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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.

 
     
 
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