State Medicaid Fraud Control Units
Program Funding
Annual program obligations reported to SAM.gov.
Program Objective
To investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in health facilities and board and care facilities and of Medicaid beneficiaries in non-institutional or other settings.
Eligibility
Eligible Applicants
- State
- U.S. Territory Government
- U.S. State Government
States, the District of Columbia, and the U.S. Territories. An established State Medicaid Fraud Control Unit must be a single identifiable entity of the State government which the Secretary certifies (and the Office of Inspector General annually re-certifies) as complying with the requirements of 1903(q) of the Social Security Act (42 CFR 1007) regarding location, function and procedure. Applicants must also comply with section 1902 (a)(61) of the Act as amended by the Omnibus Budget Reconciliation Act of 1993. Tribes (American Indian/Alaskan Native/Native American) are not eligible to apply.
How to Apply
Award Procedure
States are awarded funds based on a detailed description of estimated expenditures needed to support the program. Award funds are distributed quarterly on a fiscal year basis as follows: October 1, January 1, April 1, and July 1.
Decision Timeline
- Appeal: From 60 to 90 days
The time required to process an application may take up to 90 days.
Program details & compliance
Description
To investigate and prosecute Medicaid provider fraud as well as patient abuse or neglect in health facilities and board and care facilities and of Medicaid beneficiaries in non-institutional or other settings.
Mission Categories
Primary: General Health and Medical
Use of Funds
Allowed Uses
The statute authorizes 90 percent matching funds for the first 12 quarters, and 75 percent matching funds thereafter for investigation and prosecution of fraud and patient abuse in the State Medicaid Programs. A unit must be separate and distinct from the single State Medicaid agency. A unit must also employ sufficient professional, administrative and support staff to carry out its duties and responsibilities in an effective and efficient manner.
Required Documentation
Units must submit applications containing proposed organization, administration, agreements, detailed budgets and procedures for certification of eligibility (see 42 CFR 1007). Costs will be determined in accordance with 2 CFR 200 and 45 CFR 75. Governors in States applying for Federal assistance must approve the application pursuant to 42 CFR 1007.15(a).
Reporting & Compliance
Applicable 2 CFR 200 Subparts
- Subpart B — General Provisions
- Subpart C — Pre-Federal Award Requirements
- Subpart D — Post-Federal Award Requirements
- Subpart E — Cost Principles
- Subpart F — Audit Requirements