Tag Archives: Medicaid Fraud Control Units

OIG Tallies Medicaid Fraud Control Unit Achievements in FY 2016

The OIG has released national and state-by-state data quantifying State Medicaid Fraud Control Unit (MFCUs) accomplishments in fiscal year 2016. During this period MFCUs were credited with a total of: 1,721 indictments (1,249 involving fraud and 472 involving abuse or neglect); 1,564 convictions (1,160 involving fraud and 404 involving abuse or neglect); 998 civil settlements … Continue Reading

OIG Report Highlights MFCU Achievements

The OIG has released its Medicaid Fraud Control Units Fiscal Year 2015 Annual Report, which compiles data on investigations and prosecutions by the 50 MFCUs. According to the OIG, MFCUs attained 1,553 convictions in FY 2015, the highest in the last five years. Almost one-third of these convictions involved personal care services attendants, and 71% … Continue Reading

HHS Proposes Changes to State Medicaid Fraud Control Unit Rules

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have proposed amendments to the regulations governing State Medicaid Fraud Control Units (MFCUs). The proposed rule would reflect statutory changes and policies adopted since the MFCU regulations were initially issued in 1978. Among other things, the rule would incorporate statutory … Continue Reading

House Energy & Commerce Committee Schedules Hearing to Review Medicaid Program Integrity Legislation

On September 11, 2015, the House Energy & Commerce Subcommittee on Health will hold a hearing to discuss legislative proposals intended to reduce Medicaid waste, fraud, and abuse.  Bills to be discussed include: Draft legislation to encourage territories to create Medicaid Fraud Control Units. Draft legislation addressing recent OIG findings that health care providers terminated … Continue Reading

OIG Releases Medicaid Fraud Control Units Fiscal Year 2014 Annual Report

The OIG has released its Medicaid Fraud Control Units (MFCU) Fiscal Year 2014 Annual Report, which highlights statistical achievements of the 50 MFCUs nationwide, along with related OIG oversight activities. With regard to criminal cases, the report notes: MFCUs reported 1,318 criminal convictions, most frequently involving home health care aides, certified nursing aides, and other medical support; … Continue Reading

OIG Posts FY 2014 State Medicaid Fraud Control Unit (MFCU) Data

The HHS Office of Inspector General (OIG) has released detailed statistical data on MFCU enforcement actions, recoveries, and expenditures for fiscal year 2014. Overall, state MFCUs reported more than $2 billion in criminal and civil recoveries (settlements, judgments, or prefiling settlements) in FY 2014, more than $1.7 billion of which were civil recoveries. The states … Continue Reading

FY 2013 Medicaid Integrity Program Report

The OIG’s “Medicaid Integrity Program Report for Fiscal Year 2013,” released earlier this month, provides details on funding for the OIG’s Medicaid program integrity efforts, summarizes significant OIG Medicaid-related reviews and investigations, highlights Medicaid Fraud Control Unit activities, and notes Medicaid-related projects included in the OIG’s Work Plan for FY 2014.… Continue Reading

OIG Issues Annual Report on Medicaid Fraud Control Unit (MFCU) Activities

The OIG has released its Medicaid Fraud Control Units Fiscal Year 2013 Annual Report, which highlights achievements from the investigations and prosecutions conducted by the 50 MFCUs along with related OIG oversight activities. In FY 2013, MFCUs nationwide reported a total of 1,341 criminal convictions in cases involving Medicaid fraud and patient abuse and neglect, … Continue Reading

OIG Final Rule on Data Mining by State Medicaid Fraud Control Units

On May 17, 2013, the HHS Office of Inspector General (OIG) published a final rule amending current regulations prohibiting State Medicaid Fraud Control Units (MFCU) from using federal matching funds to identify fraud through screening and analyzing State Medicaid data (known as data mining). In order to “support and modernize MFCU efforts to effectively pursue … Continue Reading

OIG Proposes Revisions to Performance Standards for State Medicaid Fraud Control Units, Posts Interactive MFCU Statistical Map

The HHS Office of Inspector General (OIG) is seeking comments on a proposal to revise standards for assessing the performance of the State Medicaid Fraud Control Units (MFCUs), replacing standards established in 1994. Comments will be accepted until December 5, 2011. Separately, the OIG has posted an interactive map with summaries of state MFCU statistical information, including … Continue Reading

OIG Proposes to Allow Medicaid Fraud “Data Mining”

The HHS Office of Inspector General (OIG) has published a proposed rule that would end a current prohibition on State Medicaid Fraud Control Units (MFCU) using federal matching funds to identify fraud through screening and analyzing state Medicaid claims data – a practice known as “data mining.” The OIG proposes to permit federal financial participation … Continue Reading
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