Performance Improvement 2008. How Many Referrals of Suspected Fraud Do Medicare Fraud Control Units Receive and from Whom?


This study determined the sources and number of suspected fraud referrals that Medicaid Fraud Control Units (MFCUs) reported receiving and the number of these that they accepted for investigation.

Within most States, two agencies share primary responsibility for protecting the integrity of the Medicaid program. The State Medicaid agency is responsible for ensuring proper payment, recovering misspent funds, identifying suspected Medicaid fraud, conducting a preliminary review to determine the extent of potential fraud, and making referrals to its MFCU. The MFCU is responsible for reviewing the referrals it receives from the State Medicaid agency and other sources to determine if they merit criminal or civil investigation. The HHS Office of Inspector General requested that MFCUs provide data on the number of suspected fraud referrals received and the number accepted for investigation from the State Medicaid agencies and from other sources for the period July 2002 through June 2005.

Medicaid Fraud Control Units reported receiving a total of 13,733 suspected fraud referrals over the 3-year period, of which 29 percent came from State Medicaid agencies. Total State Medicaid agency contributions to MFCU-accepted referrals remained constant over the 3-year period, but individual State contributions fluctuated widely.

Report Title: Suspected Medicaid Fraud Referrals,
Agency Sponsor:
OS-OIG, Office of Inspector General
Federal Contact:
Claire Barnard, 202-205-9523
Performer: Office of Inspector General

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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