Earlier this week, the Office of Inspector General for the
Department of Health and Human Services ("OIG") posted
its fiscal year ("FY") 2016 data about Medicaid Fraud
Control Units ("MFCUs") across the country.
Federal law requires each state to operate a MFCU separate and
distinct from the state Medicaid Agency. MFCUs are charged with
investigating and prosecuting fraud committed by Medicaid
providers and in the state's administration of the Medicaid
Program, as well as patient abuse/neglect that occurs in a
Medicaid-funded facility or at the hands of Medicaid
providers. MFCUs currently operate in 49 states and the
District of Columbia (North Dakota presently has a waiver but
proposals to create a MFCU have been introduced in the state
legislature). They are typically part of a state's
Attorney General's office and are required to employ
investigators, attorneys and auditors. The OIG is responsible
for overseeing MFCUs. It annually recertifies MFCUs, assesses
their performance and compliance with Federal requirements, and
administers a Federal grant award that funds a portion of each
MFCU's operational costs.
As reflected in the OIG's data, in FY 2016, some MFCUs
operated with as few as 4 to 6 staff members on board (Montana,
South Dakota, Wyoming), while others had many multiples more. For
example, Florida had 156 staff members, Texas had 165, California
had 185, and New York had 298. In terms of total numbers,
investigations, indictments, convictions, settlements reached, and
recoveries obtained have not changed dramatically over the past few
years, but FY 2015 saw a seemingly anomalous decrease in civil
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