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Web Links and Other Resources

AARP of Virginia

www.aarp.org/states/va

Administration on Aging

https://www.usa.gov/federal-agencies/administration-on-aging

   

Alcohol and Aging Awareness

www.abc.virginia.gov/education/programs/aaag

Alzheimer’s Association

www.alz.org

   

American Association for Geriatric Psychiatry

www.aagponline.org

American College of Rheumatology

www.rheumatology.org

   

American Geriatrics Society

www.americangeriatrics.org

American Heart Association

www.heart.org/heartorg

   

American Red Cross

www.redcross.org

American Seniors Housing Association

www.seniorhousing.org

   

Attorney General of Virginia

www.ag.virginia.gov

Attorney General of Virginia: Consumer Protection Section

www.ag.virginia.gov/consumer-protection/index.php/file-a-complaint

   

Better Business Bureau

www.bbb.org

Blue Ridge Poison Center

www.brpc.virginia.edu

   

Caregiving Online

www.caregiving.com

911 Cell Phone Bank

www.911cellphonebank.com

   

Consumer Sentinel

www.ftc.gov/sentinel

Department of Criminal Justice Services

www.dcjs.virginia.gov

   

Department of Emergency Management

www.vaemergency.gov

Department of Health and Human Services

www.hhs.gov/

   

Department of Professional and Occupational Regulation

(DPOR)   www.dpor.virginia.gov/

 

   

Federal Trade Commission

www.ftc.gov

File of Life Program     (804) 795-7715

www.folife.org    or     Sterling Ideas Unlimited - Joy Ferguson

   

Food and Nutrition Information Center

www.nal.usda.gov/fnic

Homeland Security

www.dhs.gov

   

IdentityTheft Center

www.idtheftcenter.org

IdentityTheft for Consumers

www.consumer.ftc.gov

   

 

Medicaid Fraud Control Unit(VA)

ag.virginia.gov/programs-initiatives/medicaid-fraud

   

Medicare: The Official U.S. Government Site

www.medicare.gov

My Optimum Health

www.optum.com/solutions/individuals/get-healthy-stay-healthy.html

   

National Association of Triads

www.nationaltriad.org

National Capital Poison Center

www.poison.org

   

National Center on Elder Abuse

www.ncea.acl.gov

National Consumers League

www.nclnet.org

   

National Consumer Voice for Quality Long-Term Care

www.theconsumervoice.org

National Council on Aging

www.ncoa.org

   

National Crime Prevention Council

www.ncpc.org

National Do-Not-Call Registry

www.donotcall.gov or call 1-888-382-1222

   

National Institute of Arthritis and Musculoskeletal and Skin Diseases

www.niams.nih.gov

National Institute of Neurological Disorders and Stroke

www.ninds.nih.gov

   

National Institute on Aging

www.nia.nih.gov

National Sheriff’s Association

www.sheriffs.org

   

Neighborhood Watch

www.nnw.org

Nursing Home Abuse Center

www.nursinghomeabusecenter.com

   

Project Lifesaver International

www.projectlifesaver.org

 
   

Senior Navigator

www.seniornavigator.org

Social Security Administration

www.ssa.gov

   

Victim/Witness Programs in VA

www.dcjs.virginia.gov/victims-services

Virginia Adult Protective Services

www.dss.virginia.gov/family/as/aps.cgi

   

Virginia Association of Area Agencies on Aging

www.vaaaa.org

Virginia Association of Chiefs of Police

www.vachiefs.org

   

Virginia Center on Aging at VCU

www.sahp.vcu.edu/vcoa

Virginia Crime Prevention Center

www.dcjs.virginia.gov/law-enforcement/programs/crime-prevention-center

   

Virginia Department for Aging and Rehabilitative Services

https://vadars.org

Virginia Department of Social Services

www.dss.state.va.us

   

Virginia Poison Center

http://www.poison.vcu.edu/

Virginia Sheriffs’ Association

www.vasheriff.org

   

Women’s Health Initiative

www.nhlbi.nih.gov/whi

 
   

 

 

 

 

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MFCU - Frequently Asked Questions

What is Medicaid?

Medicaid is a healthcare program available to those who cannot afford medical services including low-income families, children, disabled individuals, and the elderly. Medicaid is administered by each individual state, but is jointly funded by state and federal governments. For more information on Medicaid, contact the Department of Medical Assistance Services, see This email address is being protected from spambots. You need JavaScript enabled to view it., or call (804) 786-7933.

What is Medicare?

