logo
logo
logo
MENU
Categories
Hospitals and Health Systems - Audits and ReimbursementHospitals and Health Systems - Consent and TreatmentHospitals and Health Systems - Corporate and GovernanceHospitals and Health Systems - Corporate ComplianceHospitals and Health Systems - Fraud and AbuseHospitals and Health Systems - Government InvestigationsHospitals and Health Systems - Health RecordsHospitals and Health Systems - HIPAA and HITECHHospitals and Health Systems - Managed CareHospitals and Health Systems - Medical Staff IssuesHospitals and Health Systems - Medical Training ProgramsHospitals and Health Systems - MedicareHospitals and Health Systems - Mergers, Affiliations and Joint VenturesHospitals and Health Systems - Peer ReviewHospitals and Health Systems - Professional Services AgreementsMedical SocietiesPharmaceutical Industry - Agreements with PhysiciansPharmaceutical Industry - Clinical ResearchPharmaceutical Industry - Regulatory CompliancePhysicians and Providers - Audits and ReimbursementPhysicians and Providers - CertificationsPhysicians and Providers - CredentialingPhysicians and Providers - Disciplinary ActionsPhysicians and Providers - Employment AgreementsPhysicians and Providers - Fraud and AbusePhysicians and Providers - Government InvestigationsPhysicians and Providers - HIPAA and PrivacyPhysicians and Providers - ImpairmentPhysicians and Providers - LicensingPhysicians and Providers - LitigationPhysicians and Providers - MedicarePhysicians and Providers - Peer ReviewPhysicians and Providers - Practice AcquisitionsPhysicians and Providers - Practice IssuesPhysicians and Providers - Regulatory CompliancePhysicians and Providers - SupervisionPhysicians and Providers - TrainingUncategorized
David N. Vozza
Member
David N. Vozza
Visit Profile

Whistleblower Complaints Resulting in Increased MFCU Investigations

Considering the significant financial incentives and awards provided to whistleblowers, it should come as no surprise that there has been a marked increase in the number of health care fraud investigations commenced by federal and state agencies.  The New York State Medicaid Fraud Control Unit (“MFCU”) is one such agency and is increasingly worthy of the attention of health care practitioners who treat Medicaid patients in the state.  A division of the New York State Attorney General’s office, MFCU, has become increasingly active reviewing Medicaid program expenditures, which now account for over $50 billion dollars of the state’s annual budget.  Practitioners are encouraged to review the MFCU Resource Center materials.

MFCU has complete investigative authority and is armed with wide-ranging powers to prosecute alleged violations of health care fraud statutes and regulations related to the Medicaid program.  MFCU has the power to issue subpoenas for medical records and other documents, interview employees of medical practice, and even refer matters to regulatory agencies, such as the New York State Department of Health.  These investigations may result in either criminal proceedings or civil enforcement actions brought against an alleged violator.  The types of arrangements that are typically investigated by MFCU and that result in adverse actions are:

  • Billing for services not rendered or incorrectly coding the services or procedures provided to patients
  • Entering into financial arrangements with other practitioners that provide financial reimbursement, or “kickbacks,” in exchange for referrals
  • Employing practitioners or staffers who are excluded or otherwise barred from government health care plans
  • Operation of a “Medicaid Mill” wherein revenue is generated by billing Medicaid for a wide range of services without medical necessity
  • Selling access to prescription drugs
  • “Double-Billing” whereby a practitioner is alleged to submit claims to both Medicaid and a commercial insurance company
  • Accepting cash payments from patients for services otherwise covered by Medicaid

As always, practitioners are strongly encouraged to consult with healthcare counsel to review their compliance with applicable regulations.  Strict compliance with these regulations will significantly reduce the risk of falling under the scrutiny of MFCU.  If you have any questions about this or any other legal matter, please email me at dnvozza@norris-law.com.

Share
Related Posts
Negotiating Management Services Agreements
Steering Clear of the OPMC in NY
Federal District Court in New York State Overturns U.S. Department of Labor Regulations Concerning Sick Leave for Health Care Providers
David N. Vozza
Member
David N. Vozza
Visit Profile
Related Posts
Negotiating Management Services Agreements
Steering Clear of the OPMC in NY
Federal District Court in New York State Overturns U.S. Department of Labor Regulations Concerning Sick Leave for Health Care Providers
Share
Join our growing team
We are looking for quality attorneys to help us do more for our clients. At Norris McLaughlin, each attorney has the same opportunity to succeed whether you’re at the beginning of a career or pinnacle of the profession.
Subscribe to our content
Receive timely legal information
delivered to your inbox
Subscribe to our content
Receive timely legal information
delivered to your inbox
© 2021, Norris McLaughlin, P.A., All Rights Reserved. Attorney Advertising.
Meritas

We use cookies to ensure that we give you the best experience on our website. If you continue to use this site we will assume you consent to our cookie policy. Learn more