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Medicaid Fraud Control Unit (MFCU)

Overview

Medicaid Fraud Control Units (MFCU or Unit) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. OIG certifies, and annually recertifies, each MFCU. OIG collects information about MFCU operations and assesses whether they comply with statutes, regulations, and OIG policy. OIG also analyzes MFCU performance based on 12 published performance standards and recommends program improvements where appropriate.

The MFCUs share common characteristics:

• MFCUs must be “single, identifiable” entities whose professional staff are required to work full-time on MFCU duties.

• States administer the MFCUs, but they are jointly funded on a matching basis with the Federal Government. (The Federal Government pays 90 percent of a Unit's costs for the first 3 years of a Unit's operation and 75 percent for subsequent years; the States pay the remaining portion.)

• MFCUs operate on an interdisciplinary model and must employ investigators, auditors, and attorneys.

• The MFCUs are required to have statewide authority to prosecute cases or to have formal procedures to refer suspected criminal violations to an office with such authority.

• The MFCUs' investigative authority extends to Medicaid-funded facilities and to "board and care" facilities that do not receive Medicaid funding. OIG, or another agency's Inspector General, may in some circumstances permit the Units to investigate fraud in Medicare or other Federal programs.

From Office of Inspector General, Department of Health & Human Services, http://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/index.asp (accessed Apr. 21, 2012).