New DHS compliance and integrity unit to investigate beneficiaries for fraud | Arkansas Blog

Thursday, September 14, 2017

New DHS compliance and integrity unit to investigate beneficiaries for fraud

Posted By on Thu, Sep 14, 2017 at 1:33 PM

click to enlarge MORE REORGANIZATION: DHS Director Cindy GIllespie (file photo). - BRIAN CHILSON
  • BRIAN CHILSON
  • MORE REORGANIZATION: DHS Director Cindy GIllespie (file photo).

The Arkansas Department of Human Services (DHS) on Thursday announced the creation of a new unit that will focus on fighting beneficiary fraud and "fraudulent activities" in non-Medicaid programs. DHS is creating the Office of Security, Compliance and Integrity as part of Director Cindy Gillespie's ongoing efforts to reorganize the sprawling agency.

It bears repeating that this unit will investigate Medicaid beneficiaries. Provider fraud will continue to be investigated by the independent Office of Medicaid Inspector General; the Attorney General's office also does that through its Medicaid Fraud Control Unit.

Gillespie said in a press release that the new unit will allow DHS to "beef up the work we do to protect the integrity of our programs and do more to identify beneficiary fraud and fraudulent activities in the programs we administer. ... It’s incumbent upon us as an agency to protect the integrity of programs so that they remain strong for those who need them and to ensure state dollars are used wisely."

(Two editorial observations. First, although the outcome of Gillespie's ambitious plans to remake DHS remain to be seen, her efforts seem largely credible to me. Ensuring compliance is part of the job of any agency, and fraud has been a major problem in the summer feeding program overseen by DHS. Second, though, I find it hard to accept the idea that beneficiary fraud is a major problem, in part because I feel basic health care is something that should be available to everyone. There's a huge difference between a provider illicitly milking Medicaid for thousands of dollars and an individual illicitly seeking health insurance. But there's another problem with aggressively investigating beneficiaries: Medicaid is a convoluted program that's difficult to navigate even for providers, experts, and sometimes DHS itself. It seems to me there's a risk that beneficiaries could be investigated for honest mistakes, such as not dropping coverage if their income fluctuates.)

When asked if the agency had any sense of how large of a problem beneficiary fraud currently is, DHS spokesperson Amy Webb said it did not. "That's one of the reason why we feel we need to move forward with this reorganization ... we may be able to find some numbers for the state," she said

Webb said that the unit's investigative work could potentially lead to criminal prosecution of beneficiaries that committed fraud. She noted that Medicaid beneficiaries are supposed to be proactive about communicating with DHS. "When people's situation changes, they're required by law to give us notice within 10 days," she said.

The full release:
DHS Continues Re-organization to Strengthen Agency’s Internal Integrity, Controls

The Arkansas Department of Human Services (DHS) announced Thursday it will re-organize several units into a new Office of Security, Compliance and Integrity as part of an effort to strengthen the agency’s internal integrity and controls and bolster its ability to find and fight fraud. The new office will report to David Sterling, Senior Legal Advisor and Chief Counsel at DHS.

“After significant re-organization in other areas, we are now able to beef up the work we do to protect the integrity of our programs and do more to identify beneficiary fraud and fraudulent activities in the programs we administer. This new office will help us do that,” said DHS Director Cindy Gillespie. “It’s incumbent upon us as an agency to protect the integrity of programs so that they remain strong for those who need them and to ensure state dollars are used wisely.”

The Office of Security, which is led by retired U.S. Secret Service Special Agent-In-Charge of the Little Rock field office Brian Marr, will be renamed the Office of Security, Compliance and Integrity. It will oversee the Fraud and Internal Affairs units, as well as a new “watchdog” unit focused on non-Medicaid program integrity under its Compliance and Integrity arm so that all can work more effectively together. Michael Crump, a former prosecutor in Pulaski County, will be responsible for managing the Compliance and Integrity arm of the office. He will work closely with the independent Office of Medicaid Inspector General, which investigates Medicaid provider fraud and is responsible for Medicaid program integrity.

Crump has worked for DHS for 10 years, most recently as Assistant Director of Operations within the Division of Medical Services. He also recently participated in an intensive Lean Six Sigma training program and will use those new skills to oversee four Lean Six Sigma projects dealing with identifying, investigating and prosecuting beneficiary fraud. Lean Six Sigma is a team-based approach to systematically reducing waste and variation in business processes. Gillespie said the hope is that by improving processes, the agency will identify and investigate more beneficiary fraud allegations in programs like SNAP and Medicaid and will work more closely with prosecutors across the state to seek convictions.

Marr will continue to be responsible for planning, developing and administering security and safety programs and procedures for DHS personnel and facilities across the state, DHS’s emergency assistance functions, as well as overseeing the new Compliance and Integrity arm.

“I’m confident that Michael and Brian can lead this department in making sure our programs are strong and are upholding the highest standards of integrity, and that people who are receiving services are truly eligible and are doing what is required of them to participate,” Sterling said.

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