November 2016
A recently published proposed rule expands the functions and responsibilities of state Medicaid Fraud Control Units (MFCUs).

The rule was issued by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) on Sept. 20 for MFCUs, which operate under the auspices of State Attorneys General and are separate and distinct from state Medicaid agencies. Overseen by HHS-OIG, MFCUs have authority to investigate and prosecute Medicaid provider fraud in addition to patient abuse or neglect in health care and board and care facilities. As part of its oversight, HHS-OIG must annually recertify each MFCU, assess each MFCU’s performance and compliance with federal requirements, and administer a federal grant award to fund a portion of each MFCU’s operational costs.

The purpose of the proposed rule, which gives broader investigative and prosecutorial powers to state MFCUs, is two-fold:
  • First, it incorporates statutory changes that have been made since the 1977 amendments to the Social Security Act to provide for federal participation in the costs attributable to establishing and operating state MFCUs. 
  • Second, it aligns the current rule with practices and policies that have developed and evolved since the initial version of the rule, codified at 42 C.F.R. Part 1007, was issued in 1978. 
With the exception of two prior revisions – the first in 2011 to implement the Affordable Care Act’s payment suspension provisions and the second in 2013 to allow federal fiscal participation (FFP) for data mining under certain circumstances – the regulation has not undergone a wholesale revision since its 1978 promulgation. 

To view the full alert, click here.

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