South Carolina Did Not Fully Comply With Requirements for Reporting and Monitoring Critical Events Involving Medicaid Beneficiaries With Developmental Disabilities

Submitting OIG:

Department of Health & Human Services OIG

Date Issued:

Friday, April 1, 2022

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

A-04-18-07078

Component, if applicable:

Centers for Medicare & Medicaid Services

Centers for Medicare and Medicaid Services

External entity, if applicable:

South Carolina Department of Health & Hu

Location(s):

SC,

United States

Type of Report:

Audit

Questioned Costs:

Funds for Better Use:

Number of Recommendations:

View Document:

Attachment	Size
41807078.pdf	2.58 MB

Recommendation Number	Recommendation Status	Significant Recommendation
22-A-04-048.01	Open	No
We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to ensure that providers follow the reporting requirements for critical events.
22-A-04-048.02	Open	No
We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to provide training to providers on recognizing and reporting critical incidents according to reporting requirements.
22-A-04-048.03	Open	No
We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to perform analytical procedures, such as data matches, on Medicaid claims data to identify any unreported critical incidents, and investigate as needed.
22-A-04-048.05	Open	No
We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to impose sanctions on providers to compel compliance with timely reporting requirements for allegations of ANE and deaths.
22-A-04-048.06	Open	No
We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to require that the IMC contact providers before the results of internal reviews are due to ensure that providers submit such results within required timeframes.
22-A-04-048.08	Open	No
We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to develop and implement strategies and processes to prevent future ANE incidents and unexplained beneficiary deaths.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

22-A-04-048.01

Open

We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to ensure that providers follow the reporting requirements for critical events.

22-A-04-048.02

Open

We recommend that the South Carolina Department of Health and Human Services work with the Department of Disabilities and Special Needs to provide training to providers on recognizing and reporting critical incidents according to reporting requirements.

22-A-04-048.03

Open