Skip to main content
U.S. flag

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

Medicaid Fraud Control Units

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud as well as abuse or neglect of residents in health care facilities and board and care facilities and of Medicaid enrollees in noninstitutional or other settings.

MFCUs operate in each of the 50 States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. MFCUs, usually a part of the State Attorney General's office, employ teams of investigators, attorneys, and auditors; are constituted as single, identifiable entities; and must be separate and distinct from the State Medicaid agency. OIG, in exercising oversight for the MFCUs, annually recertifies each MFCU, assesses each MFCU's performance and compliance with Federal requirements, and administers a Federal grant award to fund a portion of each MFCU's operational costs.

Program Requirements and Standards

Archived Administrative Requirements and Cost Principles
(applicable to FY 2015 and prior MFCU grant awards)

The terms and conditions of the award include all legally enforceable requirements pertaining to the award, whether included in statute, regulation, policy guidance, or this award document.

General Terms and Conditions

OIG applies a series of performance standards, developed in accordance with section 1902(a)(61) of the Social Security Act, as part of its oversight of the MFCUs. The standards assist OIG in the certification and recertification of the MFCUs and help to determine whether the MFCUs carry out their duties efficiently and effectively.

Performance Standards, 89 FR 76431 (effective September 18, 2024)

On occasion, OIG and other Federal agencies issue policy transmittals (designated below by year and sequence of publication) and other guidance materials applicable to MFCUs. The materials provide interpretations or implement Federal regulations and statutes.

Archives - Archived policy transmittals and other guidance are found here. OIG archives policy transmittals and other policy guidance when the guidance has been updated, been replaced by regulation, or become obsolete.

MFCU Activities and OIG Oversight

OIG conducts periodic reviews and inspections of individual MFCUs to determine whether Units meet the performance standards and comply with laws, regulations, and policy transmittals. The resulting OIG reports present background on the Units, observations, findings, and recommendations for improvement.

These reports summarize the activities and accomplishments of all Units for the fiscal year, as well as trends over recent years.

Annual Summary of Grant Expenditures and Statistics

As part of its responsibilities to combat Medicaid fraud and patient abuse and neglect, each MFCU maintains statistical information. The information includes numbers of investigations, indictments, and convictions by the MFCUs, as well as the amount of monetary recoveries for both civil and criminal cases. The documents below include an annual summary of this information for the MFCU community as well as a chart and interactive map containing detailed information for each MFCU. The statistical information for each MFCU should be interpreted in light of the State-specific organization and authorities governing the MFCU. For more information, please contact the MFCU directly.

Data Mining Applications

Reporting MFCU Convictions

Federal regulations state that MFCUs should, on a timely basis, transmit to HHS-OIG all pertinent information on MFCU convictions. MFCUs must use the Exclusion Referrals portal to transmit this information.

Submit the MFCU's Annual Statistical Report (ASR)

OIG requests that ASR information be provided through the ASR Portal no later than November 30.

State Enforcement Actions

OIG administers the MFCU awards, which are non-discretionary grants to each of the States, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Eligibility and funding are specified in the statute and regulation referenced above. Following are resources to aid the MFCUs throughout the lifecycle of the grant. If you have any questions, please reach out to the grants management officer listed on your notice of award.

OIG has Federal grant oversight for the MFCUs, including the responsibility to certify, and annually recertify, each of them. States and territories are required to maintain a MFCU or receive a waiver from the Centers for Medicare & Medicaid Services. The District of Columbia, 50 States, and the territories of Puerto Rico and the U.S. Virgin Islands are certified to operate MFCUs.

Illinois Certification Letter

North Dakota Certification Letter

Puerto Rico Certification Letter

U.S. Virgin Islands Certification Letter

Other Resources