What is the Medicaid Fraud Control Unit?
The Medicaid Fraud Control Unit (MFCU) is the single entity of West Virginia state government that is certified annually by the Secretary of the U.S. Department of Health and Human Services to conduct statewide investigations of health care providers that defraud the Medicaid program. In addition, the MFCU investigates complaints of criminal abuse or neglect in any health care facility, as well as allegations of misappropriation of patients' private funds in Medicaid facilities. The unit is also charged with the investigation of fraud in the administration of the Medicaid program.
The MFCU is authorized by Section 1, Article 7, Chapter 9 of the West Virginia State Code and §1007 of Title 42 of the Code of Federal Regulations.
What is Medicaid Provider Fraud?
Medicaid providers include doctors, dentists, hospitals, nursing facilities, home and community-based services, pharmacies, clinics, counselors, personal care, and any other individual or company that is paid by the Medicaid program to provide health care services. If a provider intentionally misrepresents the services rendered, and therefore increases the reimbursement from West Virginia Medicaid, provider fraud has occurred.
Medicaid provider fraud costs taxpayers hundreds of millions of dollars every year. In addition to the monetary impact, Medicaid fraud can also impact patient care. Unsuspecting patients may be subjected to unnecessary or unsafe procedures, or may have false diagnoses inserted into their medical records.