In
1977 Congress enacted legislation, the Medicare-Medicaid
Anti-Fraud and Abuse Amendments, P.L. 95-142,
which established the state Medicaid
Fraud Control Unit (MFCU) program
and provided the states with incentive funding
to investigate and prosecute Medicaid provider
fraud. Federal regulations require the MFCU's
to be certified annually by the Secretary of
the Department of Health and human Services
(DHHS), Office of Inspector General (OIG). The
enabling federal legislation emphasizes the
necessity of having an integrated multi-disciplinary
team of attorneys, investigators and auditors
in one office in order to successfully prosecute
these complex financial crimes.
The MFCUs are required to be separate and distinct
from the state Medicaid programs to avoid institutional
conflicts of interest. The units are generally
located in the state Attorney General's Office,
although some MFCUs are located in other state
agencies with law enforcement responsibilities.
In our state our MFCU is in the Office of the
Attorney General in the Division of Criminal
Justice.
The mission of law enforcement is to protect
life and property. The Medicaid Fraud
Section is unique in the Division of
Criminal Justice in that our mission, which
is "to protect the Medicaid program and
its beneficiaries from fraud, waste and abuse,"
addresses both of these mandates. Fifty percent
of Medicaid program expenditures are directly
funded by state taxpayer dollars, making the
Medicaid program one of the largest expenditures
in the state budget. |