unit professional staff were so large.  The 
Unit should use the results of its review to develop an action plan to lower 
staff caseloads.  The plan should include the Units strategy for expanding 
staff capacity, such as by using different case management or prioritization 
techniques, or through hiring additional staff.   
 
   
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  14 
OEI-12-18-00210   
UNIT COMMENTS AND OIG RESPONSE 
The Kansas Unit concurred with our recommendation to review its caseload 
management practices and develop an action plan to lower staff members 
caseloads.  The Unit stated that it has already undertaken or plans to take 
the following actions: 
1.  The Unit hired an additional investigator; 
2.  The Unit reviewed its process for reviewing incoming cases to streamline 
and prioritize cases that should be worked or referred to another office 
for review or action;   
3.  The Unit revised its case management system to simplify the case 
closing process;  
4.  Unit management assigned a Unit investigator and attorney to 
concentrate on personal care services cases to ensure that these cases 
are processed more efficiently; and 
5.  For purposes of requesting legislative approval for FY 2020 funding, the 
Attorney General reviewed the need for additional Unit staff.  The Unit 
anticipates that the Attorney General will request legislative approval to 
increase Unit funding for an increase in Unit staff size.  
For the full text of the Units comments, see Appendix D. 
   
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  15 
OEI-12-18-00210   
APPENDIX A:  MFCU Performance 
Standards19 
1)  A Unit conforms with all applicable statutes, regulations, and policy 
directives, including: 
A)  Section 1903(q) of the Social Security Act, containing the basic 
requirements for operation of a MFCU; 
B)  Regulations for operation of a MFCU contained in 42 CFR part 1007; 
C)  Grant administration requirements at 45 CFR part 92 and Federal cost 
principles at 2 CFR part 225; 20 
D)  OIG policy transmittals as maintained on the OIG website; and 
E)  Terms and conditions of the notice of the grant award. 
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. 
A)  The Unit employs the number of staff that is included in the Units budget 
estimate as approved by OIG. 
B)  The Unit employs a total number of professional staff that is commensurate 
with the States total Medicaid program expenditures and that enables the 
Unit to effectively investigate and prosecute (or refer for prosecution) an 
appropriate volume of case referrals and workload for both Medicaid fraud 
and patient abuse and neglect. 
C)  The Unite employs an appropriate mix and number of attorneys, auditors, 
investigators, and other professional staff that is both commensurate with 
the States total Medicaid program expenditures and that allows the Unit to 
effectively investigate and prosecute (or refer for prosecution) an 
appropriate volume of case referrals and workload for both Medicaid fraud 
and patient abuse and neglect. 
D)  The Unit employs a number of support staff in relation to its overall size 
that allows the Unit to operate effectively. 
E)  To the extent that a Unit maintains multiple office locations, such locations 
are distributed throughout the State, and are adequately staffed, 
commensurate with the volume of case referrals and workload for each 
location. 
3)  A Unit establishes written policies and procedures for its operations and 
ensures that staff are familiar with, and adhere to, policies and 
procedures. 
A)  The Unit has written guidelines or manuals that contain current policies and 
procedures, consistent with these performance standards, for the 
investigation and (for those Units with prosecutorial authority) prosecution 
of Medicaid fraud and patient abuse and neglect. 
B)  The Unit adheres to current policies and procedures in its operations. 
 
