Fraud, Waste, and Abuse

Fraud, Waste, and Abuse A. The Division of Medicaid investigates suspected cases of fraud, waste, and abuse. B. The Division of Medicaid makes a formal, written fraud referral to the Medicaid Fraud Control Unit (MFCU) as required under federal and/or state law or regulations. C. The Division of Medicaid suspends all payments to a provider when the Division of Medicaid determines there is a credible allegation of fraud as required under federal and/or state law or regulations. D. The Division of Medicaid notifies providers of suspension of payments within five (5) days of the suspension unless requested in writing by a law enforcement agency to temporarily withhold such notice. E. The Division of Medicaid will: 1. Make a referral to the appropriate law enforcement agency if there is reason to believe that a beneficiary has defrauded the Medicaid program. 2. Conduct a full investigation if there is reason to believe that a beneficiary has abused the Medicaid program or if an applicant made a false statement or failed to disclose a material fact in his/her Medicaid application.