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Series: OIG Oversight of Medicaid Fraud Control Units

Announced on  | Last Modified on  | Series Number: SRS-E-26-001
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

The 53 Medicaid Fraud Control Units (MFCUs)-located in the 50 States, the District of Columbia, Puerto Rico, and the Virgin Islands-investigate and prosecute Medicaid provider fraud as well as complaints of abuse or neglect in health care facilities, board and care facilities, and of Medicaid beneficiaries in noninstitutional or other settings. OIG provides oversight for MFCUs and administers a Federal grant award to fund a portion of each MFCU's operational costs. OIG, in exercising oversight for MFCUs, annually recertifies each MFCU and assesses each MFCU's performance and compliance with Federal requirements. OIG also provides technical assistance and training, and identifies effective practices in MFCU management and operations. We will perform onsite reviews of a sample of MFCUs. We will also issue an annual report that will analyze the statistical information that was reported by MFCUs, describing in the aggregate the outcomes of MFCU criminal and civil cases. The report will also identify trends in MFCU case results.

There are 5 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (4)

Project OEI-06-25-00150 • Announced on Oct 1, 2025

Project OEI-07-25-00140 • Announced on Oct 1, 2025

Project OEI-07-26-00020 • Announced on Oct 1, 2025

Project OEI-09-24-00410 • Announced on Oct 1, 2025

COMPLETED PROJECTS IN THIS SERIES (1)

OIG Oversight of Medicaid Fraud Control Units

Project OEI-07-25-00060 • Completed on December 12, 2025

TIMELINE

  • October 1, 2025
    Series Number SRS-E-26-001 Assigned
  • October 1, 2025
    Projects Announced

    Project OEI-06-25-00150

  • OIG Oversight of Medicaid Fraud Control Units - OEI-07-25-00060

  • Project OEI-07-25-00140

  • Project OEI-07-26-00020

  • Project OEI-09-24-00410

  • December 12, 2025
    Project Complete - OEI-07-25-00060

    OIG Oversight of Medicaid Fraud Control Units has been marked as complete. This evaluation resulted in 7 recommendations.

  • Today
    4 Evaluations In-Progress
  • Est FY2027
    Estimated Fiscal Year for Series Completion

1 REPORT PUBLISHED

Oklahoma Medicaid Fraud Control Unit: 2025 Inspection (OEI-07-25-00060)

The Oklahoma Unit reported 55 indictments, 49 convictions, 17 civil settlements, and $10.1 million in recoveries during our review period of fiscal years 2022–2024. The Unit maintained positive working relationships with external partners; made recommendations to the State Medicaid agency to limit improper payments; and investigated fraud and patient abuse or neglect cases involving a mix of provider types. However, the Unit did not always adhere to the MFCU performance standards or comply with applicable requirements.

  • The Unit’s policies and procedures did not address certain aspects of its operations.
  • The Unit took steps to maintain an adequate volume and quality of fraud referrals from the Program Integrity Unit (PIU) and managed care organizations (MCOs), but the Unit received few fraud referrals from these sources during our review period.
  • Sixteen percent of cases open during our review period had significant investigative delays.
  • The Unit lacked a case management system capable of efficiently managing and reporting case information and performance data.
  • The Unit did not consistently conduct and document periodic supervisory reviews of cases during our review period.
  • The Unit did not report substantial proportions of its adverse actions and convictions to Federal partners within the required timeframes.
  • The Unit’s memorandum of understanding (MOU) with the State Medicaid agency generally reflected current practice, policy, and legal requirements, but the MOU did not reference the CMS Performance Standard for Referrals.

26-E-07-010.01 to MFCU - Open Unimplemented
Update expected on 06/11/2026
Update its policies and procedures manual to address certain aspects of its operations.

26-E-07-010.02 to MFCU - Open Unimplemented
Update expected on 06/11/2026
Build upon its efforts to increase the volume and quality of fraud referrals from the PIU and MCOs.

26-E-07-010.03 to MFCU - Open Unimplemented
Update expected on 06/11/2026
Take steps to mitigate investigative delays.

26-E-07-010.04 to MFCU - Open Unimplemented
Update expected on 06/11/2026
Take steps to implement a case management system capable of efficiently managing and reporting case information and performance data.

26-E-07-010.05 to MFCU - Open Unimplemented
Update expected on 06/11/2026
Take steps to conduct and document periodic supervisory reviews of cases in accordance with Unit policy.

26-E-07-010.06 to MFCU - Open Unimplemented
Update expected on 06/11/2026
Take steps to ensure that it reports all convictions and adverse actions to Federal partners within the appropriate timeframes.

26-E-07-010.07 to MFCU - Open Unimplemented
Update expected on 06/11/2026
Revise its MOU with the State Medicaid agency to reference the CMS Performance Standard for Referrals.

View in Recommendation Tracker
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
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Target Groups
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Financial Groups
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