lauren Plymale, Director
Lauren.E.Plymale@wvago.gov
The Attorney General's Medicaid Fraud Control Unit (MFCU) serves as the state's designated entity for investigating health care providers that defraud the Medicaid program. The unit is certified annually by the Secretary of the U.S. Department of Health and Human Services to conduct these statewide investigations.
The division investigates allegations of fraud in the Medicaid program, criminal abuse or neglect of residents in health care facilities, and misappropriation of patients' private funds in Medicaid facilities. The MFCU also examines potential fraud in the administration of the Medicaid program itself.
Operating under the authority of Section 1, Article 7, Chapter 9 of the West Virginia State Code and §1007 of Title 42 of the Code of Federal Regulations, the division targets various forms of provider fraud. These include phantom billing, upcoding, unbundling, duplicate billing, generic-brand substitution, kickbacks, bribery, unnecessary services, falsified cost reports, and credential misrepresentation.
The division also investigates abuse, defined as intentional infliction of bodily injury on an incapacitated adult; neglect, defined as unreasonable failure by a caregiver to provide necessary care; and financial exploitation, defined as intentional misappropriation of funds belonging to elderly or incapacitated adults.
For more information, please contact:
West Virginia Attorney General's Office
Medicaid Fraud Control Unit
100 Dee Drive, Suite 101
Charleston, WV 25311
Phone: 304-558-1858
Fax: 304-558-3498