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Medicaid Fraud Control Unit Data Mining: Outcomes, Challenges, and Beneficial Practices

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid health care fraud and patient abuse or neglect. Since 2013, MFCUs have had the option to apply to OIG for approval to use data mining. This program integrity method could improve MFCUs' ability to identify potential fraud and patient abuse or neglect cases and more effectively target their resources to significant areas of vulnerability. We will examine MFCUs' experiences in implementing and using data mining, including any challenges and specific successes, and we will also evaluate the outcomes of their activities.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
March 2022 Centers for Medicare and Medicaid Services Medicaid Fraud Control Unit Data Mining: Outcomes, Challenges, and Beneficial Practices Office of Evaluation and Inspections OEI-09-22-00120 2022