State Enforcement of Medicare and Medicaid That Will Impact Your Organization

As compliance officers, we often focus (and rightfully so) on enforcement efforts coming from a national or federal level. However, we also need to be mindful of enforcement efforts at the state level now more than ever.

Medicaid Fraud Control Units (MFCUs) are one of the driving forces behind state enforcement. “Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as abuse or neglect of residents in health care facilities and board and care facilities and of Medicaid beneficiaries in noninstitutional or other settings.” –OIG HHS. MFCUs came into being a few decades ago after the federal government realized that nursing home residents who paid with Medicaid were being used and abused for financial gain.

MFCUs’ efforts focus on behavioral health, home services, hospital claims, and long-term care. In addition to MFCUs’, many state health and human service departments have state-run Offices of Inspector General (OIG). These offices will frequently perform proactive audits and monitor excluded individuals and/or parties.

Join our upcoming webinar on how states enforce non-compliance. Our compliance expert CJ Wolf, M.D., will cover what you need to know to prevent issues in your organization. In this webinar, he will cover:

• • Compliance enforcement efforts at the state level through Medicaid Fraud Control Units  
  • Activity by state level operated Offices of Inspector General  
  • Strategies for staying on top of state enforcement activities