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- MFCUs </li> </ul> </div> <div id="leftContentInterior"> <h1>Medicaid Fraud Control Units - MFCUs </h1> <p>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 <a class="fancybox-iframe" href="./characteristics.html">common characteristics</a>.</p> <h2 class="acc_trigger"><a name="null">Regulations/Statutes</a></h2> <div class="acc_container"> <div class="block"> <ul> <li>42 CFR pt. 1007 <a class="exit" target="_blank" href="https://web.archive.org/web/20130508135337/http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/pdf/CFR-2011-title42-vol5-part1007.pdf">"State Medicaid Fraud Control Units"</a></li> <li><a href="./regulations_statutes/76-FR-14637-3-17-11.pdf">Proposed Rule: State Medicaid Fraud Control Units; Data Mining</a></li> <li style="padding-bottom:0 !important;">42 CFR section 455.23 <a href="./45523.asp">CMS Payment Suspension Rule</a> (effective March 25, 2011) <ul> <li><a href="./files/payment-suspensions-info-bulletin-3-25-2011.pdf">CMS Information Bulletin on Payment Suspensions</a></li> </ul></li> <li>45 CFR pt. 92 <img class="cleanPdf" src="/web/20130508135337im_/https://oig.hhs.gov/images/icon_pdf.gif" alt="pdficon"/> <a target="_blank" class="clean" href="./regulations_statutes/45%20CFR%2092.pdf">"Uniform Administrative Requirements for Grants and Cooperative Agreements to State, Local, and Tribal Governments"</a></li> <li>OMB Circular A-87 <a class="exit" href="https://web.archive.org/web/20130508135337/http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&tpl=/ecfrbrowse/Title02/2cfr225_main_02.tpl">"Cost Principles for State, Local, and Indian Tribal Governments"</a> (incorporated by 45 CFR section 92.22)</li> <li><a target="_blank" href="./regulations_statutes/Social%20Security%20Provisions.pdf">Social Security Act Provisions</a></li> </ul> </div> </div> <h2 class="acc_trigger"><a name="null">Performance Standards</a></h2> <div class="acc_container"> <div class="block"> <div class="related" style="width:200px;"> <h3>Archived Standards</h3> <p>The original standards, published in 1994, are superseded by standards published on June 1, 2012, but still apply in evaluating activities of the MFCUs in earlier periods.</p> <ul> <li><a href="/web/20130508135337/https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/files/Performance%20Standards.pdf">(59 FR 49080)</a> </ul> </div> <p>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.</p> <ul> <li><a href="/web/20130508135337/https://oig.hhs.gov/authorities/docs/2012/PerformanceStandardsFinal060112.pdf">(77 FR 32645)</a> </li> </ul> </div> </div> <h2 class="acc_trigger"><a name="null">Policy Transmittals</a></h2> <div class="acc_container"> <div class="block"> <p>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.</p> <ul> <li>89-1 <a href="./policy_transmittals/89-1%20Full%20time%20and%20Part%20time%20Employees.pdf">Full-time and Part-time Employees</a></li> <li>89-2 <a href="./policy_transmittals/89-2%20Budget%20Submissions.pdf">Budget Submissions</a></li> <li>90-1 <a class="clean" href="./policy_transmittals/90-1%20Definition%20of%20Convictions%20and%20Plea%20Negotiations.pdf"><span class="pdf"> </span>Definition of Convictions and Plea Negotiations</a></li> <li>92-4 <a href="./policy_transmittals/92-4%20Revised%20Quarterly%20Statistical%20Report.pdf">Revised Quarterly Statistical Report</a></li> <li>99-01 <a class="clean" href="./policy_transmittals/99-01%20Investigation,%20Proscecution,%20and%20Referral%20of%20Civil%20Fraud%20Cases.pdf"><span