Medicaid Fraud Control Unit

In 2011, the Attorney General’s Office launched a new initiative – at no cost to taxpayers – to bolster the Office’s award-winning Medicaid Fraud Control Unit (“MFCU”) with dozens of additional prosecutors, investigators and auditors.

The MFCU, the largest unit within the Attorney General’s Criminal Division, is the centerpiece of New York’s effort to investigate, penalize, and prosecute individuals and companies responsible for improper or fraudulent Medicaid billing schemes. A revenue-generating agency that recovers taxpayer money through successful fraud prosecutions, the MFCU utilizes a team-based approach to identify and investigate frauds committed by hospitals, nursing homes, pharmacies, doctors, dentists, nurses, and other health care entities billing the Medicaid Program.

Medicaid Fraud Control Unit targets, among other things, large-scale frauds involving overbilling, kickbacks, substandard drugs and medical equipment, and “Medicaid mills” run by organized criminals. It also handles numerous cases in order to safeguard elderly and disabled New Yorkers from abuse and neglect in nursing homes and other health care facilities.

The enhancement to the MFCU - the addition of dozens of new prosecutors, investigators, and auditors devoted to cracking down on Medicaid fraud – is funded by using money that MFCU itself recovers, as well as a federal program which provides the unit with 3:1 matching funds. The funding from the federal program and MFCU’s recoveries has provided sufficient funds to bolster the capabilities of the MFCU, without costing state taxpayers a dime.

In previous years, there had been a direct relationship between the number of prosecutors in the MFCU and the number of Medicaid fraud recoveries the unit has obtained. The enhanced unit has recovered and returned over a billion dollars back to New York State’s Medicaid Program.