OIG Releases Medicaid Fraud Control Unit (MFCU) Annual Report for FY2014
I. Gains in State Exclusion Enforcement Efforts Highlighted
The Office of the Inspector General’s (OIG) annual Report for the State Medicaid Fraud Control Units (MCFUs),1 released earlier this week, announced that one third of all OIG Exclusions (1,337 of 4,017) were the result of MFCU investigations, prosecutions, and convictions. We also note that licensure revocations and patient abuse (both primarily State related issues) accounted for an additional 1,933 exclusions at 1,744 and 189 respectively according to the HCFAC report issued in March. State issues and State efforts were a large percentage of last year’s exclusions.
II. State Initiated Exclusion by MFCU
The Annual Report also highlighted a State initiated exclusion in which the West Virginia MFCU entered into a civil agreement with the owner of a durable medical equipment (DME) company. The DME company allegedly collaborated with an excluded provider to bill both Medicare and Medicaid for back braces that were provided by the excluded company. After submitting the charges to Medicare and Medicaid, the DME company allegedly kept ½ of the reimbursement and passed the remaining monies on to the excluded company using false invoices to support the billing.
Paul Weidenfeld, Co-Founder and CEO of Exclusion Screening, LLC, is the author of this article. He is a longtime health care lawyer whose practice has focused on False Claims Act cases and health care fraud matters generally. Contact Paul should you have any questions at: firstname.lastname@example.org or 1-800-294-0952.
 State Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse and neglect in health care facilities or board and care facilities in their respective states. They are governmental entities but they must be separate and independent from the State Medicaid Program. The annual reports are prepared in conjunction with the OIG’s oversight responsibility for the Units, and are used in part to determine whether or not to re-certify the various units.