Medicaid Fraud Control Unit
Medicaid, or the Medical Assistance Program, was established by Congress in 1965. The Medicaid Program is administered at the State level by the Medical Services Administration in the Department of Community Health. The Michigan Medicaid program, over $4.5 billion, is 50% funded by the Federal government and 50% funded by the State of Michigan. Medicaid helps eligible individuals and families who need assistance paying medical bills.
In 1977, the United States Congress recognized that fraud was occurring in the Medicaid program and that special investigative/prosecution units were required. As a result, legislation was passed providing for the establishment of state Medicaid Fraud Control units. In 1978, the Office of Attorney General created a Medicaid Fraud Control Unit, and it was certified by the Federal government the same year. In 1986, it became the Health Care Fraud Division of the Attorney General's office.
The division is comprised of attorneys, investigators, auditors, other professionals and support staff. Pursuant to Federal certification, it has jurisdiction to investigate and prosecute Medicaid provider fraud and abuse and neglect in facilities receiving Medicaid dollars. The division also has jurisdiction to seek civil recovery of fraudulently obtained Medicaid dollars.
Health Care Fraud
The Health Care Fraud Division exists to identify, prosecute, and prevent fraudulent activity by doctors, dentists, pharmacists, and other health care providers participating in the Medicaid program. Allegations of misappropriation of patient trust funds and identity theft in resident care facilities are also investigated. Taxpayer dollars provide health care to indigent patients and other recipients. It is vital that these dollars be effectively spent to help those in need. Fraud affects everyone--the recipients of care, the taxpayers who pay for it, and the overwhelming majority of providers who conscientiously provide quality care.
Since its inception, the HCFD has obtained criminal restitution orders totaling $7,401,187.70; civil judgments totaling $11,082,643.53; and settlement agreements providing for the recovery of $3,137,154.65 to the Medicaid Program. In total, the HCFD has obtained court orders and settlements requiring the return of $21,620,985.88 to the Medicaid Program. Additionally, the HCFD has collected $1,131,397.15 from Medicaid providers to offset the HCFD's investigation and prosecution costs.
Nursing Home Abuse/Neglect
The worth of a society is often measured by the care and protection afforded to its weak and dependent members. No one should live in fear of being harmed, especially by persons legally charged with and paid for attending to his or her needs. The Health Care Fraud Division investigates and prosecutes Medicaid-funded health care facilities and their employees who harm or neglect their patients or residents.
Not every instance of patient injury is the result of a crime. Inappropriate non-criminal treatment to a patient or resident of a health care facility should be reported to the facility through the administrator, director of nursing, or the charge nurse, AND to the Department of Community Health, which has a statutory obligation to monitor and assess the care rendered to patients.