Medicaid Fraud

Barbara L. Zelner, Executive Director, National Association of Medicaid Fraud Control Units (NAMFCU)

The National Association of Medicaid Fraud Control Units (NAMFCU) founded in 1978, represents the 50 federally certified state Medicaid Fraud Control Units.(MFCUs) These Units, generally located in the state Attorneys General office, are 75 percent funded by the federal government and 25 percent by the state. They are charged with investigating and prosecuting Medicaid provider fraud. In addition, the Units review complaints of abuse or neglect against residents in health care facilities receiving Medicaid funding and may review complaints about the theft of residents' private funds in these facilities. The Units are also responsible for investigating fraud in the administration of the Medicaid program.

The Ticket to Work and Work Incentives Improvement Act of 1999 authorizes the Units, with the approval of the Inspector General of the relevant federal agency, to investigate fraud in other federally-funded health care programs, if the case is primarily related to Medicaid. This law also authorizes the Units,on an optional basis, to investigate and prosecute resident abuse and neglect in non-Medicaid board and care facilities.

Forty-four of the MFCUs are located in the office of the state attorney general. Connecticut, the District of Columbia, Illinois, Iowa, Tennessee and West Virginia are located in other departments of state government. North Dakota received a waiver from the federal government and does not have an MFCU.

A Unit is intended to operate using a "strike force" concept of investigators, attorneys and auditors working full-time to develop Medicaid fraud investigations and prosecutions. Each Unit operates under the administrative oversight of the Inspector General of the U.S. Department of Health and Human Services and must be recertified annually.

NAMFCU provides a forum for the nationwide sharing of information concerning the problems of Medicaid fraud. It works to foster cooperation on law enforcement and federal issues affecting the MFCUs, to improve the quality of Medicaid fraud investigations and prosecutions by conducting training programs, to provide technical assistance for Association members and to provide the public with information about the MFCU program.

The Association is staffed by an Association Administrator/Meeting Planner and a Membership/Global Case Coordinator in addition to its Executive Director.

NAMFCU Website

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