19 77 Fed. Reg. 32645 (June 1, 2012). 
20 For FYs 2016 and later, grant administration requirements and cost principles are found at 
45 CFR part 75. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  16 
OEI-12-18-00210   
C)  Procedures include a process for referring cases, when appropriate, to 
Federal and State agencies.  Referrals to State agencies, including the State 
Medicaid agency, should identify whether further investigation or other 
administrative action is warranted, such as the collection of overpayments 
or suspension of payments. 
D)  Written guidelines and manuals are readily available to all Unit staff, either 
online or in hard copy. 
E)  Policies and procedures address training standards for Unit employees. 
4)  A Unit takes steps to maintain an adequate volume and quality of 
referrals from the State Medicaid agency and other sources. 
A)  The Unit takes steps, such as the development of operational protocols, to 
ensure that the State Medicaid agency, managed care organizations, and 
other agencies refer to the Unit all suspected provider fraud cases.  
Consistent with 42 CFR 1007.9(g), the Unit provides timely written notice to 
the State Medicaid agency when referred cases are accepted or declined 
for investigation. 
B)  The Unit provides periodic feedback to the State Medicaid agency and 
other referral sources on the adequacy of both the volume and quality of 
its referrals. 
C)  The Unit provides timely information to the State Medicaid or other agency 
when the Medicaid or other agency requests information on the status of 
MFCU investigations, including when the Medicaid agency requests 
quarterly certification pursuant to 42 CFR 455.23(d)(3)(ii). 
D)  For those States in which the Unit has original jurisdiction to investigate or 
prosecute patient abuse and neglect cases, the Unit takes steps, such as the 
development of operational protocols, to ensure that pertinent agencies 
refer such cases to the Unit, consistent with patient confidentiality and 
consent.  Pertinent agencies vary by State but may include licensing and 
certification agencies, the State Long Term Care Ombudsman, and adult 
protective services offices. 
E)  The Unit provides timely information, when requested, to those agencies 
identified in (D) above regarding the status of referrals. 
F)  The Unit takes steps, through public outreach or other means, to 
encourage the public to refer cases to the Unit. 
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. 
A)  Each stage of an investigation and prosecution is completed in an 
appropriate timeframe. 
B)  Supervisors approve the opening and closing of all investigations and 
review the progress of cases and take action as necessary to ensure that 
each stage of an investigation and prosecution is completed in an 
appropriate timeframe. 
C)  Delays to investigations and prosecutions are limited to situations imposed 
by resource constraints or other exigencies. 
6)  A Units case mix, as practicable, covers all significant providers types 
and includes a balance of fraud and, where appropriate, patient abuse 
and neglect cases. 
A)  The Unit seeks to have a mix of cases from all significant provider types in 
the State. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  17 
OEI-12-18-00210   
B)  For those States that rely substantially on managed care entities for the 
provision of Medicaid services, the Unit includes a commensurate number 
of managed care cases in its mix of cases. 
C)  The Unit seeks to allocate resources among provider types based on levels 
of Medicaid expenditures or other risk factors.  Special Unit initiatives may 
focus on specific provider types. 
D)  As part of its case mix, the Unit maintains a balance of fraud and patient 
abuse and neglect cases for those States in which the Unit has original 
jurisdiction to investigate or prosecute patient abuse and neglect cases. 
E)  As part of its case mix, the Unit seeks to maintain, consistent with its legal 
authorities, a balance of criminal and civil fraud cases. 
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. 
A)  Reviews by supervisors are conducted periodically, consistent with MFCU 
policies and procedures, and are noted in the case file. 
B)  Case files include all relevant facts and information and justify the opening 
and closing of the cases. 
C)  Significant documents, such as charging documents and settlement 
agreements, are included in the file. 
D)  Interview summaries are written promptly, as defined by the Units policies 
and procedures. 
E)  The Unit has an information management system that manages and tracks 
case information from initiation to resolution. 
F)  The Unit has an information management system that allows for the 
monitoring and reporting of case information, including the following: 
1)  The number of cases opened and closed and the reason that 
cases are closed. 
2)  The length of time taken to determine whether to open a case 
referred by the State Medicaid agency or other referring 
source. 
3)  The number, age, and types of cases in the Units 
inventory/docket. 
4)  The number of referrals received by the Unit and the number 
of referrals by the Unit to other agencies. 
5)  The dollar amount of overpayments identified. 
6)  The number of cases criminally prosecuted by the Unit or 
referred to others for prosecution, the number of individuals 
or entities charged, and the number of pending prosecutions. 
7)  The number of criminal convictions and the number of civil 
judgments. 
8)  The dollar amount of fines, penalties, and restitution ordered 
in a criminal case and the dollar amount of recoveries and the 
types of relief obtained through civil judgments or prefiling 
settlements. 
8)  A Unit cooperates with OIG and other Federal agencies in the 
investigation and prosecution of Medicaid and other health care fraud. 
A)  The Unit communicates on a regular basis with OIG and other Federal 
agencies investigating or prosecuting health care fraud in the State. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  18 
OEI-12-18-00210   
B)  The Unit cooperates and, as appropriate, coordinates with OIGs Office of 
Investigations and other Federal agencies on cases being pursued jointly, 
case involving the same suspects or allegations, and cases that have been 
referred to the Unit by OIG or another Federal agency. 
C)  The Unit makes available, to the extent authorized by law and upon request 
by Federal investigators and prosecutors, all information in its possession 
concerning provider fraud or fraud in the administration of the Medicaid 
program. 
D)  For cases that require the granting of extended jurisdiction to investigate 
Medicare or other Federal health care fraud, the Unit seeks permission 
from OIG or other relevant agencies under procedures as set by those 
agencies. 
E)  For cases that have civil fraud potential, the Unit investigates and 
prosecutes such cases under State authority or refers such cases to OIG or 
the U.S. Department of Justice. 
F)  The Unit transmits to OIG, for purposes of program exclusions under 
section 1128 of the Social Security Act, all pertinent information on MFCU 
convictions within 30 days of sentencing, including charging documents, 
plea agreements, and sentencing orders. 
G)  The Unit reports qualifying cases to the Healthcare Integrity & Protection 
Databank, the National Practitioner Data Bank, or successor data bases. 
9)  A Unit makes statutory or programmatic recommendations, when 
warranted, to the State government. 
A)  The Unit, when warranted and appropriate, makes statutory 
recommendations to the State legislature to improve the operation of the 
Unit, including amendments to the enforcement provisions of the State 
code. 
B)  The Unit, when warranted and appropriate, makes other regulatory or 
administrative recommendations regarding program integrity issues to the 
State Medicaid agency and to other agencies responsible for Medicaid 
operations or funding.  The Unit monitors actions taken by the State 
legislature and the State Medicaid or other agencies in response to 
recommendations. 
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. 
A)  The MFCU documents that it has reviewed the MOU at least every 5 years, 
and has renegotiated the MOU as necessary, to ensure that it reflects 
current practice, policy, and legal requirements. 
B)  The MOU meets current Federal legal requirements as contained in law or 
regulation, including 42 CFR 455.21, Cooperation with State Medicaid 
fraud control units, and 42 CFR 455.23, Suspension of payments in cases 
of fraud. 
C)  The MOU is consistent with current Federal and State policy, including any 
policies issued by OIG or the Centers for Medicare & Medicaid Services 
(CMS). 
D)  Consistent with Performance Standard 4, the MOU establishes a process to 
ensure the receipt of an adequate volume and quality of referrals to the 
Unit from the State Medicaid agency. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  19 
OEI-12-18-00210   
E)  The MOU incorporates by reference the CMS Performance Standard for 
Referrals of Suspected Fraud From a State Agency to a Medicaid Fraud 
Control Unit. 
11)  A Unit exercises proper fiscal control over Unit resources. 
A)  The Unit promptly submits to OIG its preliminary budget estimates, 
proposed budget, and Federal financial expenditure reports. 
B)  The Unit maintains an equipment inventory that is updated regularly to 
reflect all property under the Units control. 
C)  The Unit maintains an effective time and attendance system and personnel 
activity records. 
D)  The Unit applies generally accepted accounting principles in its control of 
Unit funding. 
E)  The Unit employs a financial system in compliance with the standards for 
financial management systems contained in 45 CFR 92.20. 
12)  A Unit conducts training that aids in the mission of the Unit. 
A)  The Unit maintains a training plan for each professional discipline that 
includes an annual minimum number of training hours and that is at least 
as stringent as required for professional certification. 
B)  The Unit ensures that professional staff comply with their training plans and 
maintain records of their staffs compliance. 
C)  Professional certifications are maintained for all staff, including those that 
fulfill continuing education requirements. 
D)  The Unit participates in MFCU-related training, including training offered by 
OIG and other MFCUs, as such training is available and as funding permits. 
E)  The Unit participates in cross-training with the fraud detection staff of the 
State Medicaid agency.  As part of such training, Unit staff provide training 
on the elements of successful fraud referrals and receive training on the 
role and responsibilities of the State Medicaid agency. 
 
