I don't mean to sound stupid, but shouldn't the MFCU always check for merit or validity. You just don't arrest someone without evidence. I'm sure glad they caught that one. G-d knows how many innocent people you have already arrested.
FY 2007 - 2008
Submitted by:
The Agency for Health Care Administration
and Medicaid Fraud Control Unit (MFCU)
Department of Legal Affairs
December 29, 2008
Submitted by:
The Agency for Health Care Administration
and Medicaid Fraud Control Unit (MFCU)
Department of Legal Affairs
December 29, 2008
COMPLAINTS
Complaints serve as the basis for most nvestigations opened by the unit. In FY 2006-07 the unit received a total of 911 complaints. For FY 2007-08, the unit received a total of 1,094 complaints. Of the 911 complaints received in FY 2006-07, 568 were opened as operational cases. Of the 1,094 complaints received FY 2007-08, 377 were opened as operational cases. This decline resulted from an MFCU policy change regarding thresholds for opening an investigation. Prior unit policy called for the opening of an operational case, whenever possible, based upon the mere receipt of a complaint. There was little, if any, review to determine the validity or viability of a complaint or an allegation. Unlike the complaint review process, the case opening and case closing process was identified as a cumbersome process, particularly when no sufficient predicate was established that the complaint or allegation had merit. The unit’s policy has been changed to require a 30-day review of complaints and allegations to determine whether the matter had merit, could be referred or was unfounded. Case openings will now occur only when there is a criminal or civil predicate that warrants further investigative activities. As a result, complaints are being screened more quickly and complaints and/or allegations that are more viable lead to the opening of a full investigation.
State’s Efforts to Control Medicaid Fraud and Abuse December 2008 3
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