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Medicaid Fraud Control Units - MFCUs

Medicaid Fraud Control Units (MFCU) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. Currently, MFCUs operate in 49 States and in the District of Columbia. Forty-four of the MFCUs are located as part of Offices of State Attorneys General; the remaining 6 are in other State agencies. 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 performance standards and recommends program improvements where appropriate. The MFCUs share common characteristics.

Regulations/Statutes

Performance Standards

OIG applies a series of performance standards, developed in accordance with section 1902(a)(61) of the Social Security Act, as part of its oversight of the MFCUs. The standards assist OIG in the certification and recertification of the MFCUs and help to determine whether the MFCUs carry out their duties efficiently and effectively.

Policy Transmittals

Onsite Review Reports

OIG conducts onsite reviews to determine whether Units meet the performance standards and comply with laws, regulations, and policy transmittals. The resulting OIG reports present background on the Units, findings, and recommendations for improvement.

OIG Annual Reports

These reports summarize the activities and accomplishments of all Units for the fiscal year, as well as trends over recent years.

Archived Annual Reports FY 2006-2008

Expenditures & Statistics

As part of its responsibilities to combat Medicaid fraud and patient abuse and neglect, each MFCU maintains statistical information. The information includes numbers of investigations, indictments, and convictions by the MFCUs, as well as the amount of monetary recoveries for both civil and criminal cases. The documents below include an annual summary of this information for the MFCU community as well as a chart and interactive map containing detailed information for each MFCU. The statistical information for each MFCU should be interpreted in light of the State-specific organization and authorities governing the MFCU. For more information, please contact the MFCU directly.

Reporting Medicaid Fraud

You may direct complaints of suspected Medicaid fraud to OIG's Hotline 1-800-HHS-TIPS (1-800-447-8477) or directly to a MFCU or State Medicaid Agency.

Grants Management

Data Mining Applications

Training

Directory of MFCU Directors

Related Links

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201