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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, Medicaid Fraud Control Unit

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 13 projects in this series.

Project titles will remain unpublished until projects are complete and reports are posted.

ACTIVE PROJECTS IN THIS SERIES (8)

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

Project OEI-06-26-00100 • Announced on Dec 17, 2025

Project OEI-12-26-00160 • Announced on Jan 28, 2026

Project OEI-04-26-00290 • Announced on Apr 15, 2026

Project OEI-06-26-00300 • Announced on Apr 27, 2026

Project OEI-04-26-00360 • Announced on Jun 30, 2026

Project OEI-07-26-00380 • Announced on Jul 20, 2026

Project OEI-07-26-00550 • Announced on Aug 5, 2026

COMPLETED PROJECTS IN THIS SERIES (5)

OIG Oversight of Medicaid Fraud Control Units

Project OEI-09-24-00410 • Completed on September 23, 2026

OIG Oversight of Medicaid Fraud Control Units

Project OEI-07-25-00140 • Completed on September 14, 2026

Alabama Medicaid Fraud Control Unit: 2025 Inspection

Project OEI-04-25-00400 • Completed on September 9, 2026

OIG Oversight of Medicaid Fraud Control Units

Project OEI-06-25-00150 • Completed on June 30, 2026

OIG Oversight of Medicaid Fraud Control Units

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

TIMELINE

  • September 15, 2025
    Project Announced

    Alabama Medicaid Fraud Control Unit: 2025 Inspection - OEI-04-25-00400

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

    OIG Oversight of Medicaid Fraud Control Units - OEI-06-25-00150

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

  • OIG Oversight of Medicaid Fraud Control Units - OEI-07-25-00140

  • Project OEI-07-26-00020

  • OIG Oversight of Medicaid Fraud Control Units - 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.

  • December 17, 2025
    Project Announced

    Project OEI-06-26-00100

  • January 28, 2026
    Project Announced

    Project OEI-12-26-00160

  • April 15, 2026
    Project Announced

    Project OEI-04-26-00290

  • April 27, 2026
    Project Announced

    Project OEI-06-26-00300

  • June 30, 2026
    Project Complete - OEI-06-25-00150

    OIG Oversight of Medicaid Fraud Control Units complete. This evaluation resulted in 3 recommendations.

  • June 30, 2026
    Project Announced

    Project OEI-04-26-00360

  • July 20, 2026
    Project Announced

    Project OEI-07-26-00380

  • August 5, 2026
    Project Announced

    Project OEI-07-26-00550

  • September 9, 2026
    Project Complete - OEI-04-25-00400

    Alabama Medicaid Fraud Control Unit: 2025 Inspection complete. This evaluation resulted in 9 recommendations.

  • September 14, 2026
    Project Complete - OEI-07-25-00140

    OIG Oversight of Medicaid Fraud Control Units complete. This evaluation resulted in 4 recommendations.

  • September 23, 2026
    Project Complete - OEI-09-24-00410

    OIG Oversight of Medicaid Fraud Control Units complete. This evaluation resulted in 6 recommendations.

  • Today
    8 Evaluations In-Progress
  • Est FY2028
    Estimated Fiscal Year for Series Completion

5 REPORT PUBLISHED

Florida Medicaid Fraud Control Unit: 2025 Inspection (OEI-06-25-00150)

From total Federal and State operational expenditures of approximately $62.1 million, the Florida MFCU reported 217 indictments, 170 convictions, 39 civil settlements and judgments, and nearly $182.9 million in recoveries during our review period of FYs 2022–2024. The Unit maintained strong working relationships with Federal partners, took steps to address vacancies and staff turnover, and maintained a continuous case flow. However, the Unit did not always adhere to the MFCU performance standards or comply with applicable requirements. We found:

  • The Unit took steps to improve the quality of referrals of fraud and patient abuse and neglect from its primary referral sources but further action is needed.
  • The Unit did not consistently report adverse actions to the National Practitioner Data Bank (NPDB) within the appropriate timeframe but had improved its reporting since the last OIG inspection.
  • The Unit’s training plan lacked annual minimum training hour requirements for some of its investigators, although all staff received, on average, more than 30 hours of training each year.

26-E-06-028.01 to MFCU - Open Unimplemented
Update expected on 12/29/2026
Build upon its efforts to improve the quality of referrals from its primary referral sources.

