Medicaid Fraud Control Units - MFCUs

• 42 CFR pt. 1007 "State Medicaid Fraud Control Units"
• Proposed Rule: State Medicaid Fraud Control Units; Data Mining
• 42 CFR section 455.23 CMS Payment Suspension Rule (effective March 25, 2011)
  • CMS Information Bulletin on Payment Suspensions
• 45 CFR pt. 92 "Uniform Administrative Requirements for Grants and Cooperative Agreements to State, Local, and Tribal Governments"
• OMB Circular A-87 "Cost Principles for State, Local, and Indian Tribal Governments" (incorporated by 45 CFR section 92.22)
• Social Security Act Provisions

OIG applies a series of performance standards, developed in accordance with section 1902(a)(61) of the Social Security Act, as part of its oversight of the MFCUs. The standards assist OIG in the certification and recertification of the MFCUs and help to determine whether the MFCUs carry out their duties efficiently and effectively.

• (77 FR 32645)

On occasion, OIG issues policy transmittals to provide guidance and instructions to MFCUs. The transmittals may also provide interpretations of Federal regulations, statutes, and other policies as they apply to MFCUs.

• 89-1 Full-time and Part-time Employees
• 89-2 Budget Submissions
• 90-1  Definition of Convictions and Plea Negotiations
• 92-4 Revised Quarterly Statistical Report
• 99-01  Investigation, Prosecution, and Referral of Civil Fraud Cases
• 99-02  Public Disclosure Requests and Safeguarding of Privacy Rights
• 2000-1 Extended Investigative Authority
• 2010-1 Program Income

OIG conducts onsite reviews to determine whether Units meet the performance standards and comply with laws, regulations, and policy transmittals. The resulting OIG reports present background on the Units, findings, and recommendations for improvement.

• Go to Onsite Review Reports

As part of its responsibilities to combat Medicaid fraud and patient abuse and neglect, each MFCU maintains statistical information. The information includes numbers of investigations, indictments, and convictions by the MFCUs, as well as the amount of monetary recoveries for both civil and criminal cases. The documents below include an annual summary of this information for the MFCU community and, commencing in fiscal year 2010, a chart and interactive map containing detailed information for each MFCU. The statistical information for each MFCU should be interpreted in light of the State-specific organization and authorities governing the MFCU. For more information, please contact the MFCU directly.

• Annual Grant Expenditures and Statistics
  • FY 2011
  • FY 2010
  • FY 2009
• Statistical Chart
  • FY 2011
    • Interactive Map
  • FY 2010
    • Interactive Map
• OIG MFCU Annual Reports FY 2006–2008
  • Fiscal Year 2008
  • Fiscal Year 2007
  • Fiscal Year 2006
• Quarterly Statistical Report Template
• Quarterly Statistical Report Instructions

You may direct complaints of suspected Medicaid fraud to OIG's Hotline 1-800-HHS-TIPS 1-800-447-8477) or directly to a MFCU or State Medicaid Agency.

• MFCU Financial Grant Overview
  On June 21, 2012, OIG conducted the webcast MFCU Grants Overview. MFCU staff members who would like to view the webcast may email MFCUgrants@oig.hhs.gov to obtain the link and passcode.
• SF 424 (includes SF 424a and SF 424b)
• SF 425
• Budget Calendar

• Directory of MFCU Directors

• CMS Medicaid Integrity Program
• HHS Division of Payment Management
• National Association of Medicaid Fraud Control Units (NAMFCU)
• State Enforcement Actions
• State False Claims Act Reviews