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  • State Medicaid Fraud Control Units

    I was wandering if anyone works with, or has experience with Medicaid Fraud Control Unit investigators, either in NY or elsewhere. I am applying for an entry-level investigator position with my state's MFCU (in NY it's part of the Office of the Attornet General), and would appreciate any info. What's the day-to-day is like? It the job interesting? Do you/they work with other agencuies? Anything esle I should know? I realize this probably differs a lot state by state (although I believe they get federal funding, and so are somewhat standatized in what they do), but any little but helps.

  • #2
    HHS OIG here who works with them often. Plus we hire from their ranks frequently. They get 75% funding from the Feds so they are accountable, by the Feds, for the caseload type they work. I know they do traditional health care fraud (HCF) but where I work they do a ton of patient abuse cases. Nursing home personnel stealing money from patients, sexual assault of patients, etc.

    They tend to have better take home cars than HHS OIG because they get to use their state (?) funding to purchase various types of nice rides whereas HHS OIG has to lease medium/compact size vehicles from GSA.

    They also work traditional HCF where Medicaid funds are involved. They can also work Medicare fraud cases as long as there is Medicaid involved to, which there almost always is, and usually if an HHS OIG Agent is working with them. To be clear, HHS OIG can work both Medicare and Medicaid, even without MFCU involvement. However, we work a majority of our cases with these state MFCU counterparts.

    I see a lot of turnover due to pay. Some states don't pay crap while others pay more. I suspect the bigger MFCU offices pay more like Texas, California, NY, and Florida. Some state's MFCUs are small, maybe 4 Agents total, for the WHOLE state.

    Sometimes MFCU Agents, like HHS, are hired without HCF experience. That's okay, it can be taught on-the-job, to some extent, but I see a lot of turnover because some guys may come from a local PD and then try their hand at HCF and they can't grasp it or don't want to learn. Those guys move on in these type of positions to other non-HCF Attorney General position or quit altogether. This is a shame because the units I've seen typically allow for career advancements due to turnover so you could rise through the ranks faster than say HHS OIG.

    They work jointly with HHS OIG and any other Federal agency that does HCF, so long as there is a Medicaid nexus. Such example agencies are HHS OIG (Medicare insurance), RRB OIG (Railroad Retirement Medicare), OPM OIG (FEHB), DCIS (TriCare), VA OIG (VA Health Benefits), USPS OIG (workman's comp fraud), DOL OIG (workman's comp fraud), and FBI (who has jurisdiction over every type of Federal and private-pay insurance fraud).

    Oh, and a place like NY, you can be guaranteed they are out beating the streets and using LEO techniques like pole cams, UC, search warrants, arrest warrants, etc. The bigger the MFCU the more opportunities you would have to make for a more robust work experience.

    MFCUs are essentially HHS OIG for the state but with 1) better cars 2) lower pay and 3) potentially equivalent casework IF they work more than patient abuse and get involved in the bigger Federal HCF conspiracy type cases. OR are go-getters and develop their own big HCF cases and we HHS just tag along. Sometimes goes both ways.

    Best bet, get on with the MFCU, enjoy your career there but stay long enough to at least qualify for a state pension. Then jump ship to the Feds at HHS OIG, work your 20 years here as a Fed making 6-figure salary, then when you retire from HHS, go back to the MFCU if you want to supplement your Fed retirement. I've seen many HHS do this over the years.
    Piko
    Forum Member
    Last edited by Piko; 11-06-2021, 09:15 AM.

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  • #3
    In Pa, the IG has unarmed agents who handle these types of crimes. If anything requires an armed presence, they'll call the Office of Attorney General to handle it.
    I don't answer recruitment messages....

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    • Jack2005
      Jack2005
      Forum Member
      Jack2005 commented
      Editing a comment
      Thanks, good to know.

    • Piko
      Piko
      Forum Member
      Piko commented
      Editing a comment
      To avoid any potential confusion, the PA MFCU carries a firearm and is sworn. Additionally, they just got some recently expanded authorities from the state peace officer authority they already had. Orlando is correct and I just confirmed with my PA MFCU contact, the PA State IG Agents do not carry.

      Remember, Attorney General's Offices have multiple different units, the MFCU being a small part of the overall Attorney General's Office (AGO). The PA IG and PA MFCU are entirely two separate entities.
      Piko
      Forum Member
      Last edited by Piko; 11-06-2021, 10:30 PM.

  • #4
    In CA, the state MFCU is under the CA Attorney General’s Office aka CA Dept. of Justice. Most MFCU’s are under the AG’s office. The Special Agents are assigned to the Division of Medi-Cal Fraud and Elder Abuse. SAs work multimillion dollar healthcare fraud cases, usually as a part of a team along side HHS-OIG and FBI. In CA, the Division is funded 75% by the federal government. SAs in CA are sworn state peace officers and conduct the full range of criminal investigations. You can check out the thread on this site titled CA DOJ SAs and there will be more specific info regarding this Division. You can also reach out to me directly if you have any specific questions.

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  • #5
    There's a lot of good info on the HHS OIG website, and I'm sure you can dig for information put out by the NY OAG. The last oversight report on the NY MFCU is from 2017 but it's worth looking over for insight into the office composition, cases and whatever else:
    New York Medicaid Fraud Control Unit: 2017 Onsite Inspection Report (OEI-12-17-00340) 09-20-2018 (hhs.gov)

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  • #6
    Thank you all, I appreciate all the information. If anyone else knows anything, please keep the replies coming.
    Jack2005
    Forum Member
    Last edited by Jack2005; 11-06-2021, 08:01 PM.

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