 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  20 
OEI-12-18-00210   
APPENDIX B:  Unit Referrals by Source for Fiscal 
Years 2015 Through 2017 
  FY 2015  FY 2016  FY 2017  Grand Totals 
Abuse &  Abuse &  Abuse &  Abuse & 
Referral Source  Fraud  Fraud  Fraud  Fraud 
Neglect1  Neglect  Neglect  Neglect 
Adult Protective Services  7  0  4  2  4  4  15  6 
Anonymous  7  3  11  4  3  2  21  9 
Office of Inspector General  5  2  7  1  3  0  15  3 
Licensing Board  1  0  3  0  1  0  5  0 
Local Prosecutor  1  0  1  0  0  0  2  0 
Long-Term Care Ombudsman  0  0  0  0  0  0  0  0 
Managed Care Organizations  13  1  12  0  28  0  53  1 
State Medicaid Agency Other  0  1  2  0  38  2  40  3 
State Medicaid Agency SURS or PI 
1  0  0  0  1  0  2  0 
Unit2 
Other  15  2  12  0  10  2  37  4 
Law Enforcement  8  5  4  5  7  6  19  16 
Private Citizen  29  20  20  11  18  11  67  42 
Private Health Insurer  0  0  1  0  0  0  1  0 
Provider  18  1  15  0  4  0  37  1 
Provider Association  0  0  1  0  0  0  1  0 
Other State Agency  15  0  9  0  4  0  28  0 
State Survey and Certification  0  0  9  0  3  17  12  17 
     Total  120  35  111  23  124  44  355  102 
     Annual Total  155  134  168  457 
 
