Medicaid Fraud Control Units (MFCUs) have an important and difficult role—that of investigating and prosecuting Medicaid fraud. Until recently, due to a lack of access to data and technology, MFCUs have been limited in their ability to detect and mitigate fraud, and to protect the integrity of their State Medicaid programs. MFCU activities have been driven by back-end responses to referrals from Medicaid Program Integrity divisions, responding to Qui Tam cases or investigating tips from informers.
Two major changes have recently empowered MFCUs with new opportunities to detect, prevent, and mitigate fraud and abuse through a proactive frontend approach that provides unprecedented effectiveness and efficiency. These changes are:
1. New legislation, which allows MFCUs to access Medicaid data in order to detect potential fraud.
2. New data-driven technologies and analytics that can detect and reveal indicators of Medicaid fraud and abuse by identifying patterns and anomalies in Medicaid claims and other public records data.
Learn about how innovative and effective technology and data solutions go far beyond query building for finding fraud, waste and abuse in Medicaid. Fortunately, changes in legislation and advances in technology have created an opportunity for MFCUs to greatly improve their ability to detect fraud and shift the momentum back in their favor.
Access White Paper HereDownload PDF