Finding Text
Condition: Required screening and license verification for 10 of 25 providers tested was not properly supported by the Department's records. Criteria: 42 CFR 455.410 states that the State Medicaid agency must require all enrolled providers to be screened. Per 42 CFR 455.412, the agency must verify the provider?s license has not expired and is valid. Context: A sample of 25 out of approximately 25,000 providers who received payment during the year were tested to determine whether required screening was performed before the provider was enrolled. For one provider out of 25 providers tested for compliance, the Department was not able to provide evidence that the provider was properly screened before being enrolled. For one out of 25 providers tested, the Department was not able to provide evidence that the provider?s license was verified. For 8 of 25 providers tested, the Department was not able to provide documentation that the required screening was performed. Cause: Although the Department has policies and procedures in place to ensure the proper forms and documentation is maintained, the Department depends on third-party vendors to perform various provider screenings. The screenings performed by the third-party vendor were not kept by the Department. Effect: There is no documentation to show that a provider screening and license verification was conducted to show compliance with Medicaid requirements. Questioned Cost: Unknown Repeat Finding: This is not a repeat finding. Recommendation: We recommend that the Department review and update controls to ensure proper screening and license verification is performed for all providers and that documentation of the screening and verification is retained in all cases. Current Status/Plan of Action: MAD continues to work with its third-party vendor to determine whether the providers? documentation was maintained in the legacy system prior to the transfer of records into the current MMIS system. A corrective action will be developed once the root cause analysis is completed. The Program intends to complete corrective actions by the end of fiscal year 2023. Responsible Person: MAD Compliance Officer, Julie Lovato and PPSB Bureau Chief, Tashi Gyalkhar.