SIOUX FALLS, S.D. — A federal report has criticized South Dakota’s efforts to combat Medicaid fraud, finding that a key unit within the state’s Department of Social Services is understaffed.
The report issued Wednesday by the inspector general’s office of the U.S. Department of Health and Human Services found that the state’s Medicaid Fraud Control Unit, which is part of the attorney general’s office, was generally in compliance with federal requirements, the Argus Leader (http://argusne.ws/2ctmCpD ) reported.
But officials determined that the Department of Social Services, which administers the Medicaid program, was understaffed and not referring many cases to the unit as a result. The department’s Program Integrity Unit is in charge of reviewing Medicaid claims and reporting potential cases of fraud and abuse to the state’s Medicaid Fraud Control Unit.
“Typically, referrals from the (Program Integrity) Unit are an essential component of a (Medicaid Fraud Control Unit’s) ability to effective investigate and prosecute Medicaid provider fraud,” the report said.
It noted that between 2013 and 2015, only 8 percent of fraud control unit referrals for potential fraud investigations came from the Social Services Department’s Program Integrity Unit. That number is less than half of the referrals that came from private individuals.
“The limited number of staff within the PI Unit may have affected the PI Unit’s ability to provide referrals to the MFCU,” according to the report, which stated that as of March, the Social Services Department only had two fraud investigators.
The Social Services Department didn’t respond to the newspaper’s request for comment.
Sara Rabern, spokeswoman Attorney General Marty Jackley, said “the source of referrals is not important” to the Medicaid Fraud Control Unit.
“Once we receive a referral, we will work with all of our partners in an attempt to resolve the case,” she said.