Medicare is health insurance for: people 65 or older; people under 65 with certain disabilities; and people of any age with end-stage renal disease. There are different parts of Medicare including Medicare Part A that is hospital insurance; Medicare Part B which is Medical Insurance; Medicare Part C which is also known as Medicare Advantage and offers health plan options run by Medicare-approved private insurance companies; and Medicare D which provides Medicare prescription drug coverage. For more information or questions about Medicare, see www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227).)

What is a Medicaid Fraud Control Unit?

A Medicaid Fraud Control Unit (“Unit” or “MFCU”) is a single identifiable entity of state government, annually certified by the Secretary of the U.S. Department of Health and Human Services. The Unit has either statewide criminal prosecution authority or formal procedures for referring cases to local prosecutorial authorities with respect to the detection, investigation and prosecution of suspected criminal violations of the Medicaid program. See 42 U.S.C. §1396b(q). There are 49 MFCUs plus the District of Columbia. Forty-three are currently located in the office of the state Attorney General. Connecticut, D.C., Georgia, Illinois, Iowa, Tennessee and West Virginia have Units which are in other departments of state government. North Dakota received a waiver from the federal government and does not have a Unit.

What is the National Association of Medicaid Fraud Control Units (NAMFCU)?

The National Association of Medicaid Fraud Control Units (NAMFCU) was founded in 1978 to provide a forum for a nationwide sharing of information concerning the problems of Medicaid fraud, to improve the quality of Medicaid prosecutions by conducting training programs, to provide technical assistance to Association members and to provide the public with information about the MFCU program. All 50 MFCUs are members of the Association. NAMFCU is headquartered in Washington, D.C. and is staffed by an Executive Director, an Association Administrator and a part-time Association Assistant.

When was the MFCU established?

The MFCUs, created by Congress in 1977, are federal and state-funded law enforcement entities that investigate and prosecute provider fraud and violations of state law pertaining to fraud in the administration of the Medicaid program. In addition, the MFCUs are required to review complaints of resident abuse or neglect in nursing homes and other health care facilities. The Virginia Medicaid Fraud Control Unit (MFCU) was established in 1982.

Who works for the Virginia MFCU?

The Virginia MFCU is made up of investigators, nurses, auditors, analysts, lawyers and staff. This team works together to recover millions of taxpayer dollars for the Commonwealth each year.

Must each state have a MFCU?

Under federal law, each state must have a Unit unless the state demonstrates to the satisfaction of the Secretary of the Department of Health and Human Services that a Unit would not be cost effective because minimal fraud exists in the state's Medicaid program and Medicaid beneficiaries will be protected from abuse and neglect.

What is the jurisdiction of a MFCU?

A Unit's function is to implement a statewide program for the investigation and prosecution of health care providers who defraud the Medicaid program. In addition, a Unit reviews complaints of abuse or neglect against patients in health care facilities receiving Medicaid funding or patients receiving Medicaid-covered home care and may review complaints of the misappropriation of patients' private funds. The Unit is also charged with investigating fraud in the administration of the Medicaid program. The Ticket to Work and Work Incentives Improvement Act of 1999 authorizes the Units, with the approval of the Inspector General of the relevant federal agency, to investigate fraud in other federally-funded health care programs, if the case is primarily related to Medicaid. This Act also authorizes the Units, on an optional basis, to investigate and prosecute resident abuse or neglect in non-Medicaid board and care facilities.

How can citizens help?

While committing significant resources to protect the public, the Virginia Attorney General's Office welcomes the assistance of citizens in fighting health care fraud. Under Virginia's Fraud Against Taxpayers Act, people who blow the whistle on Medicaid Fraud are entitled to share in a percentage of funds recovered by the Commonwealth. You should be aware that whistleblowers have rights. You might be protected, under state law, from being retaliated against or fired by your employer for reporting abuse and fraud. Consult with a private attorney for more on your rights under this Act.

How are MFCUs funded?

MFCUs receive annual grants (Federal Financial Participation or "FFP") from the U.S. Department of Health and Human Services. Grant amounts must be matched with state funding. Initially, a Unit receives federal funding at a 90 percent level. After its first three years, the FFP is reduced to 75 percent.

How much has the Virginia MFCU recovered?

Since 1982, the Virginia MFCU has recovered nearly $2 billion.

What is the extent of federal oversight over a MFCU?

Each Unit operates under the administrative oversight of the Inspector General of the U.S. Department of Health and Human Services and must be recertified annually. As part of the recertification process, the Inspector General reviews a Unit's application for recertification and may conduct on-site visits. Additionally, the MFCUs are required to submit annual reports to the Inspector General. These reports include specific statistical data required by federal legislation on the number and type of cases under investigation, the number of convictions obtained and the number of dollar recoveries to the Medicaid program. The day-to-day supervision of a Unit rests with the parent agency.

