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The ProviderTrust Blog

Your source for healthcare compliance news, advice from industry experts, and all things related to OIG exclusions.

OIG Exclusion List, OIG, Medicaid, mfcu

MFCU Reporting Accuracy: Then and Now

Posted by Michael Rosen, ESQ on Thu, Jul 13, 2017

The Office of Inspector General (OIG) is not the only source for exclusions. Did you know that the state Medicaid agency and/or State Attorney General, if applicable, in each state must report its actions to the Federal OIG promptly after the agency takes a final action? (Social Security Act 1902(a)(41) and 42 CFR 1002.3(b)(3). In this article, we'll take a look at how well reporting has taken place given the latest OIG research data, and compare Q1 2017 results from our latest CHIRP report.

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OIG Exclusion List, Fraud and Abuse, mfcu, OIG Exclusion

The Path of an OIG Exclusion

Posted by Michael Rosen, ESQ on Thu, Jun 15, 2017

Maybe the Wizard of Oz had good advice: follow the yellow brick road. It may have curves and present different paths, and you may meet some interesting people along the way, but in the end, it can take you to the big castle. In this case, the castle is the Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) - the ultimate enforcer for healthcare fraud. The OIG has enforcement powers with the wave of its wand. Those powers include the statutory authority to impose civil fines and penalties (CMP) and exclusions against individuals and/or entities that stray from the yellow brick road.

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OIG, mfcu

State Medicaid Fraud Control Units: You have 30 Days

Posted by Michael Rosen, ESQ on Tue, Feb 21, 2017

State Medicaid Fraud Control Units (MFCU) are responsible for investigating Medicaid fraud. This is part of the responsibility assigned to them from CMS as a part of receiving federal health care dollars to reimburse those services and items covered by Medicaid.

According to the OIG site, "Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in healthcare facilities and board and care facilities. MFCUs operate in 49 states and the District of Columbia. The MFCUs, usually a part of the State Attorney General's office, employ teams of investigators, attorneys, and auditors; are constituted as single, identifiable entities; and must be separate and distinct from the State Medicaid agency. OIG, in exercising oversight for the MFCUs, annually re-certifies each MFCU, assesses each MFCU's performance and compliance with Federal requirements, and administers a Federal grant award to fund a portion of each MFCU's operational costs."Performance Standard 8(f) states that a Unit should transmit to the federal OIG reports of all convictions for the purpose of exclusion from Federal health care programs, within 30 days of sentencing.

On June 1, 2012, the Federal Register published an important mandate to measure the success of state Medicaid Fraud Control Units. 

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OIG, Compliance Data, mfcu

The State of MFCU Reporting to the OIG: 2015 in Review

Posted by Mike Rosen on Tue, Sep 27, 2016

Auditing

The OIG is tasked with auditing the performance of state Medicaid Fraud Control Units (MFCU).  The mission of Medicaid Fraud Control Units (MFCUs or Units) is to investigate and prosecute Medicaid provider fraud and patient abuse or neglect under state law. 

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