State Medicaid Fraud Control Units

 

To investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in health facilities and board and care facilities and of Medicaid beneficiaries in non-institutional or other settings.

Active 93.775 Centers For Medicare and Medicaid Services, Department of Health and Human Services A - Formula Grants Not applicable. Social Security Act (The Act), as amended, Title XIX, Section 1902(a)(61) States, the District of Columbia, and the U.S. Territories. An established State Medicaid Fraud Control Unit must be a single identifiable entity of the State government which the Secretary certifies (and the Office of Inspector General annually re-certifies) as complying with the requirements of 1903(q) of the Social Security Act (42 CFR 1007) regarding location, function and procedure. Applicants must also comply with section 1902 (a)(61) of the Act as amended by the Omnibus Budget Reconciliation Act of 1993. Tribes (American Indian/Alaskan Native/Native American) are not eligible to apply. Grantees are State entities. Units must submit applications containing proposed organization, administration, agreements, detailed budgets and procedures for certification of eligibility (see 42 CFR 1007). Costs will be determined in accordance with 2 CFR 200 and 45 CFR 75. Governors in States applying for Federal assistance must approve the application pursuant to 42 CFR 1007.15(a). Preapplication coordination is not applicable. 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. The standard application forms (SF 424 and SF 424A) must be used for the application. The Inspector General's staff is available to assist with technical development of programs, plans, and budget amendments and revisions. States are awarded funds based on a detailed description of estimated expenditures needed to support the program. Award funds are distributed quarterly on a fiscal year basis as follows: October 1, January 1, April 1, and July 1. Contact the headquarters or regional location, as appropriate for application deadlines The time required to process an application may take up to 90 days. From 60 to 90 days. If the application is not approved, the State may submit an amended application at any time. The application for the annual re-certification must be submitted 60 days prior to the end of each certification period. Not applicable. The statute authorizes 90 percent matching funds for the first 12 quarters, and 75 percent matching funds thereafter for investigation and prosecution of fraud and patient abuse in the State Medicaid Programs. A unit must be separate and distinct from the single State Medicaid agency. A unit must also employ sufficient professional, administrative and support staff to carry out its duties and responsibilities in an effective and efficient manner. Performance Reports: Performance monitoring is required through the submission of annual reports by the MFCUs to HHS/OIG and through site visits to the MFCUs that are conducted by the HHS/OIG. OIG performs periodic onsite reviews of the State program, as appropriate, as well as an annual re-certification review of each SMFCU. All records are to be retained for 3 years, in accordance with 45 CFR 75.361. Statutory formula is not applicable to this assistance listing.

Matching is mandatory. States are awarded, through the issuance of a grant award, for 90 percent of their costs for the first 12 quarters, and 75 percent thereafter, computed against a quarterly maximum allowable of the higher of $125,000, or one-fourth of 1 percent of the sums expended by the Federal, State, or local government in carrying out the State plan under Title XIX of the Social Security Act.

MOE requirements are not applicable to this assistance listing. Grant periods are 1 year in length and funds are distributed quarterly based on an approved annual budget and limitations on entitlement. Method of awarding/releasing assistance: Quarterly. None/Not specified. Richard B. Stern
330 Independence Ave., S.W., Cohen Building
Washington, DC 20201 US
richard.stern@oig.hhs.gov
Phone: (202) 619-0480 http://www.oig.hhs.gov 75-0512-0-1-551 (Formula Grants) FY 22$306,641,000.00; FY 23 est $346,000,000.00; FY 24 est $365,000,000.00; FY 21$299,000,000.00; FY 20$290,000,000.00; FY 19$280,800,000.00; FY 18$270,000,000.00; - FY 2021: Range $344,536 to $41,264,032; Average $5,408,956 42 CFR 1007, 45 CFR 75, and Performance Standards originally issued September 1994 and revised in June 2012. Not applicable.