Source:  OIG analysis of Unit Annual Statistical Reports, FYs 2015-2017. 
1 The category of referrals of patient abuse and neglect includes referrals regarding misappropriation of patients private funds. 
2 The abbreviation PI stands for program integrity; the abbreviation SURS stands for Surveillance and Utilization Review Subsystem. 
. 
 
   
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  21 
OEI-12-18-00210   
APPENDIX C:  Detailed Methodology 
Data Collection and Analysis 
We collected and analyzed data from the seven sources 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.21  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. 
(1) Review of Unit Documentation.  Prior to the onsite inspection, we 
reviewed the Units policies and procedures.  We also reviewed the 
recertification analysis for FYs 2015-2017, which included examining the 
Units recertification materials, including (1) the annual reports, (2) Unit 
Directors recertification questionnaires, (3) the Units memorandum of 
understanding with the State Medicaid agency, (4) the Program Integrity 
Directors questionnaires, and (5) the OIG Special Agent in Charge 
questionnaires.  We also reviewed the Units self-reported FY 
2015-2017 annual statistical reports about case outcomes.  We reviewed 
the 2012 OIG onsite review recommendations and the Units 
implementation of those recommendations.   
(2)  Review of Unit Fiscal Controls.  We conducted a limited review of the 
Units control over its fiscal resources.  Prior to the onsite review, we 
analyzed the Units response to an internal controls questionnaire and 
we conducted a desk review of the Units financial status reports.  We 
followed up with Unit officials to clarify issues identified in the internal 
controls questionnaire.  We also selected a purposive sample of 
30 items from the current inventory list of 436 items maintained in the 
Units office and verified those items onsite. 
(3)  Interviews with Key Stakeholders.  In April and May 2018, we 
interviewed key stakeholders, including officials in the Kansas State 
Medicaid Program Integrity Unit; the Kansas Department for Aging and 
Disability Services; Kansas Adult Protective Services; and the United 
States Attorneys Offices.  We also interviewed the supervisor from OIGs 
Region VII Office of Investigations, which works regularly with the Unit.  
We focused these interviews on the Units relationship and interaction 
with OIG and other Federal and State authorities.  We used the 
information collected from these interviews to develop subsequent 
interview questions for Unit management. 
(4)  Onsite Interviews with Unit Management and Staff.  We conducted 
structured onsite interviews with the Units management in May 2018.  
 