26-E-06-028.02 to MFCU - Open Unimplemented
Update expected on 12/29/2026
Take steps to ensure that it reports all adverse actions to the NPDB within the required timeframe.

26-E-06-028.03 to MFCU - Open Unimplemented
Update expected on 12/29/2026
Update its training plan to include annual minimum training hour requirements for each professional discipline.

View in Recommendation Tracker

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 - Closed Implemented
Closed on 07/01/2026
Take steps to mitigate investigative delays.

26-E-07-010.04 to MFCU - Closed Implemented
Closed on 07/01/2026
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 - Closed Implemented
Closed on 07/01/2026
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 - Closed Implemented
Closed on 07/01/2026
Revise its MOU with the State Medicaid agency to reference the CMS Performance Standard for Referrals.

View in Recommendation Tracker

North Carolina Medicaid Fraud Control Unit: 2025 Onsite Inspection (OEI-07-25-00140)

With an average staff size of 48 during the review period, FY 2022 through FY 2024, the Unit reported 16 indictments, 26 convictions, 41 civil settlements and judgments, and $98,507,530 in recoveries.

27-E-07-003.01 to MFCU - Open Unimplemented
Update expected on 03/13/2027
Build upon its efforts to attain sufficient staffing by recruiting and retaining qualified staff and minimizing case disruptions during staffing shortages.

27-E-07-003.02 to MFCU - Open Unimplemented
Update expected on 03/13/2027
Update policies and procedures to establish processes for sharing referrals and engaging in consistent deconfliction of cases with Federal partners including OIG and USAO.

27-E-07-003.03 to MFCU - Open Unimplemented
Update expected on 03/13/2027
Develop and implement a plan with the DOJ financial office to support robust fiscal controls.

27-E-07-003.04 to MFCU - Open Unimplemented
Update expected on 03/13/2027
Update its training plan requirements for auditor and investigator staff and verify that all staff meet the Unit's training requirements.

View in Recommendation Tracker

Georgia Medicaid Fraud Control Unit: 2024 Onsite Inspection (OEI-09-24-00410)

26-E-09-038.01 to MFCU - Open Unimplemented
Update expected on 03/22/2027
Examine position descriptions and salaries to ensure a fair and competitive salary and benefit package that enables the Unit to recruit and retain qualified staff.

26-E-09-038.02 to MFCU - Open Unimplemented
Update expected on 03/22/2027
Expand efforts to increase fraud and patient abuse or neglect referrals.

26-E-09-038.03 to MFCU - Open Unimplemented
Update expected on 03/22/2027
Take steps to ensure that periodic supervisory reviews are documented in the case files.

26-E-09-038.04 to MFCU - Open Unimplemented
Update expected on 03/22/2027
Take steps to ensure timely reporting of all convictions and adverse actions to Federal partners.

26-E-09-038.05 to MFCU - Open Unimplemented
Update expected on 03/22/2027
Establish written policies and procedures for maintaining an inventory of the Unit's equipment.

26-E-09-038.06 to MFCU - Open Unimplemented
Update expected on 03/22/2027
Include information to track equipment in the Unit's equipment inventory list.

View in Recommendation Tracker

Alabama Medicaid Fraud Control Unit: 2025 Inspection (OEI-04-25-00400)

27-E-04-002.01 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Hire additional staff in accordance with its approved budget and in relation to State Medicaid expenditures

27-E-04-002.02 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Develop a plan to expand the size of the Unit

27-E-04-002.03 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Update its policies to include coordinating cases with Federal partners

27-E-04-002.04 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Reinforce the terms of the MOU with the PIU to increase the number of fraud referrals

27-E-04-002.05 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Ensure that periodic supervisory reviews of case files are consistently documented

27-E-04-002.06 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Implement a new case management system that allows for efficient access and accurate reporting

27-E-04-002.07 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Improve communication with the USAO in the Southern District

27-E-04-002.08 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Report all adverse actions to the NPDB within the required timeframes

27-E-04-002.09 to MFCU - Open Unimplemented
Update expected on 03/08/2027
Revise the 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 Medicaid Fraud Control Unit
Issue Areas
OIG Statutory Authority and Regulatory Matters Managed Care Financial Stewardship
Target Groups
-
Financial Groups
Medicaid