About Medicaid Fraud Control Units

Medicaid Fraud Control Units (MFCUs) conduct a statewide program for the investigation and prosecution of health care providers who defraud the Medicaid program. Other duties of a MFCU include:

  • Reviewing complaints of abuse or neglect in nursing home and board and care facilities.
  • Reviewing complaints of the misappropriation of patients’ private funds in nursing homes.
  • Investigating fraud in the administration of the program.

History of Medicaid Fraud Control Units

Medicaid, which was created in 1965, operated with few controls against fraud and without any specific state or federal law enforcement agencies responsible for monitoring criminal activity within the program. The need for the MFCUs came about when the public and Congress realized that too many nursing home patients were held hostage by the greed of a small number of facility operators and often dishonest health care practitioners who used the Medicaid program as their own private “ATM machine.”

In 1977, legislation was passed which provided each state with the opportunity and resources to establish a MFCU to investigate and prosecute provider fraud and resident abuse. Permanent federal funding was provided for the MFCUs in 1980, allowing the federal government to ensure each Unit's activities are devoted exclusively to investigating and prosecuting provider fraud, resident abuse, and fraud in the administration of the Medicaid program.