Each year the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) releases its annual Medicaid Fraud Compliance Performance Report. There is much to learn from this compendium of information provided by 50 Medicaid Fraud Control Units (MFCUs), and this article will highlight some of the accomplishments and significant cases.
Why MFCUs Exist
The mission of the MFCUs is to investigate and prosecute under state law Medicaid provider fraud and patient abuse or neglect. With limited exceptions, each state is required to have an MFCU. Cases can be brought from the public or a state or federal agency for investigation and/or criminal prosecution or civil action. Outcomes can include criminal conviction, civil settlements, exclusions, or other program recommendations (including overpayment recoveries).