Evidence record
North Dakota Medicaid Fraud Control Unit: 2025 Inspection
- Jurisdiction
- North Dakota
- Audit organization
- Office of Inspector General, U.S. Department of Health and Human Services
- Publication date
- August 2026
- Source record
- Metadata record
Findings
8
Recommendations
6
Overall 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.
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.
Findings (8)
Each finding has a stable link.
- F-1313
The Unit Director did not oversee all aspects of the Unit’s investigative work.
- F-1314
The Unit’s electronic case management system did not allow the Unit to efficiently access case information.
- F-1315
The Unit did not consistently document relevant facts, information, and supervisory reviews in its case files.
- F-1316
The Unit’s MOU with the PIU did not reference the CMS Performance Standard for Referrals, as required.
- F-1317
The Unit’s inventory list was not fully accurate.
- F-1318
The Unit received few fraud referrals from the PIU and MCO, despite outreach.
- F-1319
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.
- F-1320
Nearly half of the Nonglobal case files did not contain documentation of supervisory approvals to open a case.
Recommendations (6)
- R-1168
Ensure that the Unit Director oversees all aspects of the Unit’s investigative work
Related finding F-1313 - R-1169
Build upon its efforts to increase the volume and quality of fraud referrals from the PIU and MCO
Related finding F-1318 - R-1170
Implement a case management system that allows efficient access to case information
Related finding F-1314 - R-1171
Ensure that case files document all relevant facts, information, and supervisory reviews
Related finding F-1315 - R-1172
Revise the Unit’s MOU with the PIU to include reference to the CMS Performance Standard for Referrals
Related finding F-1316 - R-1173
Ensure that the Unit’s inventory list is accurate
Related finding F-1317