The Trump administration on Tuesday said it would freeze federal funding for New York’s Medicaid Fraud Control Unit (MFCU), a state agency responsible for investigating and prosecuting fraud in the safety-net government healthcare program.
In a letter sent to New York officials, HHS Inspector General Thomas March Bell accused the state of not securing enough criminal indictments and convictions and said millions of dollars in funding would be suspended through at least Sept. 30.
The move is the second suspension of a state Medicaid fraud unit this year by the Republican Trump administration, and part of a barrage of anti-fraud actions it has aggressively promoted in the healthcare sector. They have included the creation of a new task force, targeted investigations, funding deferrals, and demands for revalidation of healthcare providers that have touched all states but focused largely…
PAYROLL & HR CONTROLS (PREVENTING “GHOST” SCHEMES)
Payroll fraud is often the hardest to detect because it “looks” like a normal business expense.
- Segregation of Duties (SoD): The person who adds new employees to the system must not be the same person who approves the monthly pay run.
- Mandatory Vacation Policy: Require all financial and HR staff to take 5–10 consecutive days of leave annually. Fraud often surfaces when the perpetrator isn’t there to “hide” the trail.
- Ghost Employee Audit: Perform a quarterly “Headcount Reconciliation” where managers must physically verify every name on their payroll list exists.
- Self-Pay Blocking: Ensure the payroll software has a hard-coded block preventing administrators from editing their own salary or bank details.