Nearly every State has a Medicaid Fraud Control Unit (MFCU) to investigate and prosecute cases of Medicaid fraud and patient abuse and neglect.  MFCUs are a key part of an array of federal and state agencies combating healthcare fraud and abuse, including State Medicaid agencies, the HHS Office of Inspector General (OIG), and Center for Program Integrity at the Centers for Medicare and Medicaid Services (CMS).

From the OIG, here are some interesting statistics on MFCU activities in FY 2010:

Medicaid Investigations:

  • State MFCUs conducted 13,210 investigations related to allegations of Medicaid fraud or abuse.
  • 9,710 investigations related to alleged Medicaid fraud.
  • 3,500 investigations related to allegations of patient abuse and neglect or misuse of patient funds.

Indictments for Medicaid Fraud or Abuse:

  • MFCU investigations resulted in 1,603 individuals’ being indicted or criminally charged.
  • 1,048 were indicted for Medicaid fraud and 555 for patient abuse and neglect.
  • These are in addition to indictments by the U.S. Department of Justice.

Convictions for Medicaid Fraud or Abuse:

  • MFCUs reported 1,329 convictions in FY 2010.
  • Of these, 839 related to Medicaid fraud and 490 related to patient abuse and neglect.

Recoveries from Civil and Criminal Cases:

  • In FY 2010, States reported $1.8 billion in recoveries for both civil and criminal cases handled by the 50 MFCUs.
  • There were 1,077 civil judgments and settlements in FY 2010.
  • MFCUs have an ROI of about 9 to 1.  In FY 2010, MFCUs had a Return on Investment (ROI) of $8.98 per $1 spent by the federal and State governments.
  • The investigations and recoveries by MFCUs are in addition to those by other authorities, such as the OIG and State Medicaid agencies.

MCFU Budgets:

The budgets of State Medicaid Fraud Control Units (MFCUs) totaled $205.5 million in FY 2010 – $153.8 million in federal funds and $51.7 million in State funds.  States receive 75% federal Medicaid match for the operating costs of a MFCU.

MFCU Organization and Staffing:

States administer the MFCUs, with a MFCU typically part of a State Attorney General’s office or State Justice Department.  MFCUs operate on an interdisciplinary model, with investigators, auditors, and attorneys.  MFCUs employed 1,827 individuals in 2010.

MFCU staff work closely with the OIG, U.S. Attorneys, State Medicaid agencies, staff and contractors from the Centers for Medicare and Medicaid ServicesMedicaid Integrity Program, and MFCUs in other States.

State Medicaid agencies also employ auditors, analysts, fraud examiners, and other professionals, as well as contractors, working on Medicaid program integrity, including identification, recovery, and prevention of over payments.

Federal rules governing the operation of a State Medicaid Fraud Control Unit.  The OIG has specific performance standards for MFCUs.

For more information, visit the National Association of Medicaid Fraud Control Units (NAMFCU).