North Dakota Medicaid Fraud Control Unit: 2025 Inspection
Learn how the AI-generated research projects were createdOverall Conclusion
The Unit did not fully conform to several performance standards during FYs 2022–2024, but concurred with all recommendations and has taken corrective actions, including implementing a new case management system in 2026 and updating the MOU with CMS standards. This progress is expected to strengthen the Unit’s compliance and operations.
Audit Scope
Onsite inspection conducted in August 2025, covering FYs 2022–2024, to assess the North Dakota MFCU’s performance and operations under the MFCU grant program and CMS standards.
Key Findings Summary
The Unit Director did not oversee all aspects of the Unit’s investigative work.
The Unit’s electronic case management system did not allow the Unit to efficiently access case information.
The Unit did not consistently document relevant facts, information, and supervisory reviews in its case files.
View the Findings tab to see all 8 findings
AI-Assisted
AI Scope Summary
The North Dakota Medicaid Fraud Control Unit: 2025 Inspection aimed to evaluate the unit’s compliance with the MFCU performance standards and overall operations over FYs 2022–2024 through an onsite review in August 2025, identifying deficiencies in investigative leadership, case management, documentation, referrals, and fiscal controls, and noting corrective actions taken, including a new case management system and updated MOU; the objective is to inform future audits and strengthen oversight of similar units.
AI-Generated Insight
This inspection identified governance and information-management gaps at the North Dakota MFCU, including supervisory oversight of investigations, disparate case-management systems, and incomplete case-file documentation, with improvements underway such as a new case-management system launched in 2026 and an updated MOU reflecting CMS referral standards. The findings provide a basis for ongoing monitoring of case referrals, documentation practices, and data integration across systems.
Audit Objectives
To assess the performance and operations of the North Dakota Medicaid Fraud Control Unit (MFCU or Unit).
Audit Findings (8)
The Unit Director did not oversee all aspects of the Unit’s investigative work.
The Unit’s electronic case management system did not allow the Unit to efficiently access case information.
The Unit did not consistently document relevant facts, information, and supervisory reviews in its case files.
The Unit’s MOU with the PIU did not reference the CMS Performance Standard for Referrals, as required.
The Unit’s inventory list was not fully accurate.
The Unit received few fraud referrals from the PIU and MCO, despite outreach.
The Unit did not always report adverse actions and convictions to Federal partners within required timeframes, but the Unit corrected this issue during our review period.
Nearly half of the Nonglobal case files did not contain documentation of supervisory approvals to open a case.
Recommendations (6)
Ensure that the Unit Director oversees all aspects of the Unit’s investigative work
Build upon its efforts to increase the volume and quality of fraud referrals from the PIU and MCO
Implement a case management system that allows efficient access to case information
Ensure that case files document all relevant facts, information, and supervisory reviews
Revise the Unit’s MOU with the PIU to include reference to the CMS Performance Standard for Referrals
Ensure that the Unit’s inventory list is accurate