How does Medicaid spending in Virginia compare to other states?

According to the Virginia Senate Finance Committee's report dated November 17, 2011, the Commonwealth ranks among the lowest spending states in terms of per capita Medicaid expenditures. The report also states that Medicaid spending per beneficiary is slightly below the U.S. average.

Who is covered by Medicaid in Virginia?

According to DMAS's newsletter titled The Virginia Medicaid Program at a Glance February 2015 issue, the Virginia Medicaid population in state fiscal year 2014 was comprised of:

  • 614,798 children
  • 267,844 parents or caregivers of children and pregnant women
  • 78,729 elderly persons
  • 224,688 persons with a disability

What is the cost of serving different Medicaid populations?

According to the Virginia Senate Finance Committee's report dated November 17, 2011, the aged, blind, and disabled have more intensive and expensive health and long-term care needs compared to children and families. Children and families tend to use emergency rooms for routine health care.

How do Medicaid fraud cases typically arise?

While specifics may vary from state to state, a primary source of referrals is the agency responsible for auditing and reviewing Medicaid provider claims, the Medicaid agency. Other significant sources of referrals are the MFCUs in other states as well as other law enforcement agencies.

Who are providers?

Providers can be:
  • Nurses, CNAs, PAs, or NPs
  • Physicians
  • Transportation Companies
  • Ambulances
  • Counselors
  • Hospitals
  • Nursing Homes
  • Medicaid-covered home care
  • Clinics
  • Home Care Agencies
  • Laboratories
  • Home Health Care Providers
  • And any other service, providers, companies, organizations or individuals, or employee or agent of company, organization, or individual that provides goods or services to Medicaid recipients for which payments is claimed. See Medicaid 42 C.F.R. § 1000.30.

What is patient abuse or neglect?

Patient abuse or neglect occurs when a person or caregiver knowingly causes physical harm to a resident of a health care facility or fails to give a resident needed medical service.

How do the multi-state/federal global settlements arise and how are they handled?

The National Association of Medicaid Fraud Control Units (NAMFCU) will typically appoint global case teams based on referral from the Department of Justice. The NAMFCU President appoints a global case team, generally consisting of three to four attorneys and an analyst, from the state Medicaid Fraud Control Units. Global settlement agreements are negotiated by teams working in conjunction with the United States Department of Justice. The agreements are based on model language and resolve civil fraud allegations concerning the state Medicaid programs. Global case teams are essential to the recovery of fraud dollars to the states since providers are unlikely to settle the case without resolving the states' share of any Medicaid recovery.

What federal consequences follow a felony conviction for Medicaid fraud?

Under federal regulations, providers who are convicted of a program related offense are excluded for a minimum of five years from receiving funds from any federally funded health care program, either as a health care provider or employee. Often, this sanction has a greater impact on the convicted individual and the provider community at large than the criminal penalties assessed in the case.

How does Medicaid fraud affect me?

The Virginia Medicaid budget for FY 2014 was $7 billion. When providers steal from the Medicaid program in Virginia, they diminish the resources that are available to recipients under the program. Not only can the amount of available services decrease, but the quality of treatment provided by dishonest providers is diminished as they try to reduce costs and increase their own profit. So, it is in all of our best interests to report Medicaid fraud as well as abuse and neglect.

 

 

 

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Virginia MFCU Contact Information

MFCU Contact Info: Picture of grounds at Virginia Capitol BuildingMedicaid Fraud Control Unit
Office of the Attorney General

202 North Ninth Street
Richmond, VA 23219
1-800-371-0824 or (804) 786-2071
(804) 786-3509 (fax)

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

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Complaint Form Guidelines
Medicaid Fraud Control Unit (MFCU)

MFCU Form fill in - image of someone writing.


To complete the complaint form (please read instructions below prior to completing the form):

Online Complaint Form
*Adobe Acrobat required, click here to download free Acrobat Reader.

  1. Fill in the blanks with as much information as you can.

  2. Please provide your name, address and telephone number (with area code) so our investigators can contact you for more information or when their preliminary investigation is completed.

  3. If you have additional documents that you would like to send, please put your name on the documents so we can match them up with your complaint (if applicable).

  4. Be sure to retain a copy for your records.

  5. After completing the form, please mail or fax using the information below:

Email
This email address is being protected from spambots. You need JavaScript enabled to view it.

Fax
804-786-3509

Mail: 
Office of the Attorney General
Medicaid Fraud Control Unit

202 North Ninth Street
Richmond, VA 23219

An investigator will review your complaint.
Your complaint will become an active case, or it will be closed due to insufficient evidence or because no crime was committed.