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.
- 42 CFR pt. 1007 "State Medicaid Fraud Control Units"
- Final Rule: State Medicaid Fraud Control Units; Data Mining (78 FR 29055)
- 42 CFR section 455.23 CMS Payment Suspension Rule (effective March 25, 2011)
- 45 CFR pt. 92 "Uniform Administrative Requirements for Grants and Cooperative Agreements to State, Local, and Tribal Governments"
- OMB Circular A-87 "Cost Principles for State, Local, and Indian Tribal Governments" (incorporated by 45 CFR section 92.22)
- Social Security Act Provisions
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.
On occasion, OIG issues policy transmittals to provide guidance and instructions to MFCUs. The transmittals may also provide interpretations of Federal regulations, statutes, and other policies as they apply to MFCUs.
- 90-1 Definition of Convictions and Plea Negotiations
- 99-01 Investigation, Prosecution, and Referral of Civil Fraud Cases
- 99-02 Public Disclosure Requests and Safeguarding of Privacy Rights
- 2000-1 Extended Investigative Authority
- 2010-1 Program Income
- 2013-1 MFCU Authority in Personal Care Waiver Cases
- 2013-2 Elements of and Process for Submitting a Complete Data Mining Application
- 2014-1 Employment and Reimbursement of Full- and Part- Time Staff and Performance of
- 89-1 Full-time and Part-time Employees (Archived)
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.
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.
- Statistics for Each MFCU
- Annual Summary of Grant Expenditures and Statistics
- Quarterly Statistical Report Template
- Quarterly Statistical Report Instructions
- General Terms and Conditions
- MFCU Financial Grant Overview
On June 21, 2012, OIG conducted the webcast MFCU Grants Overview. MFCU staff members who would like to view the webcast may email MFCUgrants@oig.hhs.gov to obtain the link and passcode.
- SF 424 (includes SF 424a and SF 424b)
- SF 425
- Budget Calendar
- MFCU Financial Grant Overview
MFCU staff members who would like to view a webcast version may email MFCUgrants@oig.hhs.gov to obtain the link and passcode.
- MFCU Onsite Review Process
- Cost Allocation and Indirect Cost Rates
- OIG Exclusion Program
- National Practitioner Data Bank MFCU Reporting Requirements
- State Long-Term Care Ombudsman Programs
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Priority recommendations summarized.
FY 2014 Work Plan
OIG projects planned for 2014.
Significant OIG activities in 6-month increments.