Procedures for Reporting Suspected Fraud

H13- 011– Procedure March 5, 2013

TO: Home and Community Services (HCS) Division Regional Administrators Area Agency on Aging (AAA) Directors Developmental Disabilities Administration (DDA) Regional Administrators

FROM: Kathy Leitch, Assistant Secretary, Developmental Disabilities Administration Bea-Alise Rector, Director, Home and Community Services Division

SUBJECT: Procedures for Reporting Suspected Fraud PURPOSE: To provide instructions to ADSA staff on how to report instances of suspected fraud by ADSA clients and providers. This MB rescinds the previous MB H10-040, dated June 15, 2010. BACKGROUND: Suspected Medicaid provider fraud must be reported to the Medicaid Fraud and Control Unit (MFCU) and to the Office of Program Integrity (OPI) at the Health Care Authority. All other suspected fraud must be reported to the Office of Fraud and Accountability (OFA). MFCU and OFA collaborate on investigations that may involve both entities. ADSA must track the number, type and disposition of referrals for reporting to state and federal entities.

Currently, suspected fraud is reported directly to either MFCU or OFA by field staff. This process does not include OPI and does not provide a centralized system to track and report referrals.

WHAT’S NEW, Field staff will no longer report suspected fraud directly to MFCU or OFA. CHANGED, OR Reports will now be submitted to ADSA headquarters (HQ). ADSA HQ will CLARIFIED forward the reported information to OPI, MFCU and/ or OFA, as required. New reporting forms have been developed to standardize and centralize fraud reporting.

All instances of suspected fraud must be reported regardless of the alleged dollar amount involved.

ADSA HQ staff will monitor, track, and report on the follow-up provided by the fraud investigators.

ACTION: Effective immediately, all HCS/AAA/DDA staff must report:  All suspected client fraud by completing DSHS Form 12-209.  All suspected provider fraud by completing DSHS Form 12-210. Once completed, staff must email these forms to: [email protected] RELATED REFERENCES: None ATTACHMENT(S): DSHS 12-209 Client Fraud Report DSHS 12-210 Provider Fraud Report

CONTACT(S): Reagan Charuhas, Statewide Investigation Unit (SIU), DDA (360) 725-3453 [email protected]

Linda Lunsford, Program Manager, DDA (360) 725-3440 [email protected]

Jennifer Smith, Program Integrity Manager, HCS (360) 725-2551 [email protected]