class="pdf"> </span>Investigation, Prosecution, and Referral of Civil Fraud Cases</a></li> <li>99-02 <a class="clean" href="./policy_transmittals/99-02%20Public%20Disclosure%20Requests%20and%20Safeguarding%20of%20Privacy%20Rights.pdf"><span class="pdf"> </span>Public Disclosure Requests and Safeguarding of Privacy Rights</a></li> <li>2000-1 <a href="./policy_transmittals/2000-1%20Extended%20Investigative%20Authority.pdf">Extended Investigative Authority</a></li> <li>2010-1 <a href="./policy_transmittals/2010-1%20State%20Fraud%20Policy%20Transmittal%20Number%2010-01%20Program%20Income%203-22-2010.pdf">Program Income</a></li> <li>2013-1 <a href="./policy_transmittals/2013-1MFCU-Authority-in-Personal-Care-Waiver-Cases.pdf">MFCU Authority in Personal Care Waiver Cases</a></li> </ul> </div> </div> <h2 class="acc_trigger"><a name="null">Onsite Review Reports</a></h2> <div class="acc_container"> <div class="block"> <p>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.</p> <ul> <li><a href="/web/20130508135337/https://oig.hhs.gov/reports-and-publications/oei/m.asp#mfcu">Go to Onsite Review Reports</a></li> </ul> </div> </div> <h2 class="acc_trigger"><a name="null">Expenditures & Statistics</a></h2> <div class="acc_container"> <div class="block"> <p>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 as well as 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. </p> <ul class="expenditures"> <li>Annual Summary of Grant Expenditures and Statistics <ul> <li><a href="./expenditures_statistics/fy2012.asp">FY 2012</a></li> <li><a href="./expenditures_statistics/fy2011.asp">FY 2011</a></li> <li><a href="./expenditures_statistics/fy2010.asp">FY 2010</a></li> </ul> </li> <li>Statistics for Each MFCU <ul> <li><a target="_blank" href="./expenditures_statistics/fy2012-statistical-chart.htm">FY 2012 Chart</a> | <a href="./expenditures_statistics/fy2012-statistical-chart.pdf">Printable Version</a> <ul> <li><a href="/web/20130508135337/https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/maps/interactive-map2012.asp">Interactive Map</a></li> </ul> </li> <li><a target="_blank" href="./expenditures_statistics/fy2011-statistical-chart.htm">FY 2011 Chart</a> | <a href="./expenditures_statistics/fy2011-statistical-chart.pdf">Printable Version</a> <ul> <li><a href="/web/20130508135337/https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/interactive-map2011.asp">Interactive Map</a></li> </ul> </li> <li><a target="_blank" href="./expenditures_statistics/fy2010-statistical-chart.htm">FY 2010 Chart</a> | <a href="./expenditures_statistics/fy2010-statistical-chart.pdf">Printable Version</a> <ul> <li><a href="/web/20130508135337/https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/interactive-map.asp">Interactive Map</a></li> </ul> </li> </ul> </li> <li>Archived Annual Reports FY 2006–2009 <ul> <li><a href="./expenditures_statistics/fy2009.asp">FY 2009</a></li> <li><a href="./annual_reports/mfcu_2008.pdf">FY 2008</a></li> <li><a href="./annual_reports/mfcu_2007.pdf">FY 2007</a></li> <li><a href="./annual_reports/MFCU%20FY%202006%20Annual%20Report.pdf">FY 2006</a></li> </ul> </li> <li><a href="./forms/QuarterlyStatisticalReportTemplate.xls">Quarterly Statistical Report Template</a></li> <li><a href="./forms/Quarterly%20Statistical%20Report%20Instructions.pdf">Quarterly Statistical Report Instructions</a></li> </ul> </div> </div> <h2 class="acc_trigger"><a name="null">Reporting Medicaid Fraud</a></h2> <div class="acc_container"> <div class="block"> <p>You may direct complaints of suspected Medicaid fraud to <a href="/web/20130508135337/https://oig.hhs.gov/fraud/report-fraud/index.asp">OIG's Hotline</a> 1-800-HHS-TIPS 1-800-447-8477) or directly to a <a class="exit" href="https://web.archive.org/web/20130508135337/http://www.cms.gov/FraudAbuseforConsumers/Downloads/smafraudcontacts.pdf">MFCU or State Medicaid Agency</a>.