Review of Program Integrity Operations At Six Managed Care Organizations Delivering Medicaid Services under a Contract with the South Carolina Department of Health & Human Services

The State contracted with six managed care organizations to deliver Medicaid managed care at an annual cost of $2.7 billion, representing 10% of the State’s annual budget, to 750,000 Medicaid beneficiaries in South Carolina. This review’s scope and objectives were: Test the six MCOs’ compliance and effective execution of the SCDHHS’s managed care contract “Section 11 - Program Integrity” focusing on the operational components of pre-payment review and post-payment review. Identify opportunities to improve SCDHHS’s biennial managed care contract, contract monitoring, and MCO compliance and effective execution of the contract.

Review of Abuse, Neglect, and Exploitation Allegations Involving SC Mentor, a Private Provider for the South Carolina Department of Disabilities and Special Needs

This review was requested by the Department of Disabilities and Special Needs for an independent review of allegations of abuse, neglect, and exploitation at SC Mentor, a private provider of residential services for DDSN consumers. An analysis of incidents did not indicate systemic abuse towards consumers inasmuch as the majority of the ANE reporting system contained allegations more akin to staff/facility performance issues and the vast majority of all allegations were unsustained by independent investigations. In the future, DDSN should expand the level of detail in its ANE reporting, which currently only reports total allegations and sustained criminal incidents.

An Introduction to the office of Inspector General /

Mode of access: Internet.

Background materials relating to Office of Inspector General, Department of Health and Human Services efforts to combat fraud, waste, and abuse [microform] /

"December 1981."

STATE OF SOUTH CAROLINA OFFICE OF THE GOVERNOR DIVISION OF FOSTER CARE REVIEW ANNUAL REPORT - 1994-95

The South Carolina Foster Care Review Board at the Office of Executive Policy and Programs annually publishes a report with summary of programs, recommendations, demographic and statistical information, and directory of state board and staff.

South Carolina Office of the State Treasurer Department of Internal Audit Policies and Procedures Manual

The purpose of this project is to develop a Policy and Procedures Manual as a written guidance for applicable and required procedures to identify processes which will improve the effectiveness of risk management, control, and governance process through the Department of Internal Audit of the South Carolina Office of the State Treasurer's Internal Audit functions.

The State Inspector General’s Annual Report of Fraud Conducted by Executive Branch State Employees Fiscal Year (FY) 2015-2016

The SIG identifies Executive Branch employee fraud through mandatory reporting by each agency; law enforcement reporting; agencies’ annual reports to the Office of the Comptroller General; and open source reporting. In FY 2015-2016, the SIG received twelve notifications of fraud involving 18 Executive Branch employees at ten statewide agencies, which resulted in estimated losses of $1,188,529. This indicates a low risk of employee fraud in the Executive Branch given its $26 billion budget and 60,000 employees.

AGREED-UPON PROCEDURES REPORT ON CONTRACT FOR PURCHASE OF NURSING CARE SERVICES WITH STATE OF SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES

The Medicaid Audits Section of the South Carolina Office of the State Auditor performs audits and reviews of cost reports filed by institutional providers of Medicaid services. These cost reports are used by the Health and Human Services Finance Commission to establish amounts to be paid to these providers for services provided to qualified Medicaid recipients. This report deals with A. Sam Karesh Long Term Care Nursing Facility in North Augusta, S.C.

Review of Preventative Controls for Fraud, Waste, and Abuse in the Supplemental Nutrition Assistance Program (SNAP), Department of Social Services

This review of preventative controls for fraud, waste, and abuse in the Supplemental Nutrition Assistance Program (SNAP), administered by the Department of Social Services, was self-initiated by the State Inspector General as part of a broader statewide review of preventative fraud, waste, and abuse management controls of major benefit programs in State agencies. This review’s scope and objectives were: Assess SNAP’s preventative management controls for fraud, waste, and abuse; Identify SNAP preventative management control best practices; and Identify opportunities to improve SNAP management controls to cost/effectively mitigate risks of fraud, waste, and abuse.

Review of the Community Residential Care Facilities Program, Department of Health and Environmental Control

This review was predicated on a credible complaint alleging substantial health and safety deficiencies in the care of a resident placed in a Community Residential Care Facility (CRCF) in Kershaw County, South Carolina. Initial investigation with subject matter experts, non-profit advocacy groups, and CRCF inspection reports revealed this single incident might be a symptom of systemic health and safety deficiencies throughout DHEC’s CRCF Program, which regulates 471 CRCFs with the approximately 17,000 vulnerable clients, primarily elderly and disabled. This review’s scope and objectives were: Assess the risk of a vulnerable population of elderly and disabled citizens residing in CRCFs living in unsatisfactory health and safety conditions; Evaluate DHEC’s CRCF Program inspection process capabilities to identify and address CRCFs with unsatisfactory health and safety living conditions; Recommend opportunities to improve the CRCF Program.

Review of Two Issues at the Long-Term Commitment Facilities, Department of Juvenile Justice: 1)Safety Threat to Employees & Juveniles; and 2)Event Reporting Process Integrity Allegations

The Legislative Oversight Committee of the South Carolina House of Representatives, referred allegations pertaining to the Department of Juvenile Justice (DJJ) which were generated during its ongoing oversight study of DJJ. Specifically, the safety issues focused on lack of control; lack of trust; and lack of adequate staffing. This review’s scope and objectives were: Investigate specific complainant allegations of DJJ employees underreporting, misreporting, or destroying ERs; Review the efficiency and effectiveness of DJJ’s event reporting process and follow-up on anomalies or potential patterns of systemic underreporting, misreporting, or missing ERs; and Assess juvenile and employee safety conditions through interviewing a cross-section of relevant employees, record review, and possibly an employee survey.

Allegation of a Violation of the State Procurement Code and Other Issues Related to a Statewide Term Contract Involving the Department of Revenue and the Department of Health and Environmental Control

A complainant alleged the Department of Revenue violated the South Carolina Procurement Code. This paper examines that complaint.

Review of Managing the Fraud Risk in the Disaster Supplemental Nutrition Assistance Program (D-SNAP), Administered by the Department of Social Services

This review was initiated based upon allegations from multiple sources of possible fraud in the Disaster Supplemental Nutrition Assistance Program (D-SNAP) administered by the South Carolina Department of Social Services (SCDSS), which was implemented in response to the 10/3/2015 statewide flooding from Hurricane Joaquin. This review’s scope and objectives were: Assess SCDSS’s D-SNAP implementation for compliance with federal guidelines, with emphasis on fraud preventative controls; Assess the SCDSS’s post-disaster review and audit methodology for compliance with federal guidelines, with emphasis on understanding the fraud risks and resolution strategies; and Identify residual risk/suspected fraud not addressed through the SCDSS review and available opportunities to address.

Fiscal Year 2015-16 Accountability Report

The South Carolina Office of Inspector General reports to the Office of State Budget its annual accountability report that includes an executive summary, organization chart, statistics, strategic planning, HR information, and key agency-specific results.

Speech of Mr. Hayne, of South Carolina, on Mr. Foot's resolution, proposing an inquiry into the expediency of abolishing the office of surveyor general of public lands, and for discontinuing further surveys, &c. Delivered in the Senate of the United States January 21, 1830.

Mode of access: Internet.