The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have proposed amendments to the regulations governing State Medicaid Fraud Control Units (MFCUs). The proposed rule would reflect statutory changes and policies adopted since the MFCU regulations were initially issued in 1978. Among other things, the rule would incorporate statutory changes that: increase the federal funding for ongoing MFCU operating costs from 50% to 75%; establish standards under which MFCUs must be operated; allow MFCUs to investigate and prosecute Medicare or other federal health care cases that are primarily related to Medicaid, with the approval of the relevant Inspector General; and allow MFCUs to investigate and prosecute patient abuse or neglect in board and care facilities, regardless of whether the facilities receive Medicaid payments. The rule also would address: the OIG’s delegated authority; MFCU authority, functions, staffing, and reporting; and disallowances. Comments on the rule are due by November 21, 2016.