</p> </div> </div> <h2 class="acc_trigger"><a name="null">Grants Management</a></h2> <div class="acc_container"> <div class="block"> <ul> <li><a href="./files/grant-overview.pdf">MFCU Financial Grant Overview</a><br/> On June 21, 2012, OIG conducted the webcast <em>MFCU Grants Overview</em>. MFCU staff members who would like to view the webcast may email <a href="https://web.archive.org/web/20130508135337/mailto:MFCUgrants@oig.hhs.gov">MFCUgrants@oig.hhs.gov</a> to obtain the link and passcode.</li> <li><a target="_blank" href="./forms/SF-424-application-package.pdf">SF 424 (includes SF 424a and SF 424b)</a></li> <li><a target="_blank" href="/web/20130508135337/https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/files/SF_425.pdf">SF 425</a></li> <li><a href="./files/mfcu_budget_calendar.pdf">Budget Calendar</a></li> </ul> </div> </div> <h2 class="acc_trigger"><a name="null">Directory of MFCU Directors</a></h2> <div class="acc_container"> <div class="block"> <ul> <li><a href="./files/contact-directors.pdf">Directory of MFCU Directors</a></li> </ul> </div> </div> <h2 class="acc_trigger"><a name="null">Related Links</a></h2> <div class="acc_container"> <div class="block"> <ul> <li><a class="exit" href="https://web.archive.org/web/20130508135337/http://www.cms.gov/MedicaidIntegrityProgram/">CMS Medicaid Integrity Program</a></li> <li><a class="exit" href="https://web.archive.org/web/20130508135337/http://www.dpm.psc.gov/">HHS Division of Payment Management </a></li> <li><a class="exit" href="https://web.archive.org/web/20130508135337/http://www.namfcu.net/">National Association of Medicaid Fraud Control Units (NAMFCU)</a></li> <li><a href="/web/20130508135337/https://oig.hhs.gov/fraud/enforcement/state/index.asp">State Enforcement Actions</a></li> <li><a href="/web/20130508135337/https://oig.hhs.gov/fraud/state-false-claims-act-reviews/index.asp">State False Claims Act Reviews</a></li> </ul> </div> </div> </div>  </div>  <div id="rightSide"> <div id="imLookingForHeading"><span>I'm Looking For</span></div> <div id="imLookingFor"> <p>Let's start by choosing a topic</p> <div id="chooseTopic"> <a href="#">Select One </a> </div> </div> <div id="topicSelection"> <a href="#" id="closeButton"><span>X</span></a> <ul class="leftSide"> <li> <a href="/web/20130508135337/https://oig.hhs.gov/reports-and-publications/compendium/"> <h3>Compendium</h3> <p>Unimplemented OIG recommendations summarized.</p> </a> </li> <li> <a href="/web/20130508135337/https://oig.hhs.gov/reports-and-publications/workplan/index.asp#current"> <h3>FY 2013 Work Plan</h3> <p>OIG projects planned for 2013.</p> </a> </li> <li> <a href="/web/20130508135337/https://oig.hhs.gov/reports-and-publications/semiannual/index.asp"> <h3>Semiannual Report</h3> <p>Significant OIG activities in 6-month increments.</p> </a> </li> </ul> <ul class="leftSide"> <li> <a href="/web/20130508135337/https://oig.hhs.gov/compliance/101/index.asp"> <h3>Compliance 101</h3> <p>Free educational resources. </p> </a> </li> <li> <a href="/web/20130508135337/https://oig.hhs.gov/compliance/advisory-opinions/index.asp#2011"> <h3>Advisory Opinions</h3> <p>Legal opinions issued by the OIG about the application of its fraud and 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