Wednesday, October 12, 2016

CMS Proposed Rule Would Expand MFCU Authority

Dianne De La Mare


The US Department of Health of Human Services, Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS), have released a proposed rule that “would update the Medicaid fraud program, which has undergone only 2 amendments since its establishment in 1978.”

In the last four decades, “growth of the Medicaid Fraud Control Units (MFCU) program…as well as changes in MFCU practice, healthcare, and the workplace have led to the need for many amendments to the regulation,” according to the agencies. The proposed rule also would incorporate statutory changes affecting MFCUs, as well s policy and practice changes that have occurred since the regulation was initially issues in 1978. These changes include a codification of OIG’s delegated authority, MFCU authority, functions and responsibilities, disallowances, and issues related to organization, prosecutorial authority, staffing, recertification and the MFCUs relationship with the state Medicaid agencies.

AHCA/NCAL will submit formal comments on the November 21, 2016, the due date.

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