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HHS OIG Reviews FY 2010 Recoveries by State MFCUs

Last week, the OIG released an interesting interactive chart listing, by state, key statistics of state Medicaid Fraud Control Units (MFCU) for FY 2010. The statistics, while perhaps an imperfect comparison among the MFCUs, provide insight into the level of activity in each state, the total amount recovered by each MFCU, and the resources allocated to combat Medicaid fraud, waste, and abuse in each state.  In total, for FY 2010, the MFCUs recovered more than $1.8 billion in judgments and settlements at a cost of approximately $205 million in MFCU expenditures. Total State Medicaid budgets exceeded $397 billion.

When asked about these statistics, Ellyn Sternfield, a Mintz Levin attorney and the former director of the Oregon Department of Justice’s MFCU, observed that  “it is difficult to compare MFCUs using just the numbers. There are significant differences in legal authority for the MFCUs based on individual state law and authority. And most MFCUs are part of their State Attorney General’s office; an individual Attorney General’s priorities will often dictate the areas of concentration of the MFCU.”

While statistics may not be the most accurate comparison of the performance of MFCUs, the OIG recently released a proposed rewrite of the MFCU regulatory Performance Standards, which each MFCU must follow as a condition of ongoing federal funding. The proposed rule requires MFCUs to take affirmative steps to maintain a case mix of both patient abuse/neglect cases and Medicaid billing fraud cases, including those involving Medicaid managed care. Ellyn noted that the “revisions recognize that a MFCU’s effectiveness is not only measured by numbers, but also by the non-specific case work that MFCUs may undertake, such as training, publication of fraud alerts, and liaison activities with provider groups.”

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Brian P. Dunphy is a member of the Health Care Enforcement & Investigations Group at Mintz. He defends clients facing government investigations and whistleblower complaints regarding alleged violations of the federal False Claims Act. Brian also handles commercial health care litigation.