Evidence record
Alabama Medicaid Fraud Control Unit: 2025 Inspection
- Jurisdiction
- Alabama
- Audit organization
- Office of Inspector General, U.S. Department of Health and Human Services
- Publication date
- September 2026
- Source record
- Metadata record
Findings
14
Recommendations
9
Overall conclusion
Overall, the Alabama MFCU generally performed in line with many standards and produced substantial case outcomes, but the inspection identified deficiencies in staffing, referral generation, case information management, and coordination with Federal partners. OIG recertified the Alabama MFCU on April 24, 2026, but noted two concerns that may limit effectiveness: staffing levels and adequacy of referrals.
Scope
Inspection of the Alabama Medicaid Fraud Control Unit covering FYs 2023–2025, conducted December 2025, examining Unit documentation, financials, interviews, a random sample of 64 nonglobal case files (out of 134 open during the period), review of all NPDB and OIG submissions, and observations of Unit operations; applied applicable MFCU performance standards.
Findings (14)
Each finding has a stable link.
- F-1370
The Unit assigned agents to work non-MFCU duties during the review period.
- F-1371
The Unit did not maintain staffing levels in accordance with its approved budget nor in relation to State Medicaid expenditures.
- F-1372
The Unit maintained policies and procedures but did not address coordination on Unit cases.
- F-1373
The Unit received few fraud referrals from the PIU, despite outreach efforts.
- F-1374
The Unit maintained continuous case flow and completed nearly all cases without delays.
- F-1375
The Unit’s case mix included both fraud and patient abuse or neglect cases and covered a range of provider types.
- F-1376
Of the Unit’s cases open 90 days or more, the majority lacked at least some documentation of required periodic supervisory reviews.
- F-1377
The Unit lacked a case management system capable of efficiently managing and reporting accurate case information and performance data.
- F-1378
The Unit maintained positive working relationships with most Federal law enforcement partners but did not have regular communication with the U.S. Attorney’s Office in the Southern District.
- F-1379
The Unit did not report one adverse action to the National Practitioner Data Bank (NPDB) within the required timeframes.
- F-1380
The Unit’s MOU with the State Medicaid Agency generally reflected current practice, policy, and legal requirements, but the MOU did not reference the CMS Performance Standard for Referrals.
- F-1381
We identified no deficiencies in the Unit’s fiscal control of its resources.
- F-1382
Unit staff generally met the Unit’s training requirements and completed training that aided in the Unit’s mission.
- F-1383
The Unit developed and shared the Narcotic Diversion Analysis Template (N-DAT) to streamline investigations for drug diversion cases.
Recommendations (9)
- R-1232
Hire additional staff in accordance with its approved budget and in relation to State Medicaid expenditures
Related finding F-1371 - R-1233
Develop a plan to expand the size of the Unit
Related finding F-1371 - R-1234
Update its policies to include coordinating cases with Federal partners
Related finding F-1372 - R-1235
Reinforce the terms of the MOU with the PIU to increase the number of fraud referrals
Related finding F-1373 - R-1236
Ensure that periodic supervisory reviews of case files are consistently documented
Related finding F-1376 - R-1237
Implement a new case management system that allows for efficient access and accurate reporting
Related finding F-1377 - R-1238
Improve communication with the USAO in the Southern District
Related finding F-1378 - R-1239
Report all adverse actions to the NPDB within the required timeframes
Related finding F-1379 - R-1240
Revise the MOU with the State Medicaid Agency to reference the CMS Performance Standard for Referrals
Related finding F-1380