The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator...
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Transcript of The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator...
![Page 1: The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator Division of Medical Assistance Quality Assurance/Program.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649eb25503460f94bb83ab/html5/thumbnails/1.jpg)
The Plan, The Plan: The Plan, The Plan: Creating a Fraud PlanCreating a Fraud Plan
Angela SaddlerRecipient Investigations Coordinator
Division of Medical AssistanceQuality Assurance/Program Integrity
![Page 2: The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator Division of Medical Assistance Quality Assurance/Program.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649eb25503460f94bb83ab/html5/thumbnails/2.jpg)
Objective Objective
• Review federal regulations and state statutes
• Explore why a fraud plan is needed
• What criteria should be included in the plan
• Who should involved in creating the plan
![Page 3: The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator Division of Medical Assistance Quality Assurance/Program.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649eb25503460f94bb83ab/html5/thumbnails/3.jpg)
Federal Regulations and State Federal Regulations and State Statutes for MedicaidStatutes for Medicaid
• 42 CFR 455.15(b) and (c)
• NCGS 108A-64, Medical Assistance Recipient Fraud
• NCGS 108A-70.28, Fraudulent Misrepresentation (used for NCHC)
• NCGS.14-100 Obtaining Property by False Pretense
![Page 4: The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator Division of Medical Assistance Quality Assurance/Program.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649eb25503460f94bb83ab/html5/thumbnails/4.jpg)
Why is a Fraud Plan Needed:Why is a Fraud Plan Needed:
• Ensures that your agency is maintaining integrity within the public assistance programs it offers
• Protects the agency when there are accusations of discrimination
• Aids in the workers treating everyone in accordance with county policies
![Page 5: The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator Division of Medical Assistance Quality Assurance/Program.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649eb25503460f94bb83ab/html5/thumbnails/5.jpg)
Suggested Criteria for Fraud PlanSuggested Criteria for Fraud Plan• County’s mission regarding allegations of fraud*• Statement on unusual or extenuating
circumstances• Types of errors (AE, IHE, IPV)• Timeframes for processing of referrals* • Types of investigations (front-ends vs. regular)*• Administrative Disqualification policy (applicable
to FNS and TANF only)• Court action criteria (civil and criminal)• Repayment and Collections policy
![Page 6: The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator Division of Medical Assistance Quality Assurance/Program.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649eb25503460f94bb83ab/html5/thumbnails/6.jpg)
WHO SHOULD BE INVOLVED IN WHO SHOULD BE INVOLVED IN TO CREATING A FRAUD PLANTO CREATING A FRAUD PLAN
• Program Integrity staff• Director• District Attorney’s office• County Attorney/DSS Attorney• Client Advocates*• Social Services Board
![Page 7: The Plan, The Plan: Creating a Fraud Plan Angela Saddler Recipient Investigations Coordinator Division of Medical Assistance Quality Assurance/Program.](https://reader035.fdocuments.in/reader035/viewer/2022072014/56649eb25503460f94bb83ab/html5/thumbnails/7.jpg)
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