Medicaid Fraud Control Units

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as abuse or neglect of residents in health care facilities and board and care facilities and of Medicaid enrollees in noninstitutional or other settings. MFCUs operate in each of the 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. MFCUs, usually a part of the State Attorney General's office, employ teams of investigators, attorneys, and auditors; are constituted as single, identifiable entities; and must be separate and distinct from the State Medicaid agency. OIG, in exercising oversight for the MFCUs, annually recertifies each MFCU, assesses each MFCU's performance and compliance with Federal requirements, and administers a Federal grant award to fund a portion of each MFCU's operational costs.

Program Requirements and Standards

- 42 CFR Part 1007, Revisions to State Medicaid Fraud Control Units Rules
  - Source: 84 FR 10700, March 22, 2019
  - Archived: 42 CFR Part 1007, State Medicaid Fraud Control Units (superseded May 21, 2019)
- 42 CFR Part 455, Program Integrity: Medicaid (as amended May 21, 2019)
- 45 CFR Part 75, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards (applicable to MFCU grant awards for FY 2016 and future years)
- Social Security Act Provisions
Archived Administrative Requirements and Cost Principles
(applicable to FY 2015 and prior MFCU grant awards)
- 45 CFR Part 92
- OMB Circular A-87
The terms and conditions of the award include all legally enforceable requirements pertaining to the award, whether included in statute, regulation, policy guidance, or this award document.

General Terms and Conditions
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.

Performance Standards, 89 FR 76431 (effective September 18, 2024)
- Performance Standards, 77 FR 32645 (Archived)
On occasion, OIG and other Federal agencies issue policy transmittals (designated below by year and sequence of publication) and other guidance materials applicable to MFCUs. The materials provide interpretations or implement Federal regulations and statutes.
Archive

Archived policy transmittals and other guidance are found here. OIG archives policy transmittals and other policy guidance when the guidance has been updated, been replaced by regulation, or become obsolete.

MFCU Activities and OIG Oversight

OIG conducts periodic reviews and inspections of individual MFCUs 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, observations, findings, and recommendations for improvement.
- Go to Individual MFCU Reports
These reports summarize the activities and accomplishments of all Units for the fiscal year, as well as trends over recent years.
- FY 2023
- FY 2022
- FY 2021
- FY 2020
- FY 2019
- FY 2018
- FY 2017
- FY 2016
- FY 2015
- FY 2014
- FY 2013
Annual Summary of Grant Expenditures and Statistics
- FY 2012
- FY 2011
- FY 2010
- FY 2009
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 Statistical Reporting (ASR)
  - ASR Template (FY 2023 and future years)
    - ASR Template (FYs up to 2022) (Archived)
  - ASR Definitions and Instructions Effective 10.1.22 (FY 2023 and future years)
    - ASR Definitions and Instructions Effective 8.17.17 (FYs up to 2022) (Archived)
Data Mining Applications
Reporting MFCU Convictions

Federal regulations state that MFCUs should, on a timely basis, transmit to HHS-OIG all pertinent information on MFCU convictions. MFCUs must use the Exclusion Referrals portal to transmit this information.
- Visit the Exclusion Referrals portal
Submit the MFCU's Annual Statistical Report (ASR)

OIG requests that ASR information be provided through the ASR Portal no later than November 30.
- Visit the ASRPortal
State Enforcement Actions
OIG administers the MFCU awards, which are non-discretionary grants to each of the States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Eligibility and funding are specified in the statute and regulation referenced above. Following are resources to aid the MFCUs throughout the lifecycle of the grant. If you have any questions, please reach out to the grants management officer listed on your notice of award.
- Grant Calendar
- Grants.gov Standard forms commonly used by the MFCUs are found at this link, including SF 424M (application for Federal assistance for non-discretionary grants); SF-424A (budget summary); and SF-425 (Federal Financial Report-FFR)
- HHS Division of Payment Management
Certification Letters

Other Resources

- Directory of MFCU Directors

Medicaid Fraud Control Units

Program Requirements and Standards

Archive

MFCU Activities and OIG Oversight

Reporting MFCU Convictions

Submit the MFCU's Annual Statistical Report (ASR)

Other Resources