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Medicaid Fraud Control Units - MFCUs

Medicaid Fraud Control Units (MFCU or Unit) investigate and prosecute Medicaid fraud as well as patient abuse and neglect in health care facilities. OIG certifies, and annually recertifies, each MFCU. OIG collects information about MFCU operations and assesses whether they comply with statutes, regulations, and OIG policy. OIG also analyzes MFCU performance based on 12 published performance standards and recommends program improvements where appropriate. The MFCUs share common characteristics.


Performance Standards

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.

Policy Transmittals

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.

Onsite Review Reports

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.

Expenditures & Statistics

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.

Reporting Medicaid Fraud

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.

Grants Management

Directory of MFCU Directors

Related Links

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201