Medicaid Fraud Control Unit

The Medicaid Fraud Control Unit’s (MFCU) primary goal is to prevent abuse of taxpayer resources through professional investigation of criminal activity. The Medicaid Fraud Control Unit staffs experienced criminal investigators, auditors, and attorneys to achieve this goal.

The MFCU investigates:

  • allegations of fraud committed by providers against the Medicaid program, as well as fraud in the administration of the Medicaid program; and
  • abuse/neglect and other crimes committed upon residents in care facilities that receive funding from the Medicaid program.
     

Provider Fraud

Medicaid provider fraud, waste, and abuse costs Iowa taxpayers millions of dollars annually and threatens the integrity of the Medicaid program.  You can help by recognizing and reporting provider fraud such as:

  • Billing for medical services or products not actually provided
  • Billing for a more expensive service or product than was actually provided
  • Billing for several services that should be combined into one billing (Unbundling)
  • Billing twice for the same medical service using two different service dates
  • Dispensing less costly drugs and billing for higher priced equivalents
  • Giving or accepting kickbacks for medical services
  • Providing unnecessary services
     

Abuse or Neglect

You can help by recognizing and reporting signs of resident abuse or neglect, such as:

  • Unusual bruising or bleeding, open wounds, bed sores or cuts
  • Burns and abrasions
  • Sudden and unexplained change in weight
  • Soiling, poor hygiene, smell of urine or feces
  • Use of physical or chemical restraints in excess of doctor’s orders
  • Infections
  • Loss of hair
  • Torn, stained, or bloody clothing or bedding
  • Disappearance of personal items
  • Sudden and unusual financial transactions

Drug Diversion is another form of abuse since it deprives the patient of proper medication.  Drug Diversion examples include:

  • Health care worker keeping, selling, or throwing away patient medications.
  • A doctor selling prescriptions.
  • Nurse ordering medication without  doctor’s approval.
     

Contact Information

If you suspect Medicaid fraud or resident abuse or neglect, report the incident to the Medicaid Fraud Control Unit.  Trained personnel will review the information and determine if an investigation is warranted or if the incident should be referred to a more appropriate government agency.

By telephone: 1-800-831-1394

By mail:
Iowa Department of Inspections and Appeals
Medicaid Fraud Control Unit
Lucas State Office Building - Third Floor
321 E. 12th Street
Des Moines, IA 50319 - 0083

 

Printed from the website on August 22, 2017 at 5:29pm.