Unit Mission

The Unit is charged with the investigation and prosecution of Medicaid providers who conduct their businesses in a fraudulent manner. The intended result of this effort is to deter all providers of medical services from engaging in fraudulent or abusive behavior.

In order to achieve this goal, the Unit will:

• Conduct professional and timely criminal investigations that lead to just results;

• Collaborate with other state and federal agencies involved in the battle against health care fraud and patient abuse and neglect. In fact, the MFCU is uniquely positioned to take the lead in investigating and prosecuting health care fraud and patient abuse and neglect in the Commonwealth;

• Seek alternatives to criminal prosecution, when appropriate, to reinforce and instill in the provider community a desire to comply with all regulations promulgated by the Department of Medical Assistance Services (DMAS);

• Refine internal operating procedures designed to produce timely investigative results and maximize Unit resources in order to promote efficient and thorough strategies for each case;

• Promote effective communication between the Unit and DMAS, thereby increasing the number and quality of referrals;

• Maintain the highest standards of excellence through aggressive training on current fraud trends and law enforcement tools in an attempt to better combat fraud in the Medicaid program; and

• Provide assistance related to nationwide civil and criminal health care fraud matters.