National Association of Medicaid Fraud Control Units

National Association of Medicaid Fraud Control Units National Association of Medicaid Fraud Control Units

Trainings

One of the founding goals of the National Association of Medicaid Fraud Control Units (NAMFCU) is to improve the quality of Medicaid provider fraud investigations and prosecutions by offering employees specialized training.  NAMFCU training programs provide MFCU staff with both the tools needed to build successful cases and a forum for sharing investigative strategies and prosecution theories with colleagues from around the country.

When Congress created the Medicaid Fraud Control program, it recognized the critical importance of training.  The Senate Finance Committee Report that accompanied the federal legislation specifically identified the need for MFCUs to employ attorneys, investigators and auditors that are specially trained to investigate and prosecute Medicaid provider fraud.  The Report concluded that the only effective way to combat complex provider fraud schemes is to employ professionals within MFCUs that are sufficiently skilled to detect and successfully prosecute fraudulent activities.  As a result, the 75% federal reimbursement matching rate that subsidizes MFCU operating expenses also includes funding for the training of MFCU personnel.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), which is the agency vested with responsibility for administering the MFCU federal grant program, has formally endorsed the need for MFCUs to have in-service specialized training relating to investigating and prosecuting Medicaid fraud and resident abuse.  OIG’s 12 performance standards that it currently uses during on-site reviews to judge the effectiveness of MFCUs include a training standard.  It establishes an expectation that each MFCU will have an annual training plan to address staff needs and sufficient funds to carry out the plan.  The standard also sets forth an expectation that staff will have access to a reasonable level of training hours and will be afforded an opportunity to satisfy professionally established continuing education requirements through fraud and resident abuse related training.

For many years, NAMFCU has offered high quality professional training for MFCUs.  Programs have focused on investigating and prosecuting fraud in a wide range of provider settings including hospitals, nursing homes, laboratories, and physician practices.  Programs have also covered a wide range of topics such as recognizing fraudulent “kickbacks”, conducting undercover operations, and effective interview techniques. NAMFCU’s training programs bring together all MFCU disciplines (prosecutors, investigators, auditors, data analysts and nurses) to learn about emerging legal issues and the most effective investigative techniques.  This specialized Medicaid fraud training cannot be found anywhere else.

The importance of MFCU training is reflected in the resources that NAMFCU devotes to its programs.  The Association maintains a standing Training Committee that is co-chaired by an attorney and an investigator and has active members from MFCUs representing all disciplines from around the country.  Specifically, the Training Committee is responsible for the following programs:  (1) 101 Medicaid Fraud Training Program; (2) 102 Medicaid Fraud Training Program; (3) 103 Medicaid Fraud Training Program; and (4) the NAMFCU Annual Training Program.