Medicaid provider fraud costs American taxpayers an incalculable amount of money and hinders the integrity of the Medicaid program. State Medicaid Fraud Control Units (MFCUs), the majority of which are in state attorney general offices, have long been at the forefront of health care fraud enforcement.
Learn more about the types of schemes used by perpetrators who commit Medicaid fraud.
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.
All 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands have Medicaid Fraud Control Units. All but five are located in the state’s Office of the Attorney General.
Learn about the oversight, structure, and administration of MFCUs.
In addition:
- MFCUs are the only law enforcement agencies in the country specifically charged with investigating and prosecuting abuse and neglect in a nursing home, other Medicaid-funded healthcare institutions, and in board and care facilities.
- A Unit receives permanent federal funding at a rate of 75% with the remaining 25% contributed by the state.
- Office of Inspector General (OIG) is the agency within the U.S. Department of Health and Human Services (HHS) that has been delegated the responsibility for administering the state MFCU grant program.
- Federal regulations prohibit MFCUs from pursuing recipient fraud unless there is a conspiracy with a provider.
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AGs Call for Federal Policy Change to Expand Medicaid Authority
As the Attorneys General of our respective states, we write in support of your legislation, H.R. 3891, that would expand the authority of Medicaid Fraud Control Units (MFCUs) to detect, investigate and prosecute Medicaid patient abuse in non-institutional settings.
