State Medicaid Fraud Control Units (93.775)
Program
93.775 State Medicaid Fraud Control Units
Federal Agency
OFFICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES
Authorization
Social Security Act, as amended, Title XIX, Section 1903, Public Law 95-142; Public Law 96-499.
Program Number
93.775
Last Known Status
Active
Objectives
To eliminate fraud and patient abuse in the State Medicaid programs.
Types of Assistance
Formula Grants.
Uses and Use Restrictions
The statute authorizes 90 percent matching funds for 12 quarters, and 75 percent matching funds thereafter for investigation and prosecution of fraud and patient abuse in the State Medicaid Programs. The unit must be separate and distinct from the State Medicaid agency. The unit must also employ sufficient professional, administrative and support staff to carry out its duties and responsibilities in an effective and efficient manner.
Eligibility Requirements
Applicant Eligibility
A single identifiable entity of the State government which the Secretary certifies (and annually re-certifies) as complying with the requirements of 1903(q) of the Act (42 CFR 1007) regarding location, function and procedure. Applicants must also comply with section 1902 (a)(61) of the Act as amended by the Omnibus Budget Reconciliation Act of 1993.
Beneficiary Eligibility
The State governments will benefit from this program.
Credentials/Documentation
Units must submit applications containing proposed organization, administration, agreements, detailed budgets and procedures for certification of eligibility (see 42 CFR 1007). Costs will be determined in accordance with OMB Circular No. A-87 for State and local governments. For other grantees, costs will be determined in accordance with 45 CFR 74, Subpart Q and 45 CFR 92. Governors in States applying for Federal assistance must approve the application pursuant to 42 CFR 1007.
Application and Award Process
Preapplication Coordination
The standard application forms, as furnished by DHHS and required by OMB Circular No. A-102 for State and local governments, must be used for the preapplication coordination. The Inspector General's staff is available to assist with technical development of programs, plans, budget amendments and revisions. This program is excluded from coverage under E.O. 12372.
Application Procedure
Application is made in the format prescribed by the IG. This program is excluded from coverage under OMB Circular No. A-110.
Award Procedure
States are awarded funds based on a detailed description of estimated expenditures needed to support the program.
Deadlines
State expenditure reports are due 30 days following each quarter. A final financial report is due 90 days after the close of the grant year, as required by 45 CFR 92. The annual report and application for re-certification are due 60 days before the end of each 1-year certification period, as required by 42 CFR 1007.
Range of Approval/Disapproval Time
Appeals
If the application is not approved, the State may submit an amended application at any time.
Renewals
The application for the annual re-certification must be submitted 60 days prior to the end of each certification period.
Assistance Considerations
Formula and Matching Requirements
States are reimbursed for 90 percent of their costs for the first 12 quarters, and 75 percent thereafter, computed against a quarterly maximum allowable of the higher of $125,000, or one-fourth of 1 percent of the sums expended by the Federal, State, or local government in carrying out the State plan under Title XIX of the Social Security Act.
Length and Time Phasing of Assistance
Funds are awarded quarterly based on an approved annual budget and limitations on entitlement. An Electronic Funds Transfer System will be used.
Post Assistance Requirements
Reports
Quarterly program and financial reports are required.
Audits
HHS/OIG/Office of Audit Services performs periodic audits of the State program; the OIG performs an annual re-certification review.
Records
All records are to be retained for 3 years, in accordance with 45 CFR 74 and 92.
Program Accomplishments
Forty-seven States and the District of Columbia are certified under this program.
Financial Information
Account Identification
75-0512-0-1-551.
Obligations
(Grants) FY 02 $119,900,000; FY 03 est $120,300,000; and FY 04 est $124,800,000.
Range and Average of Financial Assistance
$241,000 to $30,624,000; $2,476,354.
Regulations, Guidelines and Literature
42 CFR 1007, 45 CFR 74, 45 CFR 92 and Performance Standards issued September 1994.
Related Programs
93.778, Medical Assistance Program.
Information Contacts
Regional or Local Office
Not applicable.
Headquarters Office
John Bettac, Director, Medicaid Oversight Staff, Office of Investigations, Office of Inspector General, Office of the Secretary, Department of Health and Human Services, Room 5453, Cohen Building, 330 Independence Avenue, SW., Washington, DC 20201. Telephone: (202) 619-3557. (FTS is not available).
Web Site Address
Examples of Funded Projects
Not applicable.
Criteria for Selecting Proposals
Not applicable.
