As federal and state governments focus on safeguarding Medicaid dollars and preventing fraud, waste, and abuse (FWA), healthcare organizations are facing heightened enforcement, expanded oversight, and a renewed focus on accountability from entities including Medicaid Fraud Control Units (MFCUs), CMS, and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).
With organizations receiving inquiries from these governmental agencies daily, the overarching message for healthcare providers, health plans, and managed care organizations is to prioritize proactive compliance and become audit-ready now.
This article explores the recent emphasis on enforcement and strategies to help organizations adapt.
What Is the Role of Medicaid Fraud Control Units?
MFCUs are specialized state agencies tasked with investigating and prosecuting fraud committed by healthcare…
This type of fraud targets the supply chain and accounts payable departments of businesses.
- Invoice Manipulation: Criminals intercept a legitimate invoice between a supplier and a client and change the banking details to their own. The client pays the bill thinking they are paying their trusted vendor.
- Kickbacks and Bribery: A vendor secretly pays an employee of the purchasing company to ensure their bid is successful or to overlook inflated pricing.