STATE OF LOUISIANA DEPARTMENT OF JUSTICE CRIMINAL

Report
STATE OF LOUISIANA
DEPARTMENT OF JUSTICE
CRIMINAL DIVISION
PREVENTION & PROSECUTION OF MEDICAID FRAUD AND
RECIPIENT ABUSE
MEDICAID FRAUD CONTROL UNIT
Post Office Box 94005
Baton Rouge, Louisiana 70804-9005
Telephone: (225) 326-6210
Fax: (225) 326-6295
MEDICAID FRAUD CONTROL UNITS
(MFCU)
•investigate
and prosecute Medicaid fraud as well as patient
abuse and neglect in health care facilities
•operate in 49 States and in the District of Columbia.
•Forty-four of the MFCUs are located as part of Offices of State
Attorneys General
•6 are in other State agencies
MEDICAID FRAUD CONTROL UNITS
(MFCU)




OIG certifies, and annually recertifies, each MFCU
OIG collects information about MFCU operations and assesses
whether they comply with statutes, regulations, and OIG policy
OIG also analyzes MFCU performance based on 12
performance standards and recommends program
improvements where appropriate
http://oig.hhs.gov/fraud/medicaid-fraud-control-unitsmfcu/index.asp
MEDICAID FRAUD CONTROL UNITS
(MFCU)

MFCUs must be "single, identifiable" entities


States administer the MFCUs



they are jointly funded on a matching basis with the Federal Government. (The Federal
Government pays 90 percent of a Unit's costs for the first 3 years of a Unit's operation and
75 percent for subsequent years; the States pay the remaining portion.)
MFCUs operate on an interdisciplinary model


professional staff are required to work full-time on MFCU duties.
must employ investigators, auditors, and attorneys.
The MFCUs are required to have statewide authority to prosecute cases or to
have formal procedures to refer suspected criminal violations to an office
with such authority.
The MFCUs' investigative authority extends to Medicaid-funded facilities and
to "board and care" facilities that do not receive Medicaid funding. OIG, or
another agency's Inspector General, may in some circumstances permit the
Units to investigate fraud in Medicare or other Federal programs.
MFCU FEDERAL FY 2012

Combined Federal and State grant expenditures totaled $217.3
million


$162.9 were Federal funds
Collectively, all 50 MFCU’s


Employed 1,901 individuals
Conducted 15,531 investigations



1,359 individuals were indicted or charged criminally



995 criminally charged with fraud
364 criminally charged with abuse
1,337 convictions were reported



11,660 were Medicaid fraud related
3,871 were patient abuse cases
982 related to Medicaid fraud
355 related to patient abuse
Civil judgments and settlement totaled 823
MFCU FEDERAL FY 2012

Collectively, the MFCU’s reported $2.9 billion in recoveries*


Translates into a return on investment of $13.48 per $1 expended by
the Federal Government
747 of the 3,131 exclusions reported to HHS-OIG were based
on referrals made by MFCU’S
*recoveries are defined as monies that defendants are required to pay as a result of
a settlement, judgment or pre-filing settlement in criminal and civil cases and may
not reflect actual collections
LOUISIANA MFCU
Created in 1978
 Convicted hundreds of persons for program
violations and recovered millions of tax dollars
 The unit has twice been recognized as the
number one MFCU in the nation by the United
States Department of Health and Human Services,
Office of the Inspector General.

National Association of Medicaid Fraud Control Units (NAMFCU)
www.namfcu.net
LOUISIANA MFCU

Federal Fiscal Year 2012






Total Medicaid Expenditures


Investigations – 349
Indictments/charges – 91
Convicted – 150
Civil settlements/Judgments – 44
Recoveries - $124,095,613.00
$7,353,759,981.00
52 MFCU employees
MEDICAID
IS FOR THE NEEDY
--
NOT THE
GREEDY!
LOUISIANA MFCU
• Case Examples
• BFSNR
• Hospital Overlaps
• Worker not present
• False Documentation – DSW and/or Owner
• Falsified documents in personnel folder
• CPR card
• background check
• Other
• Reporting Cases
Type
name
and
search
TO REPORT FRAUD OR ABUSE CONTACT:
ATTORNEY GENERAL’S
MEDICAID FRAUD CONTROL UNIT
1-888-799-6885
Reports may also be made to The Department of Health and Hospitals (DHH), Local Police, or
the Sheriff’s Office

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