Ace the AAPC CPCO Certification 2025 – Elevate Your Compliance Game Now!

The primary role of Medicaid Fraud Control Units (MFCUs) is to investigate and prevent fraud within the Medicaid program, specifically targeting fraudulent activities perpetrated by Medicaid providers. This includes examining practices of healthcare providers who may be billing Medicaid for services not provided, overbilling for services, or providing unnecessary services. By focusing on these areas, MFCUs help to protect the integrity of the Medicaid program and ensure that resources are used appropriately for the intended beneficiaries.

While pursuing recipient fraud and investigating non-Medicaid provider fraud are important aspects of Medicaid integrity, they are not the central function of MFCUs. Additionally, determining physician eligibility for Medicaid falls outside the scope of their responsibilities. Thus, the targeted effort of MFCUs to investigate fraudulent activities among Medicaid providers is essential for maintaining the program's integrity and protecting taxpayer dollars.