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Medicaid Fraud Control Units - MFCUs

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in health care facilities and board and care facilities. MFCUs operate in 49 States and the District of Columbia. The 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


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

MFCU Activities and OIG Oversight

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.

Annual Summary of Grant Expenditures and Statistics

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.

Data Mining Applications

Reporting MFCU Information to OIG

Submit Convictions for Exclusion

Submit Convictions for Exclusion is a digital service to assist in the reporting of MFCU conviction information to OIG for purposes of program exclusion under section 1128 of the Social Security Act. MFCU performance standards state that MFCUs should, on a timely basis, transmit to OIG all pertinent information on MFCU convictions.

Submit the MFCU's Annual Statistical Report (ASR)

OIG requests that ASR information be provided on the OMB MAX portal no later than November 30.

State Enforcement Actions

Grants Management

Other Resources


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