21 All relevant regulations, statutes, and policy transmittals are available online at 
https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp.  
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  22 
OEI-12-18-00210   
We interviewed the Unit Director, Deputy Director, and Special Agent in 
Charge.  While onsite, we also spoke with other members of Unit staff.  
We asked these individuals to provide information 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; and 
(4) clarification regarding information obtained from other data sources.   
(5)  Onsite 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 2015 through 2017, as well as the following information for 
each case:  its current status; its opening and closing dates, if applicable; 
whether the case was criminal, civil, or global; the provider type involved 
in the case; and whether the case was worked jointly with OIG.  The total 
number of cases was 663.   
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 United States Department of Justice and a 
group of State MFCUs.22  We excluded 58 global cases, leaving 605 case 
files.   
From the 605 remaining case files, we selected a simple random sample 
of 50 cases for review.  We reviewed the 50 case files for adherence to 
the relevant performance standards and compliance with statute, 
regulation, and policy transmittals.  During the review of the sampled 
cases, we consulted MFCU staff to address any apparent issues with 
individual case files, such as missing documentation.   
(6)  Review of Unit Submissions to OIG and National Provider Data Bank.  
We also reviewed all convictions submitted to OIG for program 
exclusion during the review period (28 convictions), and all adverse 
actions submitted to the National Practitioner Data Bank (NPDB) during 
the review period (32 adverse actions).  We reviewed whether the Unit 
submitted information on all sentenced individuals to OIG for program 
exclusion and all adverse actions to the NPDB for FYs 2015 through 
2017.  We also assessed the timeliness of the submissions to OIG and 
the NPDB.  
(7)  Onsite Review of Unit Operations.  During our May 2018 onsite 
inspection, we reviewed the Units workspace and operations.  To 
conduct this review, we visited the Units office in Topeka, Kansas.  While 
onsite, we observed the Units offices and meeting spaces, security of 
 
22 Global cases are civil False Claims Act cases that are litigated in Federal courts by the U.S. 
Department of Justice and involve a group of MFCUs.  The National Association of Medicaid 
Fraud Control Units facilitates the settlement of global cases on behalf of the States. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  23 
OEI-12-18-00210   
data and case files, location of select equipment, and the general 
functioning of the Unit. 
 
 
   
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  24 
OEI-12-18-00210   
APPENDIX D:  Unit Comments 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  25 
OEI-12-18-00210   
 
 
 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  26 
OEI-12-18-00210   
ACKNOWLEDGMENTS 
Jordan Clementi of the Medicaid Fraud Policy and Oversight Division served 
as the team leader for this inspection.  Two agents from the Office of 
Investigations also participated in the inspection.  Office of Evaluation and 
Inspections staff who provided support include Ben Gaddis, Kevin Farber, 
and Christine Moritz.   
This report was prepared under the direction of Richard Stern, Director of 
the Medicaid Fraud Policy and Oversight Division.   
 
 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  27 
OEI-12-18-00210   
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: 
Office of Audit  The Office of Audit Services (OAS) provides auditing services for HHS, either 
by conducting audits with its own audit resources or by overseeing audit 
Services 
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 assessments help reduce waste, 
abuse, and mismanagement and promote economy and efficiency 
throughout HHS. 
Office of Evaluation  The Office of Evaluation and Inspections (OEI) conducts national evaluations 
and Inspections  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.   
Office of  The Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of fraud and misconduct related to HHS programs, 
Investigations 
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. 
Office of Counsel to  The Office of Counsel to the Inspector General (OCIG) provides general 
the Inspector  legal services to OIG, rendering advice and opinions on HHS programs and 
operations and providing all legal support for OIGs internal operations.  
General 
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. 
Kansas Medicaid Fraud Control Unit:  2018 Onsite Inspection  28 
OEI-12-18-00210