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 recoveries.
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